The health care mess: A free market proposal

"The right of the state to deal with the entire subject (health care) can assuredly not be gainsaid. The physician is a social instrument." This is just one of Flexner's statements that bespoke a deep socialist paternalism. It could have been made by John Dewey, the radical socialist educator and Flexner's contemporary. In retrospect, Flexner was a cog in the wheel of socialism and an authoritarian one to boot.

All socialists are opposed to anything that smacks of the profit motive, especially when someone else makes the profits. They also are never above using their reforms for their own profits. Flexner was vehemently opposed to proprietary medical education, and like all the socialist minded, he never recognized that his reforms would result in an even greater financial cost to society.

Licensing has been a disaster and does not protect the public, in any way. If anything, it institutionalizes incompetence and avarice. No matter how it begins, authority always has to be passed up the line to a higher authority. Discipline is filtered through these layers which usually acts only to protect the licensee. In addition to the examples above we have the horrors of incorrect limb amputations, and other disasters in respected hospitals.

How then to regulate the quality of medical care? Like everything else, through the marketplace. First of all, eliminate licensure.

Several decades ago, the AMA publication, Medical World News (MWN), reported that Milton Friedman spoke at a medical conference where he proposed exactly that. When challenged about quality assurance, Friedman proposed using insurance companies rather than licensure. MWN reported that physicians were 'still shaking their heads at that one' after the meeting. MWN was edited by Morris Fishbein, M.D., a long time opponent of alternative treatments, and a mouthpiece for the AMA.

But insurance companies would be the logical way to assure quality. It would be the insurance companies who would suffer the losses for poor medical care and in their best interests to make sure that poor practitioners did not continue. They would be immune from political pressure and, simply as a business decision, arrive at a decision. So who better?

Some have argued that malpractice rates are often highest for the most skilled physicians, especially surgeons. The argument is that they are the ones willing to tackle the most difficult cases and the ones trying the most innovative techniques. Maybe, but in a free marketplace, any patients in such conditions that would warrant such risky attempts, should be willing to incur the financial burden for them to compensate for the skilled attempt.

Allow proprietary medical schools. They would be most responsive to the needs of the people. As the demand for physicians increases, the schools would hire more instructors to train them. And why shouldn't the students who are going to enter a high paying profession have to pay for it themselves?

Eliminate all public funding for medical research and medical education. Let marketplace needs, rather than politics govern research projects. As it is, AIDS activists claim that there isn't enough research in this direction while others claim there's too much of it or not enough for their favorite projects. Once again, why not let the marketplace determine the direction of research? It could hardly be any worse than what we have and we'd save the millions of dollars that go into lobbying to accomplish the funding.

Some may argue that there would be protection against quackery. The response is that it's going on anyway and that licensure has failed miserably in preventing shoddy medical practice, disastrous results and practice motivated by sheer greed.

Others may argue a complete market system will not guarantee access to good care by the poor. But charity work has never been in short supply in the medical sphere in the first place. In fact, traditionally, medical care was the province of charitable, religious bodies. It might not be a bad idea to resurrect that venue as part of a re-alignment.

But there is even more of a reason to throw the entire system out. It's going to be destroyed by progress anyway and government will never be able to keep up with it. Federal and state authorities are scrambling to keep up with on-line medical practice. Some states have been able to penalize physicians who practice and prescribe on-line. The justification is that the physician is treating without examining the patient but it's a losing battle. Technology will be finding a way around all those problems.

We already have virtual endoscopy and whether people are aware of it or not, often their x-rays and laboratory reports are originating in India. The films or slides are being read by a radiologist, pathologist or technician on the other side of the world and at a cost far less than an American practitioner would charge. This is going to accelerate as technology eliminates distance as a barrier for all services, not just medical.

This scenario may seem far-fetched but it's not out of the question. You have a sore throat. You plug into the Internet and a physician in Pakistan or China comes onto your screen. He instructs you to open your mouth and insert a fibre optic attached to your computer that transmits the image of your throat to him. You take your temperature and tell him what it is. You attach a stethoscope to your chest and breathe while the sounds are transmitted. He does the entire examination without ever having been in the same room as you. Getting you the medication could be a challenge but in these days of rapid shipping that might be accomplished within twelve hours. You pay for everything by credit card.

With the introduction of remote control robots, it's also feasible that a future surgeon would operate on a patient from the same distance. Government will never be able to stop this. It will try but it's a losing game.

And if it's happening in medicine, traditionally the first licensed field and the most highly regulated, it will happen in all the others. Government, throw in the towel! Your days are numbered! Freedom cannot and will not be denied because human initiative and the human spirit cannot and will not be denied.

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Australia: Melbourne public hospital putting women's lives at risk

Victoria's Opposition says internal documents from the new Royal Women's Hospital show lives are being put at risk. Opposition health spokeswoman Helen Shardey has obtained a copy of the hospital's latest operational plan. She says it shows delays in accessing operating rooms and a badly-run outpatient service. She says the $250 million hospital is also suffering from a shortage of nurses.

"What these documents indicate is that the hospital is in trouble. They don't have enough staff, they are being poorly resourced and they will have to cap the number of babies they can deliver," she said. "From this report it appears that the outpatient area is not large enough to accommodate the number of patients that needs to be seen, and this report indicates the architects have been called back to redesign the outpatient area."

The Royal Women's Hospital is playing down possible risks to women and their babies at the new facility. Hospital spokeswoman Mandy Frostick says women should not be concerned about treatment being provided. "We have a yearly risk assessment process, which is a very sophisticated process at the Women's, which looks at any potential risk that could occur in any situation," she said. "And what is most important in identifying any possible risk that could occur is that we also put in place mitigation plans to prevent those risks from occurring. "There are always risks at any major hospital, We are one of three specialist maternity hospitals and we deal with very complex high-risk pregnancies. "And by that very nature we are constantly dealing with risk. We are very experienced in dealing with risk."

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