How is any of this libertarian? The libertarian solution would be that only individuals would be allowed to purchase insurance, that insurance would distribute funds to the individual (not the doctor or pharmacy), all fees would be provided prior to service being rendered and individuals would purchase meds without a prescription.
I work close enough to healthcare that I can say that while insurers do take cost of treatment into account they are looking to minimize ongoing treatment costs - if there is a 5$ pill and a 500$ pill available for treatment the insurer may prefer to trial you initially on the 5$ pill if it's been proven effective for a good proportion of patients, but they do use calculations to minimize those ongoing costs that includes costs from condition escalation (i.e. if you have a boil you're absolutely going to get antibiotics covered since dealing with a septic boil is an emergency room visit.
Note: I've spent on the order of 30 hours on the phone over the past couple months trying to get things sorted out between my doctor, my insurance, and the provider of the drug that I need for my vision. The folks at the insurance can't always help, but they've always been willing to discuss things and see what they _can_ do.
What should have happened is that they should do the ultrasound right there, on the spot. But, the dr's office can't do ultrasounds. That has to go to the imaging department, which had to be scheduled 4 weeks out. Sigh... I won't keep going, but this whole situation is stupid and engineered to extract as much money as possible.
The next time something like this comes up, if you're feeling up to it, try pushing back. If you have the time to throw at it, the worst outcome of trying is usually just staying where you started.
At the end of my many hours on multiple phone calls getting everyone to agree to pay for treatment I need... the company in charge of making it called to let me know they've been retasked to making COVID vaccine and won't be making the drug I need for at least 3 months. So no treatment for at least that long. So that's fun.
In general, the US has a problem where it pretends to love free markets, but when you look under the hood there's horrific regulatory capture and crony capitalism.
There is so much regulation around anything even remotely medically related. Just look at the HIPPA mess.
Edit: why are you downvoting without rebuttal? Its utterly false to claim the system is libertarian.
Calling it libertarian shows you know nothing about either healthcare regulation or libertarianism.
I guess the true libertarian answer is that we don't really need certification at all, or that anyone should be able to start their own certification board. Like Rand Paul and his fake ophthalmology board he started to give himself credentials.
Nothing is ever libertarian enough until we've removed all the regulations and let quacks practice medicine, is it?
https://www.washingtonexaminer.com/thanks-to-doctors-there-a...
To me, libertarianism is simply “might makes right,” with the liberty part being everyone has the opportunity to grow into a bully. I’ve never seen a SINGLE libertarian policy that couldn’t be interpreted this way, and I’m quite open to being corrected.
How about Kelo vs New London? This was the Supreme Court case establishing that the government could use eminent domain to seize people's homes and hand the property to private developers, in the interest of raising tax revenue for the city. Libertarians were against it; liberals were for it. Is that "might makes right"?
Libertarianism basically sees two possible crimes: force and fraud. Totally incompatible with "might makes right".
(Dejaque, the founder of libertarianism called Proudhon, the founder of anarchism, a "moderate anarchist, liberal, but not libertarian")
Which is lovely and all, until those doctors tell you vaccines are worthless and dangerous, and to slather a mixture of beef tallow, garlic, leek, and honey on your injuries.
We could split the difference and expand existing med schools or start new ones with similar standards.
1) independent rating agency for med schools
2) independent rating agency for doctors (i.e. med school was irrelevant)
3) patient reviews for doctors
(1) and (2) have the usual "who watches the watchers?" problems, which are fairly isomorphous to the problems with (3). And even without those issues, who wants to have do this level of research? Yeah, I know, libertarian nerds (meant with all possible respect). But almost nobody else.
Part of the point (not all of it, to be sure) of things like the AMA, the FDA and other governmental regulation is to make people's lives simpler. Stop worrying about whether the doctor you're going to see has even met a basic level of medical qualification, and focus on whether you like their personality and approach, for example.
Since we already deal with “who watches the watchers” problems in our current system, I see no problem here.
> And even without those issues, who wants to have do this level of research? Yeah, I know, libertarian nerds (meant with all possible respect). But almost nobody else.
Anyone who wants a good physician.
> Part of the point (not all of it, to be sure) of things like the AMA, the FDA and other governmental regulation is to make people's lives simpler. Stop worrying about whether the doctor you're going to see has even met a basic level of medical qualification, and focus on whether you like their personality and approach, for example.
If those things worked, this would be a point. Currently people can’t even afford to go to medical school, or afford to see a doctor, and when they get past the gatekeepers they are so desparate to get treatment that they can’t really even fathom rejecting a doctor because of a poor bedside manner.
Other countries with socialized health care systems (i.e. doctor credential gatekeeping) do not have these issues (certainly not to anything like the extent that we do). I suspect therefore that changing the credentialling process is unlikely to have much impact on these issues and/or is not the most effective way to impact these issues.
> Anyone who wants a good physician.
I'm 57 years old. I've never, ever met anyone who isn't a libertarian nerd (I have friends ...) that checks to see what medical school a physician attended. If they are "checking" at something approximating that level, they do so via clinical affiliation (e.g. "anyone at the Mayo has to be great").
> Since we already deal with “who watches the watchers” problems in our current system, I see no problem here.
Not really. The "watchers" in our current system are government agencies, not private (potentially for-profit, or at least for-big-salary) corporations. The incentives align in significantly different ways.
The easiest way to expand medicine access would probably just be to remove government restrictions on the number of medical schools, the number of hospitals, and the number of physicians. I don’t think we need to dismantle the credential system.
> I'm 57 years old. I've never, ever met anyone who isn't a libertarian nerd (I have friends ...) that checks to see what medical school a physician attended.
This why we have to be careful about generalizing from our own experience conclusively :)
> If they are "checking" at something approximating that level, they do so via clinical affiliation (e.g. "anyone at the Mayo has to be great").
There’s how things are, and how things should be. People ought to take more responsibility for their healthcare and that includes who provides it.
> Not really. The "watchers" in our current system are government agencies, not private (potentially for-profit, or at least for-big-salary) corporations. The incentives align in significantly different ways.
Perhaps you haven’t noticed but the watchers in government agencies and the for-profit, big salary corporations they are supposed to be watching are the same people. its called “regulatory capture” and “revolving door”.
This seems to suppose one (or both) of two things:
1) access to medicine is limited because of the supply of health care providers, so more providers would help
2) access to medicine is limited due to cost, and more providers would force the cost down, as per "supply and demand", "the market" etc.
> This why we have to be careful about generalizing from our own experience conclusively :)
Certainly in general, this is true. But when the claim is that "anyone who wants a good physician" would do this, not so much. Falsifiability, and all that.
> People ought to take more responsibility ...
This is a moral statement, not some sort of fundamental statement about the nature of reality. Not only is the level of personal responsibility up for the debate, but so is the form such responsibility should take. Citizens in many other countries have chosen to "take more responsibility" for their healthcare in different ways than you are proposing (by taking aggregate action to create socialized health care systems that delegate many things to the system, intentionally).
> Perhaps you haven’t noticed but the watchers in government agencies and the for-profit, big salary corporations they are supposed to be watching are the same people. its called “regulatory capture” and “revolving door”.
Speaking of over-generalizing ... also, "There’s how things are, and how things should be." I do not believe that regulatory capture is an inevitable outcome of a democratic-ish governmental structure.
I’m really not sure what to make of this, there is already a market for things such as emergency care. Even with all the regulation, when you get in an ambulance you can tell them to take you to a specific hospital.
When people are treating non-emergency conditions, the same regulated market offers them even more options. Ikm not really sure what you mean here.
> Many volumes have been written by people much smarter than me that explain the many reasons why health care is not really susceptible to what are supposedly "normal market" behaviors and benefits.
Many volumes have been written on how the four humours can be used to diagnose and treat disease. However modern medicine no longer uses the four humours model. Perhaps it is also time for modern medicine to embrace the scarcity management aspects of markets rather than looking for answers in musty old volumes.
> I'm not aware of much evidence for (1), though I don't deny that it is possible.
It is not only possible, it is the case. The bottleneck is at schools, at residencies, and at licenses. Possibly elsewhere. In a basic simple mathematical way, fewer providers means less access to care.
> Certainly in general, this is true. But when the claim is that "anyone who wants a good physician" would do this, not so much. Falsifiability, and all that.
Certain values of “want” may not be sufficient, as with anything else. Anyone who wants a good physician enough to look for one would perform the due diligence required to obtain one. Kind of like now, actually.
> This is a moral statement, not some sort of fundamental statement about the nature of reality. Not only is the level of personal responsibility up for the debate, but so is the form such responsibility should take. Citizens in many other countries have chosen to "take more responsibility" for their healthcare in different ways than you are proposing (by taking aggregate action to create socialized health care systems that delegate many things to the system, intentionally).
Yes, its a moral statement. And its an interesting question whether people who entrust bureaucrats with healthcare have taken reaponsibility or shirked it.
> Speaking of over-generalizing ... also, "There’s how things are, and how things should be." I do not believe that regulatory capture is an inevitable outcome of a democratic-ish governmental structure.
The problem is that things like social planning of healthcare provision are evidently flawed in every respect due to the belief that they can’t be trusted to markets. We don’t want to believe we are getting competent care because the government says so, we want to have confidence we are getting competent care because the incentive structure is aligned witn the outcome from the patient’s perspective. We don’t want to believe we are getting the best price for drugs because a bureaucrat claims to negotiate on our behalf with his cronies, we want to know that we get the best price in drugs because they are sold in a competitive market where companies are rivals for the business of patients.
A) you may be unconscious B) you may not know anything that would allow you to differentiate ER facilities C) you almost certainly have no information on the current wait times at an ER facility, let alone specific physicians on call D) you may be unaware of the intersection between your insurance and hospital choice (for example, I had insurance once that only covered care at a (very fine, major urban) hospital that was unable to treat my amputation accident).
So really ... just no.
If you're going to start dismissing the fact that smart people have written smart stuff on a topic by saying that we revise what is considered smart, then I'd just do the same in reverse, and say that none of the worldview/policy view that you're arguing for is supported by anyone worth paying attention to, since it's all just out of date and/or will be consigned to the trash heap of history very soon.
The books I am talking about are not "musty old volumes".
Here's Forbes from 2017: https://www.forbes.com/sites/chrisladd/2017/03/07/there-is-n...
Somewhat older, here's Krugman from 2009: https://krugman.blogs.nytimes.com/2009/07/25/why-markets-can...
Here's (supposedly) a libertarian on the problems in 2018: https://thehealthcareblog.com/blog/2018/08/02/a-libertarians...
And here's perhaps the oldest (recent) paper that got things rolling, "way back" in 1963: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2585909/
> In a basic simple mathematical way, fewer providers means less access to care.
That's a response to a completely inverted point. If there are already enough providers, then more providers doesn't mean more access to care (certainly not based on access to providers, rather than cost).
> The problem is that things like social planning of healthcare provision are evidently flawed in every respect due to the belief that they can’t be trusted to markets.
You're on the edge of a no true scotsman argument here, which means I'm going to bed.