Rx For Your Health

Post lifted from Democracy Project

Most directly put, would your personal and financial health and that of your relatives be better directed by yourself or by government bureaucrats? The new Democrat congressional majority is determined to wrest control of your prescription choices away from you, and in the process place taxpayers even deeper in debt.

One of the first orders of business for them will be to undermine the successful free-enterprise foundation under the Medicare Part D prescription drug program. Despite its enrollment, coverage and cost successes - and, indeed, because it thereby challenges so many existing government-run programs by being for the most part privately managed - the highest priority for congressional Democrats is to destroy it.

If you care at all, you must read this short and straight-forward publication prepared by a consortium of leading experts from leading think tanks: "The Facts: Medicare Part D and Prescription Drug Prices.

This joint fact sheet was jointly prepared by health policy experts from the American Enterprise Institute, the Center for Medicine in the Public Interest, the Galen Institute, The Heritage Foundation, the Institute for Policy Innovation, the Institute for Research on the Economics of Taxation, the National Center for Policy Analysis, and the Pacific Research Institute."

THEN, please send a copy to your congressperson and senator, and ask them to read it. You can easily access their email address at this site. All you need to do is enter your zip code. Then let your fingers do the talking to your representatives




Friedrich Hayek on universal health care

As the 110th Congress prepares to convene and the run for the '08 presidential nominations begins in earnest, we're seeing far more appeals from the left, both from politicians, bloggers and opinion makers to address the supposed "health care problem".

The appeals range from governmentally run universal health care to single-payer (again government) health insurance. The reasons given are also varied from the emotional "for the children" rhetoric favored by some to the technical "it would be more efficient and less costly" sobriquet.

Reading through Friedrich Hayek's monumental "The Constitution of Liberty" again over the holidays, I revisited his discussion of the topic. And, willing to risk boring you out of you skull I thought I'd share it with you. Fair warning: Long post follows.

One of the most important thoughts he has on the subject gets to the crux of designing a system which would supposedly provide equal care to all. Health care cannot really be quantified and thereby presents peculiar problems which must be understood:

"They result from the fact that the problem of "need" cannot be treated as though it were the same for all who satisfy certain objective criteria, such as age: each case of need raises problems of urgency and importance which have to be balanced against the cost of meeting it, problems which must be decided either by the individual or for him by somebody else."

And therein lies the great dilemma and the greatest threat to liberty. Because in a state run scheme it is the latter which will, indeed must, prevail. He approaches the topic of health insurance and "free health care" by saying:

"But there are strong arguments against a single scheme of state insurance; and there seems to be an overwhelming case against free health service for all. From what we have seen of such schemes, it is probable that their inexpediency will become evident in the countries that have adopted them, although political circumstances make it unlikely that they can ever be abandoned, not that they have been adopted. One of the strongest arguments against them is, indeed, that their introduction is the kind of politically irrevocable measure that will have to be continued, whether it proves a mistake or not."

That line is one of the most important points about this entire debate and one of the major reasons that many, especially among libertarians and fiscal and small government conservatives, resist the implementation of such a plan. Witness Medicare, Medicaid and Social Security. Once it is in place there is no turning back even if it is an outrageous mistake. Fine, you say, but other than resisting it, to this point, because it may turn into an expensive and inefficient debacle, what can you offer to at least lend credence to an argument against such a system? Fair question. And for that, I offer Hayek's argument, an argument that is well reasoned, not emotional, and provides some unique insights. He begins his critique by pointing out that the case for free health service is based on two fundamental misconceptions:

"They are, first, the belief that medical needs are usually of an objectively ascertainable character and as such that they can and ought to be fully met in every case without regard to economic considerations, and, second, that this is economically possible because an improved medical service normally results in a restoration of economic effectiveness or earning power and so pays for itself."

But, as he argues, both miss the mark because they mistake the nature of the problem involved in decisions concerning "the preservation of health and life":

"There is no objective standard for judging how much care and effort are required in a particular case; also, as medicine advances, it becomes more and more clear that there is no limit to the amount that might profitably be spent in order to do all that is objectively possible."

Now make sure you're clear on his point here. He's not claiming it is profitable (or rational) to spend what is necessary to do all that is objectively possible. He's arguing that if you agree that even marginal improvement, no matter how small, is "good" ("no objective standard") then there is no limit as to how much you can spend for marginal improvement. Without an objective standard for making judgments as to how much care and effort are enough care and effort, the want is infinite. He continues:

"Moreover, it is also not true that, in our individual valuation, all that might yet be done to secure health and life has absolute priority over other needs. As in all other decisions in which we have to deal not with certainties but with probabilities and chances. We constantly take risks and decide on the basis of economic considerations whether a particular precaution is worthwhile, i.e., by balancing the risk against other needs. Even the richest man will normally not do all that medical knowledge makes possible to preserve his health, perhaps because other concerns compete for his time and energy. Somebody must always decide whether an additional effort and additional outlay of resources are called for. The real issue is whether the individual concerned is to have a say and be able, by an additional sacrifice, to get more attention or whether this decision is to be made for him by somebody else. Though we all dislike the fact that we have to balance immaterial values like health and life against material advantages and wish that the choice were unnecessary, we all do have to make the choice because of facts we cannot alter."

The fundamental issue he confronts here is the right of individual choice and the attack on that right which programs such as "free health care" pose. In essence individual choice is, at some point, overruled by collective choice. As Hayek implies in his discussion of "objective standards" and the real lack of them in judgments of how much care and effort are required in a particular case, those sorts of standards must be part and parcel to any "free health service". Infinite need/want meets finite fiscal and physical resources in such a system, and consequently some method of defining the limits of "health care" within those fiscal and physical constraints must, of necessity, be made. Individual choice then is reduced to those standards and the freedom to pursue "additional sacrifice" in terms of spending more on your health is removed from your array of choices. Even when such "objective determinably standards" are outlined, they prove not to be well considered or, as Hayek says, have any "relation to reality:"

The conception that there is a an objectively determinable standard of medical services which can and ought to be provided for all, a conception which underlies the Beveridge scheme and the whole British National Health Service, has no relation to reality. In a field that is undergoing as rapid change as medicine is today, it can, at most, be the bad average standard of service that can be provided equally for all.. But since in every progressive field what is objectively possible to provide for all depends on what has already been provided for some, the effect of making it too expensive foremost to get better than average service, must, before long, be that this average will be lower than it otherwise would be."

Why the US continues to be the gold-standard for the most progressive and best medical care available instead of the British National Health Service is to be found in that paragraph. When their health is involved, people will rarely, if ever, chose the "bad average standard of service" over one which provides them the opportunity to access the best and most progressive. Health care, as provided by any universal scheme can, at best, only offer that "bad average standard of service".

Much more here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.

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