How Governments Ruined Healthcare and Why Single Payer is Based on Falsehoods

Wait Times in Canadian Healthcare

The Myth They Used to Pass Canada’s Universal Healthcare

  04/06/2018

A History Lesson

During the 19th and early 20th centuries, health care was offered in various ways, including through voluntary mutual-aid associations in Britain, Australia, and the United States. Roderick Long wrote about these fraternal societies, where members could subscribe to various services, including life insurance, disability insurance, and lodge practice. Lodge practice was an arrangement whereby a particular society or lodge would contract with a doctor to provide medical care to its members.

The doctor received a regular salary on a retainer basis, rather than charging per item; members would pay a yearly fee and then call on the doctor’s services as needed. If medical services were found unsatisfactory, the doctor would be penalized, and the contract might not be renewed. Lodge members reportedly enjoyed the degree of customer control this system afforded them. And the tendency to overuse the physician’s services was kept in check by the fraternal society’s own “self-policing”; lodge members who wanted to avoid future increases in premiums were motivated to make sure that their fellow members were not abusing the system.

The average cost of lodge practice for each member was between one and two dollars (a day’s wage) annually, whereas non-members paid the same price for each visit to the doctor. Doctors competed for lodge contracts, which kept costs low. The Canadian experience with lodge practice was similar, and, as in America and Britain, this infuriated the medical establishment.

The Medical Establishment

Most people (including rank and file doctors in the 19th century) are content to pursue their goals through voluntary interactions with others, and do not claim the right to tell others what they can and cannot do. However, there is always a minority who detest voluntary exchange on the free market, preferring to outlaw this activity by using government legislation to enrich themselves by dictating the terms of trade. This describes the medical establishment in the 19th century (and today). In Canadian Medicine, A Study In Restricted Entry (pp 195, 197), Ronald Hamowy wrote:

By the 1890s, lodge practice had reached sufficient proportions to become a common subject of condemnation in the medical journals. Of particular concern was the “cut-rate” fees for services charged by lodge practitioners, with a concomitant reduction in demand for full-priced medical services.

. . . the Canada Lancet, in commenting on the subject in 1905, noted: Just think for a moment how absurd it appears that a doctor should agree to attend a lodge of 200 men for $1.25 per year and supply the medicine! We do not hesitate to say that he would be better off by declining the $250 and take what he can get in the ordinary way.

What the Canada Lancet was really saying was “How absurd it is that a doctor should have the freedom to voluntarily negotiate fees with the riff raff. We do not hesitate to say that his selfish actions are preventing the superior medical establishment from raising their own incomes by dictating fees to the general public.”

The medical establishment wanted to raise their incomes by restricting the number of doctors (in part, by imposing irrelevant licensing criteria), but the public was not easily fooled. Hamowy (p 125) wrote:

Despite the actions of the College to suppress unregistered physicians, the public continued to firmly oppose prosecution of these practitioners throughout the nineteenth century. Nor did they believe the College and the medical journals when they insisted that their campaign against “quacks” was designed to separate out educated from unqualified physicians.

. . . many, especially poorer, Canadians persisted in consulting unlicensed physicians, whose fees were lower and who appeared no less competent in prescribing medications than did their registered brethren. The profession’s attempt to suppress these doctors was not motivated out of a selfless interest in improving the quality of medical care offered the public, but out of a desire to lessen competition, which would in turn increase their incomes.

Sadly, the medical establishment got its wish, as Hamowy (pp 129, 237) explains:

As early as 1869, one of the Council’s [Ontario Medical Council] representatives had remarked, to the delight of its other members, that “it would be a great boon to the country if not another student passed for ten years to come.”

. . . by the first decade of the twentieth century physicians throughout the Dominion had succeeded in gaining enactment of laws in each of the provinces limiting entry into the profession . . .

After many years of lobbying, the government gifted the medical establishment with legislation granting them monopoly powers over their industry, including licensing, under the pretense that only qualified physicians should be allowed to serve the public. (Government regulations always serve the interests of those who lobbied for the regulations.)

The medical establishment was highly incentivized to lobby and bribe politicians because the average monetary gain for each member of the establishment would be huge, compared to the average loss suffered by each member of the public. This dispersal of costs over a large number of citizens meant that they lacked an incentive to mount an effective opposition. Thus, the establishment gained at the expense of the public. That’s democracy!

Read More: https://mises.org/wire/myth-they-used-pass-canadas-universal-healthcare

Warning: Don’t Take The Drugs Your Doctor Gave You Until You Read This | The Daily Bell

Sickness Is Health, Big Brother looks over a patient and doctor

Your waitress wants you to get another round of drinks. We get it. She wants to sell more and boost her tip.

But what if your doctor is doing the same thing when it comes to drugs? Unfortunately, they also want to sell more, and boost their tip… from the pharmaceutical companies.

But unlike the waitress, the doctor relies on a system of lies and manipulations.

Some doctors don’t even know what they are caught up in. They perform the tests. They read the journals. The tests say you have a disease. The journals say what treatments work.

But too often the tests are designed by the drug industry. And the journals are written and reviewed by frauds.

The Tests

All the sudden, everyone has a disease! What could have caused such a vast increase in hypertension, obesity, and osteoporosis?

The answer is an expanded definition of who is considered afflicted.

You walk into your doctor’s office for a physical exam and step on the scale. Last year, the doctor said you were overweight. Now he says you are obese — at the same weight.

A nurse takes your blood pressure. You have hypertension — with the same previously healthy reading you’ve had for years.

The doctor scans your wrist bone. You have a condition called “osteopenia” — with the same bone density that was fine last time you were measured…

You are suddenly sick, simply because the definitions of disease have changed. And behind those changes, a Seattle Times examination has found, are the companies that make all those newly prescribed pills.

This is nothing new. Unfortunately, the above quotation is from the introduction to a 2005 series of articles. They were sounding the alarm early, but things have only gotten worse.

Back then, the pharmaceutical industry had a hand in designing the testing tools for osteoporosis. They helped change the definition of obesity. They redefined diseases without any strong evidence. And they did this by giving money to doctors in order to promote their agenda. Some of the doctors who received kickbacks were policy setters in the World Health Organization, the U.S. National Institute for Health, and other medical associations.

Every time the boundary of a disease is expanded — the hypertension threshold is lowered by 10 blood-pressure points, the guideline for obesity is lowered by 5 pounds — the market for drugs expands by millions of consumers and billions of dollars.

The result? Skyrocketing sales of prescription drugs. Soaring health-care costs. Escalating patient anxiety. Worst of all, millions of people taking drugs that may carry a greater risk than the underlying condition. The treatment, in fact, may make them sick or even kill them.

One woman was taking a medication to lower her blood pressure. When it was ineffective, the dose was doubled. This caused an allergic reaction which sent her to the hospital and could have been deadly. Her doctor switched her to other medications.

Her doctor, Saunders, doesn’t sound like some evil stooge taking back room bribes. He sounds like a man caught up in an industry in crisis.

But Saunders isn’t sure whom to trust. He questions the stream of studies leading to new guidelines urging broader use of new medications.

“In my heart of hearts,” he said, “I am concerned that these studies that are telling people that it’s best to get down to 120 over 80 are all paid for by drug companies who are trying to sell pills. It makes me uncomfortable. I think the days of getting unbiased information are gone.”

But this is all old news. Most people have gotten a glimpse of such conflicts of interest. But still, doctors rely on the experts. Even if your local doctor is not corrupt and money hungry, he may be listening to people who are. And worse yet, he may be reading medical journals that are a complete fraud.

Hundreds of “Scholarly Articles” Retracted

The medical journal publisher Springer has retracted almost 200 papers in the last two years because “the peer review process was compromised.”

Sadly, many of the retracted articles have to do with tumor biology. For years, people have been labeled conspiracy theorists for believing in the massive amount of corruption surrounding the cancer industry. This retraction is just the tip of the iceberg.

The most affected journals are Tumor Biology (25 papers) and Diagnostic Pathology (23 papers). The other journals are Comparative Clinical Pathology (one paper), Journal of Parasitic Diseases (four papers), Cancer Cell International (two papers), Journal of Ovarian Research (two papers), and World Journal of Surgical Oncology (one paper).

To submit a fake review, doctors often provided false emails which came back to them or someone else they could trust to provide a great review and vouch for the accuracy of the paper. Many journals accept paid entries without doing the homework to find out anything about the person submitting the paper, or who allegedly peer reviewed the piece.

But even when the medical papers are not outright lies, they can be quite misleading. According to a JAMA review:

Of the 45 eligible highly cited studies with efficacy claims (Table 2), 7 (16%) were contradicted by subsequent research, and another 7 (16%) were found to have initially stronger effects. In all these 14 cases (Box 1), subsequent studies were either larger or better controlled (randomized vs a nonrandomized original study). The findings of 20 highly cited articles (44%) were replicated (also with a larger sample size in subsequent research compared with the original highly cited study) and 11 (24%) had remained largely unchallenged.

Basically, 66% of the highly cited studies could not really be trusted. There just was not enough evidence of their findings to take them as solid truth. 32% of the studies should have been ruled out altogether, since later better studies found the results incorrect or highly exaggerated….

Read More: www.thedailybell.com/news-analysis/warning-dont-take-the-drugs-your-doctor-gave-you-until-you-read-this/

How Government Helped Create the Coming Doctor Shortage

Health Care

For the last five years, attempts to reform America’s health care system have focused primarily on the demand side of the market, and specifically on the market for insurance. Yet, these reforms have not achieved significant improvements in health care outcomes, nor reductions in cost. As health care specialist John C. Goodman has pointed out in Forbes, the slowed growth of health care spending in the United States is a trend that correlates most closely with supply side reforms such as the availability of health savings accounts. Reductions in spending or costs are certainly not an effect of the Affordable Care Act.

One of the most critical supply side issues in health care is the supply of qualified doctors. The Wall Street Journal has reported that the number of doctors per capita is in decline for the first time in two generations, and the American Association of Medical Colleges has predicted a shortage of 45,000 primary care physicians and 46,000 specialists by 2020.

In light of these statistics, it would seem prudent to adopt policies that streamline entry into the health care market, while keeping regulatory costs to a minimum. Regrettably, this is far from the case, with states erecting numerous barriers to would-be health care providers that contribute to the high prices and limited access currently set to cripple the American market. While some of these are familiar and even seem natural to most people, some of the ways in which governments act to restrict doctor supply will come as a surprise to many.

Monopolistic Medical Boards
We are generally brought up to believe that monopolies are bad. The very word conjures up images of tight-fisted tycoons in top hats and monocles squeezing employees and consumers alike for all they are worth. While natural monopolies resulting from superior business models get an unfairly bad rap, people’s capacity for critical thought seems to inexplicably switch off when confronted with those monopolies which are created and supported by government.

The case of health care regulations is an interesting one, as state governments have empowered private medical boards with unilateral authority to set the rules for the medical profession, including the issuing and revoking of medical licenses. These boards effectively function like government regulatory agencies, with the important difference that they lack the opportunity for public comments, and thus are immune from any political pressure from citizens.

If the EPA or the IRS implements a regulation that the public doesn’t like, there is a political process by which they can voice their discontent and theoretically make an impact on the decision. In fact, this happens rather frequently, and although there is still too little accountability for regulatory czars, at least the opportunity exists for political action.

With state medical boards, no such process exists, and there is little transparency in the rule-making process that determines how doctors must operate. If a particular regulation is harmful, doctors and patients have no real alternative other than moving to a different state with different requirements, an impractical solution to say the least.

The fact that these medical boards are private rather than public entities is supposed to make us feel more free, but in fact, most members of these boards are appointed by state governors. When state laws forbid competition among regulators, and signal that the government will regard as binding anything the medical board decides to do, the distinction between public and private becomes meaningless.

For example, the California Business and Professions Code (Section 2220.5) states that “The Medical Board of California is the only licensing board that is authorized to investigate or commence disciplinary actions relating to physicians or surgeons” and charges the board with investigating any and all complaints from the public, other doctors, or health care facilities, or from the board itself. Although the board is technically private, the government sanctioned monopoly on enforcement stands as a barrier to entrants of the medical profession, who are forced to comply with a monolithic set of “take ‘em or leave ‘em rules,” with which they have no choice but to comply, or risk being barred from practicing their trade.

Limits on Nurse Practitioners
Nurse practitioners represent a less expensive alternative to fully licensed doctors for patients with minor, day-to-day complaints. Frequently operating out of walk-in clinics or pharmacies, these health care providers offer convenience, competition, and innovation in a market in desperate need of all three. In response to the Affordable Care Act, many states have been loosening regulations on nurse practitioners, which is a step in the right direction, but more needs to be done if we are to truly encourage competition and increase supply.

Midwives, physicians’ assistants, and other alternative practitioners also have a key role to play in medical care, and should be permitted to practice without physician supervision. Midwifery in particular was once a vibrant industry, that has since been crippled by costly regulations.

Restrictions on Retail Clinics
Retail clinics, pharmacies, and even supermarkets are capable of offering routine medical services to patients with a convenience and regularity impossible in traditional physicians’ offices. Unfortunately, the American Medical Association (AMA) has aggressively lobbied against the availability of this type of facility.

In this, the AMA has been mostly successful. While pharmacists are permitted to administer injections to patients in Louisiana, the vast majority of states still have strict prohibitions on this sort of thing. Still, where retail clinics are permitted to operate, the effects have been dramatic. Wal-Mart has recently begun opening a series of in store clinics in a handful of states. The big-box store is boasting charges of just $40 for an office visit, about half of the industry standard, and has expanded its services to treat chronic conditions as well as the acute complaints in which most retail clinics have exclusively specialized. Additionally, the company has driven the cost of generic prescription drugs down to just $4.

Wal-Mart is leading the way in this area, by offering primary care services in fairly rural locations, where access to quality medical care can be particularly problematic. Retail clinics simply offer another option to patients, and restricting those options will always result in higher costs. Wal-Mart’s efforts offer only a glimpse at the potential for cheaper, more available medical care if states would relax their restrictions on retail clinics.

Licensing Requirements
Every student wishing to practice medicine must pass the United States Medical License Examination, and all states impose additional requirements from state licensing boards. These are frequently lengthy and expensive procedures. Medical organizations such as the AMA have an incentive to limit the number of licensed doctors practicing in the marketplace, in order to protect high wages for established incumbents.

Just as the system of taxi medallions has long hindered the transportation industry, burdensome licensing requirements are still another barrier standing in the way of expanding the doctor supply.

There is an argument to be made that stricter licensing requirements result in higher quality doctors. Whether or not this is true is debatable, depending on which studies you read, but regardless of what the answer is, there is no reason not to allow various gradations of quality in the health care market. A system, or multiple systems, of voluntary certification instead of, or in addition to, traditional licensing would offer consumers a broad array of services with corresponding differences in price.

In virtually every other market, from food, to clothing, shelter, to transportation, consumers are permitted to select a level of quality appropriate for their budget constraints. If every car was mandated to be of Cadillac quality, a lot fewer people would have the means to drive. The availability of beat up old jalopies allows consumers to trade quality for affordability and expands access to transportation for everyone. There is no reason why medical access shouldn’t work the same way.

Importing Doctors
Many nations other than the United States turn out qualified physicians, but American Licensing Boards do not fully recognize the credentials of doctors immigrating from abroad. This means that a fully capable physician from the United Kingdom or Germany will still have to serve a four year residency and go through the onerous licensing procedures.

About 15 percent of residency positions go to foreign medical graduates. If there were an alternative method of recognizing existing credentials, these slots could be filled by domestic medical students, resulting in more practicing doctors.

The Length of Schooling and the Small Number of Medical Schools
There are currently only 129 accredited medical schools in the United States, too few to turn out enough doctors to meet the demand. In order to gain accreditation, a school must undergo an eight-year process overseen by the U.S. Department of Education.

The number of residency positions available is only 110,000, a number which is determined by the way Congress chooses to fund Medicare. But directly tying the number of available residencies to Medicare funding ignores the economic realities of the health care market, and fails to provide any measure of adaptability to changing conditions.

The deficit of residency slots also contributes to the length of time it takes to become a doctor. It can take as many as ten years from the time someone begins studying medicine to when they are allowed to practice. The result of this is a remarkable lack of flexibility for the health care market to adapt to changes in demand.

Read More: mises.org/library/how-government-helped-create-coming-doctor-shortage

Healthcare: “Insurance” Now Just Means Redistribution | Mises Wire

Burns on Health Care

06/04/2017

Americans have been fighting over health insurance reform for ages. For example, 25 years ago, in 1992, over 200 congressional health care bills were introduced.

Unfortunately, while the rhetoric has focused on insurance, such as how many would supposedly gain or lose insurance if some change was implemented, that has not been the real issue. Income redistribution has. As Henry Aaron estimated that year, implementing a comprehensive national health insurance system would redistribute more income than any single national policy then in existence.

What Is Insurance?

How do we know insurance is not the real issue? Because claimed “reforms” violate so many principles of insurance.

Insurance is about reducing risk in the face of uncertain events. But insuring things that would happen for certain, say annual checkups, offers no risk reduction — it offers no benefits to weigh against the added costs of insurance administration that must be borne — yet such coverage is frequently mandated.

Similarly, small health care risks are cheaper to provide for from modest levels of savings, rather than bearing insurance administration costs. If one’s own resources were involved, absent government interventions, they would not be insured at all. Only when others are forced to bear much of the cost would people want insurance to cover such things.

Administrative costs are not the only issue, either. The benefits from risk-reduction through insurance would also have to outweigh the cost of the health care. This is made especially difficult by the fact that the insurance itself induces over-consumption of health care services.

However, when most health care costs are borne by third parties rather than individuals themselves, there are many margins at which those individuals will want better care (e.g., better and more specialized doctors and hospitals, more costly newer drugs, tests and treatment utilizing the latest technology, etc.), as well as more care. Since that added care need only be worth what an individual pays, net of insurance coverage, much of it is worth far less than its cost to society, further limiting what people would voluntarily cover based on the principles of insurance.

Those considerations explain why lunch insurance does not exist. You will almost certainly eat lunch, which also involves relatively small expenses, so there would be little risk reduction. And if someone else would pay most of your bill, you would order far more expensive lunches than otherwise, raising the premiums that you must be charged to pay for it. The benefits don’t justify the costs, again unless others are forced to pick up a substantial part of the tab.

Also, insurance is about risk reduction that people value more than the premium they must pay for it. Thus, voluntary market insurance would not mandate coverage of things people had virtually no risk of experiencing. Teetotalers would not willingly insure for alcoholism treatment. Those sure they would never use drugs would not insist on addiction treatment. Yet government “reforms” are full of such mandates. And a quarter-century ago, before many current mandates were in place, it was already estimated that up to one-quarter of the uninsured population traced back to such cost-increasing government-imposed coverage regulations.

The price controls reform proposals incorporate are also about income redistribution, rather than health insurance. Say that my age makes my actuarial risk six times that of my students. If, as Obamacare required, I could not be charged more than three times what they were, that does not reflect actual risks. Obamacare regulations simply force the young to subsidize the old. That rip-off of the young also explains why Obamacare threatened them with a penalty to force them to accept that bad “insurance” deal.

Read More: mises.org/blog/healthcare-insurance-now-just-means-redistribution

Obamacare? Trumpcare? Get Rid of it All | Mises Wire

Ever since the US government began to sink its claws into the medical industry a good 50 or so years ago, attempts at reducing costs have failed again and again. This is par for the course whenever government invades an industry.

Trying to reform this Frankenstein with either Obamacare, or Trumpcare, will solve nothing.

The problem is structural. Tinkering with this or that will just waste more time.

Read More: mises.org/blog/obamacare-trumpcare-get-rid-it-all

America’s #1 Again (In Healthcare Costs Around The World) | Zero Hedge

Burns on Health Care

No matter what; for many years now, the American healthcare system has been flawed.

As Statista’s Feliz Richter illustrates in the chart above, U.S. health spending per capita (including public and private spending) is higher than it is anywhere else in the world, and yet, the country lags behind other nations in several aspects such as life expectancy and health insurance coverage.

Read More: www.zerohedge.com/news/2017-03-23/americas-1-again-healthcare-costs-around-world

EconomicPolicyJournal.com: How Government Healthcare Interference Got Started in the U.S. and What It Will Lead To

Health Care

One of Ludwig von Mises’s keenest insights was on the cumulative tendency of government intervention. The government, in its wisdom, perceives a problem (and Lord knows, there are always problems!). The government then intervenes to “solve” that problem. But lo and behold! instead of solving the initial problem, the intervention creates two or three further problems, which the government feels it must intervene to heal, and so on toward socialism.

No industry provides a more dramatic illustration of this malignant process than medical care. We stand at the seemingly inexorable brink of fully socialized medicine, or what is euphemistically called “national health insurance.” Physician and hospital prices are high and are always rising rapidly, far beyond general inflation. As a result, the medically uninsured can scarcely pay at all, so that those who are not certifiable claimants for charity or Medicaid are bereft. Hence, the call for national health insurance.

But why are rates high and increasing rapidly? The answer is the very existence of healthcare insurance, which was established or subsidized or promoted by the government to help ease the previous burden of medical care. Medicare, Blue Cross, etc., are also very peculiar forms of “insurance.”

Read More: www.economicpolicyjournal.com/2012/07/how-government-interference-got-started.html?m=1