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cancer, health insurance

Voting Libertarian? I hope you or your kids never get sick

My thirteen-year old boys had an appointment this week. When we were done the provider who normally chats with me in that provider-to-provider way abruptly changed the conversation to tell me he finally deciding who was getting his vote. I was expecting this to be the lead in to some new Donald Trump joke. However, he showed me a map of the electoral college on his phone with several states in orange and said, “Libertarian, I’m voting Libertarian. That’s the future.”

I looked at him as my kids hovered in the door wanting to leave because there were Pokemon to catch. It took me a few second to realize he was serious. He pressed on about Obamacare not working (which I take as code for premiums being outrageously high) and what did I think?

I explained my views on Obamacare. That if health care reform is a ladder with 100 rungs Obamacare is the first rung. It is far from perfect, but at least it moves us in the right direction. That I understand political change and true reform is a long game. I used my standard go to reference for imperfect documents, the Constitution. If it were perfect when it were written we would have no amendments. We didn’t re write the whole thing each time an amendment was needed.

He was unconvinced and shook his head. The Libertarians, he argued, had a better way,

I told him his vote was his right and that I was voting for Hilliary. And then I added, “If your guy is elected I hope you never get sick.”

He looked taken aback. ‘”What?”

I pulled Oliver into the office. I asked if one day he needs heart surgery, like Oliver will again, will he have saved enough to pay the bill or is he just going to roll the dice with a charity hospital or perhaps fly to India?

“Well, Obamacare isn’t that great, is it?” he countered not answering how he would pay for a heart vale replacement.

At this point I pulled both boys back into the office and explained that their care combined was well over one million dollars in the NICU. Since then heart surgeries, intensive care units stays, and home oxygen. If this were a Libertarian health care system no insurance would have covered them. They’d have crafted a way to get out of it, by preexisting conditions or caps on costs per condition. I’m a doctor and I couldn’t have afforded the care they needed to survive. In countries without regulated health insurance parents have to pay in advance or their children don’t even get admitted to the intensive care unit at birth. Even if I’d sold my house when they were born and had a robust health savings account I’d have been bankrupt by the time they were five or six weeks old.

His answer, “Maybe we shouldn’t be saving those kids.” He looked embarrassed that he’d said it.

I wasn’t shocked or angry. That is the only logical conclusion under a Libertarian health care system. I knew that, so I wanted to make sure he did too.

He got flustered and muttered something about still being his patients. I told him I didn’t hold it against him, and walked off absolutely bewildered that someone with a graduate degree in health care could think that voting for a Libertarian was good for his own family. I honestly believe it is because people have bought into the Libertarian lies about health care or that they think it’s some kind of protest vote against the cost of health insurance, but if you are going to vote Libertarian you should understand exactly what that means next time you get sick.

Th Libertarian myth is that health care was awesome in the 1960s because doctors made house calls, a hospital stay only cost a few days pay, and there were charity hospitals. I’m not being tongue in cheek, those words are lifted directly from their web site. Yes, relying on charity is part of their plan.

Screen Shot 2016-08-02 at 7.20.38 AM

doctor and doll-1This is just false. Health care was too expensive for many in the early 1960s, especially for the elderly, who often spent their life savings on their health. That is why Medicare was introduced. No one would have introduced Medicare if everything were perfect. That’s not how governments work. 1960s medicine was only Norman Rockwell if you could afford it. In a 1963 survey 25% of people said they did not see a physician because of chest pains, 40% said they didn’t see a doctor if they had diarrhea for five days, and 35% of people with shortness of breath did not consult a physician. In 1963 the rate of hospital admission was 15% with private insurance and 9% for those without. By 1970 the rates had equalized to 13% due to Medicaid and Medicare. And charity hospitals and clinics? Well, ask doctors who have worked in them if that’s their ideal health care. I’ve worked in free county clinics and it’s patch work by dedicated professionals doing their best with little or no resources. It’s not health care, it’s health suboptimal care.

Comparing cost of care today with the 50s and 60s is ridiculous. Sure, we have too much bloat in the system and I’m eager to fix that, but keep in mind in 1959 a heart attack was managed with an EKG and nitroglycerin and oxygen. Now we have blood tests to diagnose heart attacks, medications to dissolve clots, 24 hour a day monitoring, angiography, stenting blocked vessels, and coronary artery by pass grafting. None of that expensive care existed in 1959. What about prematurity? Babies born at 34 1/2 weeks had a 40-50% chance of survival. At 26 weeks babies like mine were just wrapped up and left to die. If their mothers were lucky they got to hold them as they died. Guess when doctors starting thinking maybe they could cure some cancers with chemotherapy? Late 50s/early 60s. Obesity, a big driver of health care, was also much less prevalent.

Of course it was a cheaper and more efficient system in the 50s and 60s. The poor didn’t come in for care and none of today’s expensive care existed to offer those who did! People also walked more because there were no four car families and didn’t eat the junk food we had today.

The Libertarian party has these three ideas for health care:

 

Screen Shot 2016-08-02 at 7.40.02 AM
Excellent. Don’t get cancer. You won’t be able to pay for it. Same goes for heart disease and premature deliveries and just about any chronic care. Maybe you’ve saved really well, but then your mom falls and breaks her hip. She doesn’t have the $30,000 to pay for the surgery because she used all the money to pay for your dad’s chemo last year. Do you say sorry mom and let her die, even though the surgery could give her another 15 or so years, or pay for her care and then hope your kids don’t get sick while you build up your funds again? Hip surgery in this situation is best done within 48 hours so you don’t have a few weeks to think on it. Tick tock, what do you decide? The Charity hospital is full.

Let’s say I had been able to come up with the $1 million to get my kids through the intensive care unit, after he was discharged Oliver had 10 admissions for pneumonia (two to intensive care units), two heart surgeries, home oxygen, physical therapy and occupational therapy. Never in several lifetimes could I have saved enough money for his care.

 

Screen Shot 2016-08-02 at 7.44.08 AM

Mandating coverage for specific disabilities and disease protects people because insurance companies love to not cover expensive care. That’s why they invented preexisting conditions. Cancer is expensive let’s drop that! Oh, and Pap smears why pay for that? We don’t cover cancer anyway, so hope they’ve saved up! Prematurity? Well, there’s a $100,000 cap on that. Mental health? Great, we pay $25 a visit find a provider of your choice! Can’t find a psychiatrist to take that? Oh, sorry.

Mandates exist because most health insurance companies are trying to not pay for expensive care. The free market has already shown us what will happen without government oversight. Pre Obamacare if you had a preexisting condition coverage was inadequate at best. Who knows what a free market might decide, maybe obesity will become a preexisting condition and eligibility and rates will be calculated based on body mass index (BMI)?

 

Screen Shot 2016-08-02 at 7.53.21 AM

Sure the FDA has all kinds of issues, but a free market wants to do the bare minimum in studies. Drug companies are already not releasing unflattering studies with the regulation that we have, so you really think this will get better with less regulation? I can’t even validate this propranolol reference. Propranolol has been on the market since 1965 and generic as long as I’ve been a doctor (since 1990). I’m not aware of any 10-year delay in modern health care with this medication.

As for the real value of regulation I’ve got a one word for the Libertarian party, thalidomide.

Health Care the Unites States is Far From Perfect

That is about the only thing I agree with when it comes to the Libertarian party platform, however, the idea that people can get good medical care in a completely free unregulated market is a lie. We know this because it didn’t work  in the 1960s. We know this because in countries with little access to health insurance the poor go without basic health care and people get what they can pay for up front. A free market isn’t going to reduce the cost of by pass surgery and four days in the hospital to $500 (which I might add is a lot of money for many people).

If we had Libertarian health care system in 2003 when my children were born one or both of them would be dead. My health insurance was shitty, even as a doctor working at a University. Medicaid covered close to $500,000 in intensive care unit costs alone. In a Libertarian country they would have looked at our insurance and asked for $100,00 or more up front for each child and if I didn’t have the cash they wouldn’t have received care or they would have been transferred to an over worked charity hospital that often ran out of medications and had 30 year old ventilators.

The Libertarian platform on health care is either woefully under researched, a sad fantasy, or a willful attempt to camouflage the callousness that it represents with 1960’s nostalgia and buzz words.

If you’ve voting Libertarian you should know that.

 

Kangaroo care

> $250,000 just to get to this point in the NICU

Discussion

163 thoughts on “Voting Libertarian? I hope you or your kids never get sick

  1. Just another “you are awesome” comment

    Posted by Andersays | August 3, 2016, 10:28 am
    • Obamacare put an end to my family going to the doctor. We went from a $20 copay to a full pay until we spend $5000 in a year. One trip to the doctor costs $200 out of pocket. With our CURRENT insurance cancer would bankrupt us (but the hospital would get most of their outrageous bill paid). This is a move in the right direction? Screwing the middle class? This article was an excellent piece of cruel leftist propaganda. Good work. Maybe Libertarians don’t have the perfect solution but getting medical costs down, ending $20 bandaids and $10 for a Tylenol pill in a hospital sure does sound good to me. I can’t believe a doctor would advertise support for the profiteering and corruption of insurance companies and the continuation of this through subsidies from the Fed. Unbelievable. I don’t mind paying for medical care, I just want reasonable prices we can afford. I’d rather direct pay at fair prices than keep up the insurance scam! I am voting Libertarian as any reasonable non socialist would do.

      Posted by Jennifer Tew | August 5, 2016, 8:29 am
      • Why would an insurance carrier agree to pay $20 for a band-aid? It behooves carriers to slash healthcare costs as much as possible, and thereby increase their profits — this is one of the primary complaints levelled against them. And why would the hypothetical $20 band-aid be any less if society lost its collective mind and decided to do away with current, and past, healthcare models? People are angry — we get it. Those folks would feel better, and be better served, by watching Bruce Willis fight for freedom and the American way. But, really, this isn’t a trite popular movie, and simplistic, half-baked, ideas brought us Donald Trump. Thoughtful, intelligent, and innovative thinkers are needed today. Why not join them, and stop raging against the washing machine?

        Posted by Chris Stuart | August 5, 2016, 9:27 am
      • Do you live in a state that refused the Medicare expansion?

        Posted by Michele Sharik | August 5, 2016, 9:52 am
      • Your comment makes no sense. All plans have an out if pocket maximum precisely so that getting cancer won’t bankrupt you, and regular office visits are always covered, they don’t count towards the deductible (ER visits do, but that’s the point). More importantly, Libertarian policies will do exactly the opposite of what you want – allow plans with higher deductibles, no out of pocket cap, and more profiteering because that’s the “free market”.

        Posted by Karl | August 5, 2016, 10:13 am
      • Yes, there are big big problems with American healthcare. Why do you not look for a party that addresses those problems. Instead of voting libertarian? Do you think that removing the current ceiling of 20% on the amount from premiums that does not go on health care costs and quality improvement activities. as Libertarians propose. Will decrease profiteering? Personally I think it will increase it.

        Posted by Simeon Beresford | August 5, 2016, 10:22 am
      • $200? Where are you going to the doctor? I don’t love my Obamacare plan – it’s $628/month for me and my wife with a $7000 family deductible. My last visit to the doctor cost $98 for the office visit – the discounted cost through the insurance company, and I live on Long Island, NY, a very expensive place to live. Your entire post is hyperbole and exaggeration. Full pay? That’s not how insurance works.

        Posted by Scott | August 5, 2016, 11:50 am
      • What people have to remember is that while Obamacare was signed into law by President Obama … it was crafted by our Congress. Who owns and controls our Congress? We the people can only blame ourselves for letting this happen. We complain about it but keep voting the same people back in office. Want this to change? You know what to do.

        Posted by Randall | August 5, 2016, 12:47 pm
      • How would scrapping the current, or past, healthcare models prevent $20 band-aids (which don’t actually exist, but we’re playing your world after all)? Healthcare insurers have every incentive to charge $100 a band-aid, so there’s little disincentive to their charging even more under any regulatory environment that took the lid off their practices.

        We know how appealing this rage and indignation thing is, and how satisfying it must feel to come up with a unified theory of every political, social, and fiscal ill by sticking out that big ol’ American flag-draped sleeve and cursing something about “political correctness”. But, solutions, real solutions, are borne from thinking, innovating, and doing something besides raging against the washing machine.

        Posted by Chris Stuart | August 5, 2016, 1:55 pm
      • Then you dod a shit job choosing your plan. Did you call the free hotline to get help finding the right plan for your family? Id bet not. You floundered confused and hit a button. I know agents who sell car and house insurance who needed to call the hotline; they did fine except one bimbo who thought because she ran an a+agency for state farm she could do it herself……she ended up sounding like you.

        Posted by George | August 5, 2016, 8:03 pm
      • Either you don’t know how this works and your doctor charged you instead of the insurance company or you out and out lied. Sorry, but no plan other than the catastrophic ones has no office visit provision. And even if it’s a specialist, you would not pay $200 for a simple office visit. Either you need to study more about your coverage and make more informed decisions about your healthcare, or you should stop being dishonest about what you encountered. We’re not ALL as gullible as you imagine most people to be.

        Posted by Don Wynn | August 6, 2016, 5:43 am
      • Since I work in healthcare, in health insurance, I can tell you that is a result of your chosen carrier, not obamacare. The doctors and insurance you see are charging that. Constantly changing premiums and denial of benefits is what happened before. It’s called “lifetime maximum”.
        As a side note, saying “reasonable” and non socialist” in the same sentence that discusses pooled resources to bring down costs is amusing.
        Blaming a policy for the failures of those who are executing it poorly is in bad taste, and terribly misinformed.

        Posted by Andersays | August 8, 2016, 11:14 pm
      • Has everybody heard of the Epipen price going from $100 to $600 in the last year? It turns out that Epipen has a government patent. It also turns out its CEO is politically connected, and the FDA has repeatedly prevented international competitors who have tried to work around the patent from entering the US market. This is the suffering that has resulted. Dr. Gunter, do you have a response to this because in my mind this explains a lot of the skyrocketing prices in health care? Blessings and love to all. FREEEDOM!

        https://mises.org/blog/lack-epipen-competitors-fdas-fault

        http://dailycaller.com/2016/08/24/company-gouging-price-of-epipens-is-a-clinton-foundation-donor-and-partner/

        Posted by Mark Andrew Hamilton | August 25, 2016, 3:53 am
    • Just trying to respond to Overfiend’s comment below anywhere to see if it will let me respond; page is having serious issues..

      Re: cable situation is about ‘exclusive franchise.’ It’s often given to cable companies by politicians (who receive free air time, donations to favored charities, you know the game) with the excuse of natural monopoly, but when ‘exclusive franchise’ is taken away companies like ‘Scripps Howard’ in Sacramento in 1987 have to drastically cut their prices where there’s competition (see link below). Often, exclusive franchise is on unwritten terms, as companies found out when they apply for a license and are denied. Three court cases illustrating this are: Community Communications Co. v. City of Boulder, (10th Cir. 1981), Central Telecommunications Inc. v. TCI Cablevision, Inc 8th Circuit 1986, and Berkshire Cablevision v. Burke, 1983. I can give you the sources for that if needed, but these cases are easily accessible online. There may have been more recently. When there is no exclusive franchise, competition does its work. “As former FCC chief economist Thomas Hazlett, who is perhaps the nation’s foremost authority on the economics of the cable TV industry, has concluded, ‘we may characterize the franchising process as nakedly inefficient from a welfare perspective, although it does produce benefits for municipal franchiser.'”

      https://mises.org/library/myth-natural-monopoly

      https://mises.org/library/question-cable-monopoly

      All blessings and love.

      Posted by Mark Andrew Hamilton | August 8, 2016, 5:08 am
  2. Thank you, thank you, thank you for providing all of these facts to counter the fantasy that is “libertarian” health care.

    Posted by bri65 | August 3, 2016, 11:15 am
  3. Thanks for a really insightful read. I’m sharing for my friends who think voting Libertarian is a better choice than our others.

    Posted by Amelia | August 3, 2016, 1:48 pm
  4. Healthcare, while not political in nature has become just that! It’s a capitalist endeavor, but not at all based on free market principles in the US. Somewhere in between what the public perceives as “affordable” and what elected officials want to claim as their present to the electorate…we must strive for compromise?

    Posted by Plectrumm | August 3, 2016, 1:59 pm
  5. Thank you for this.
    My comment has always been, “How would you feel if your house burned down and the next day you got a $50,000 bill from your local fire department?”

    Posted by Erin | August 3, 2016, 8:22 pm
    • Under libertarians, this could happen.

      Posted by John | August 4, 2016, 6:38 am
    • This makes no sense.

      Fire departments are often voluntary services. Pretty libertarian.

      Healthcare is only expensive now because of MASSIVE government interference in the market.

      Why would free market medicine be expensive? You think having the choice of many many doctors giving a service that everyone needs would mean that it would be expensive?

      You might want to take a basic economics class.

      Posted by Nick | August 4, 2016, 11:29 pm
      • Really, fire departments are often volunteer? Possible ins mall rural communities with not enough people to man a full time department there may be some volunteers but I assure you our fire department is paid as is San Francisco and every other major city in the United States.

        Posted by Dr. Jen Gunter | August 5, 2016, 7:26 am
      • The number of doctors in the US is controlled by AMA. The RUC which they set up decides how many people get to qualify. How do the Libertarian proposals address this monopoly?

        Posted by Simeon Beresford | August 5, 2016, 10:37 am
      • Absolute and total freedom. No licensing laws, no government medical patents. This would lead to competition between doctors, prices would go down, and quality would go up, just like with modern technology, cars, and airplanes–where there are relatively few licensing laws etc.. Then situations like Dr. Gunter mentions above would no longer be a problem🙂.

        https://mises.org/system/tdf/3_1_5_0.pdf?file=1&type=document

        Posted by Mark Andrew Hamilton | August 5, 2016, 12:03 pm
      • Volunteer fire departments have contracts with the local municipalities to cover the expenses or each homeowner pays a yearly fee so the cost is shared across the community. A truly libertarian fire department would bill the people whose house is burning- or refuse to answer the call until given a credit card to charge it to. . (Gas, training, maintaining the equipment, replacing equipment and all associated tasks with firefighting take money even if the firefighters themselves aren’t paid.)

        Posted by Deborah K | August 5, 2016, 5:55 pm
      • Free market medicine will be expensive because when you are having a health crisis you don’t have the privilege to comparison shop, you need help right then and there.

        Didn’t you read what Dr Gunter write about affordability of medical services before Medicare?

        Posted by Anat | August 5, 2016, 10:25 pm
      • NO,NICK – ITS NOT THE GOVERNMENT DRIVING THE COSTS UP – IT THE FRIGGIN INSURANCE COMPANIES! THEY KEEP 50% OF EVERY HEALTHCARE DOLLAR! SO IF WE HAD THAT MONEY TO USE FOR HEALTHCARE, THAT INSTANTLY DOUBLES THE AMOUNT WE CAN USE FOR ACTUAL ILLNESS. INSURANCE COMPANIES RAPE US WITH THEIR GREED. THATS WHY SINGLE PAYER IS THE WAY TO GO – GET RID OF THE INSURANCE OFFICE GIRL WHO SAYS YOU CANT HAVE THE TREATMENT YOUR DOCTOR ORDERED. PUT MEDICINE BACK INTO THE HANDS OF THE DOCTORS INSTEAD OF SOME GREEDY INSURANCE EXECUTIVE!

        Posted by monti markel | August 7, 2016, 9:03 pm
      • Mark Andrew Hamilton said “modern technology, cars, and airplanes–where there are relatively few licensing laws etc..” and I say, are you kidding, all of the items you mentioned are heavily regulated.

        Posted by Bill Roberts | August 9, 2016, 7:14 am
      • Hi Bill Roberts: There’s a difference between regulation and licensing laws. I admit that cars and airplanes are regulated today, which is a shame, because they would be a lot better if they weren’t, but I may have said somewhere there’s not much regulation in those areas, and I may have misspoken. But technology can often stay ahead of regulation because they invent things and it (mercifully) takes government a long time to set up the regulation by which time they’ve invented something else … which is why computer and ipad prices, for example, are trending down with much higher quality. All blessings, man.

        Posted by Mark Andrew Hamilton | August 28, 2016, 4:09 pm
      • But I am really sorry. I believe I was sloppy with my terms. All blessings.

        Posted by Mark Andrew Hamilton | August 28, 2016, 4:21 pm
  6. I assume you are a doctor of medicine, not political science. This couldn’t be further from the truth. Perhaps the most extreme member of the libertarian party once implied this but it is certainly NOT a party platform and in no way suggestive of how the libertarian nominee views health care. I’m sure you do great things in your field, thus I suggest you keep your posts focused there. Furthermore this entire conversation sounds a bit too convenient and contrived. This so-called physician just unwittingly walked into your education on the matter? Just like that? IM diagnosing you with a severe case of nonsense fever.

    Posted by Stephen | August 3, 2016, 8:47 pm
  7. You clearly describe the condition of healthcare and health insurance in this country. Why do so many people want to believe the misstatements and outright lies? You write very clear, factual and necessary information. Keep on talking, gradually more people will listen and learn.

    Posted by Phil's Personal Perspectives | August 3, 2016, 10:37 pm
  8. So your plan is to take money (by force) from the tax payer to pay for your health care. I’m tired of both your Democratic policies and the Republican policies that never deliver what they promise and continue to put us trIllinois of dollars in debt. No thank you for your delusional way to govern

    Posted by Steve Willis | August 3, 2016, 11:34 pm
    • Excellent display of compassion!

      If you get sick, and you will as all people do, is that how you wish to be treated?

      Posted by Dr. Jen Gunter | August 5, 2016, 7:02 am
    • So, if you don’t want to pay in, are you willing to die at home without expensive treatment if you are seriously injured or require care for cancer or heart disease? Or, are you just freeloading, gambling that you will be the exception, confident that people like me will foot the bill? Perhaps health care freeloaders should wear a bracelet or get a tattoo, identifying you as someone who should just be taken back home if you arrive at the hospital, unable to pay. Healthcare freeloaders (people who can pay for insurance but chose not to pay) never think this through.

      Posted by Chris Brackett | August 5, 2016, 9:05 am
    • The whole point of paying taxes in a democracy is that the money that is taken (by force?) is to be used to benefit the citizens. What benefits the citizens more than knowing that they can see a doctor if they need one and that they don’t have to worry about not having enough money for medical care in a crisis? For me that seems a perfectly logical use of that money. More sensible than buying weapons and war machines that will be obsolete before they are used, more sensible than subsidizing already successful and profitable corporations, more sensible than so many other ways they’ve found to waste our tax money.

      Posted by getolife | August 9, 2016, 6:55 am
      • Hi Getolife: Consider that it is far more democratic to vote everyday for what you think is a good product by what you buy than to vote every few years or so on things that politicians will often not respect your viewpoints on anyway. Historically, democracy can be manipulated (Stanford U. found that in states without a paper trail to votes, Clinton drastically outpaced Sanders by 10-15% or so more than the polls predicted while Republicans had practically no difference between polls and voting) and also political entrance tests can be used that elevate some people who can vote over others who can’t (i.e. African-Americans, women, and felons).

        How much freer are we when we vote for integrity or quality or low prices every day by what we buy than just at the ballot box? And every race, every gender, every background can do it. This is the anarcho-capitalist (libertarian) dream.

        As a way of supporting this, consider this article: https://fee.org/articles/why-large-screen-tvs-are-affordable-and-health-care-is-not/

        All blessings.

        Posted by Mark Andrew Hamilton | August 19, 2016, 8:59 am
  9. Blaming modern FDA regulations for a 10 year delay in approving propranolol makes no sense at all. The modern FDA regulatory framework, when drugmakers were first required prove their drugs were effective and disclose side effects, began with the Kefauver-Harris amendment and it wasn’t passed until 1962. If propranolol wasn’t approved until 1965, then most of that delay was during the pre-Kefauver-Harris era. Not to mention, approving drugs that aren’t effective is a safety issue because they have side effects so some people will be injured or even die because of side effects from drugs that don’t work or because they were taking one that doesn’t work instead of one that does.

    Posted by Grumpy Biologist | August 3, 2016, 11:46 pm
  10. Here’s the reality. Health care costs have skyrocketed 1) because of technology. The sad thing is that the author’s children would certainly never have survived in the 1960s. However, that technology is incredibly expensive in the way we account for it today. It does not have to be, of course. In the UK and Europe the same technology is much cheaper to provide. 2) In order to compete for full-paying or insured customers, hospitals have created a “luxury” mentality. The charity hospitals of the past could not compete with this, which is why they went out of business. Does that seem bizarre? In other words, by paying for health care through private insurance plans we have created a system in which “low-cost” care cannot compete with “high-cost” care.

    Ultimately Obamacare cannot solve this problem because it is still using the private insurance market. As a result, hospitals and other health care outlets compete by providing “full service” systems with all kinds of crap they do not actually need. We ultimately need a system in which there is much less focus on competition and much more focus on cooperation.. That means concenrating higher cost technology so it is used more effectively, spreading out primary care doctors or even nurse practitioners to provide preventative care, etc. House calls? Why not. They make house calls in Europe and Cuba. We somehow think they are too expensive but they can actually reduce pressures on clinic and hospital facilities. But people would have to give up the idea that they should be able to get whatever they want whenever they want it.

    Posted by John | August 4, 2016, 6:54 am
    • Hi John: Good points. I would just point out that technology in other sectors is very cheap and good, consider computers and smart phones, because technology in those sectors aren’t regulated. Obviously, technology in medical care is immeasurably more expensive but why? According to Michael Accad MD, government licensing laws created a de facto monopoly ever since the 1910s when medical costs began to rise. There was even a committee formed in 1925, not long after, called Committee on the Costs of Medical Care, because of rapidly increasing costs.

      For instance, as a most recent example, Martin Shrekli was able to charge $750 per Daraprim dosage because the FDA granted him “the rights” to be the sole distributor. He knew no other generic versions were in the pipeline which gave him for some time, on the drug, a virtual monopoly in the US, where overseas generic versions cannot be imported. In India, a generic version of the drug costs 10 cents per dose because generic drug approval is nowhere near as difficult as in the US.

      Wouldn’t a free market with an emphasis on personal responsibility create much lower prices, like India lower prices? Many blessings🙂.

      https://niskanencenter.org/blog/martin-shkreli-show-us-how-regulation-drives-inequality/

      Posted by Mark Andrew Hamilton | August 5, 2016, 3:44 am
      • Not so sure India is the best example. Friends who work there tell me parents have to pay in advance for their babies to be admitted to the NICU, so yeah. Also, the generic drugs produced in India exist because they were invented elsewhere, so their system is profiting off the research of others. If India invented the drugs, did the safety studies, brought them to market, did the post marketing surveillance, and produced them for 10 cents a pill then I’d be interested in the comparison.

        Shrekli abused the orphan drug act and he wasn’t the first, the people who make Makena did it as well. The orphan drug act specifically exists to help companies bring needed but low volume drugs to market. A low volume drug isn’t going to recoup costs in the patent duration so the protection exists so the companies can recoup. It technically doesn’t really work and seems to just be abused.

        The biggest issue with pharmaceuticals in the United States is the lobbying by the drug companies to get these loopholes that they know how to abuse. I think the best way to start cleaning up Big Pharma is to make lobbying illegal.

        Posted by Dr. Jen Gunter | August 5, 2016, 7:19 am
      • Dear, Dear Dr. Gunter: Thank you. I sincerely appreciate you and this great discussion. I know you care for human beings deeply, or you wouldn’t have posted this. But as I understand you, you’re saying that certain people deserve X salary and should get it by government monopoly patent, so we need government to keep out legitimate versions of a drug that can be easily tested for purity and given to AIDS patients, for instance, who really need them? Hmmm. Hmmm.

        Your argument, I think, is for medical patents, and those are a government system that unnecessarily monopolizes goods and keeps them from making goods cheap and efficient and sustainably profitable. So the Model T and the airplane both developed into the modern car and the jet plane specifically because they weren’t patented, with plenty of high, relatively accessible quality and sustainable profits.

        https://fee.org/articles/how-henry-ford-zapped-a-licensing-monopoly/

        We argue for freedom and individual responsibility, individual responsibility to weep at all the suffering and to swear by God we’re going to change it. Do you see our issue, perhaps, like I, at least, see your suffering? Much sincere, deep love for you and thank you for the opportunity to talk about this.

        Posted by Mark Andrew Hamilton | August 5, 2016, 8:54 am
      • The post does not mention salary not how I think the Heath care system should be fixed. The post is about the principles of libertarianism and health care as laid out on the webpage and how that will fail a large percentage of the population.

        Posted by Dr. Jen Gunter | August 5, 2016, 8:57 am
      • Okay, but you would argue for government medical patents or against? 😉

        Posted by Mark Andrew Hamilton | August 5, 2016, 9:22 am
      • Since Dr. Gunter seems to have left the building regarding this comment, I hereby claim victory😉 lol and point out that government medical patents implement force, resulting in artificially high salaries for the patent holder and low quality because nobody else can compete or copy or improve on their product for even charitable reasons without a special dispensation. That is, the car and plane weren’t patented which is why competition improved their product quality and prices to the marvels we have today.

        Rather, in a libertarian world, entrepreneurs would have to compete to keep their ideas and products fresh at a reasonable price and couldn’t through force keep people from imitating and improving on products … like the wheel, and cars, and airplanes. The same with licensing laws. Unjust government force can’t ‘fix’ problems the same government force created of higher prices and lower quality than in a free market. Harumph😉.

        Posted by Mark Andrew Hamilton | August 5, 2016, 12:52 pm
      • Do you want a pat on the back or something, Mark Andrew Hamilton? I didn’t realize this was a judged debate, or there that was anything to win. Never mind the fact that I’m sure Dr. Gunter has other important things to do than spend all day debating with people on the internet.

        But hey, if you need that “victory”, good for you.

        Posted by Mary Sunshine | August 6, 2016, 12:46 pm
      • “Patent” means “opened” etymologically. The patent power was wisely given to Congress by the Constitution because by P U B L I S H I N G a discovery in return for a limited period of use, inventors empowered others to improve on what they had discovered. Congress can change provisions of the patent system eight ways from Sunday if that will do a better job, but surely Hamilton doesn’t want every medical advance to be held as a trade secret? Or potential inventors not to bother because they could not exploit their inventions enough to pay back the discovery costs plus a little besides?

        Posted by Keith Nightenhelser | August 7, 2016, 11:14 am
      • Hi Keith: Libertarians, of course, don’t force anybody to do anything. I’m betting, though, that it might be relatively easy to buy a product and figure out how to replicate it, generally, and if not, oh well. We’re just always against any kind of unjust force🙂..

        Posted by Mark Andrew Hamilton | August 9, 2016, 2:35 am
      • Hi Mary Sunshine: I am very sorry. I didn’t realize the comments had to be approved. If I could take out the extra ones, I would, and there is much to win. People are suffering all around us, and I would say in a completely free market system they wouldn’t be suffering near as much. All blessings.

        Posted by Mark Andrew Hamilton | August 9, 2016, 2:42 am
  11. Libertarians are the ultimate utopians. They believe in a world that has never existed.(Literally utopia means no-place). Is there anywhere in the world today where a free unregulated market is providing its citizens with excellent, low-cost health care? Is there any time in the past where an unregulated market provided first-class health care to all its citizens? I believe the answer is No. Are there places where a government-run or government-regulated health care system provides low-cost excellent health care to its citizens? Why yes, there are. The US isn’t one of them, but many countries in Europe, as well as Canada and Japan have longer life expectencies, lower infant mortality, and lower costs overall than the US, and they aren’t doing it the Libertarian way.

    Posted by EvelynU | August 4, 2016, 8:18 am
  12. Thank you for your post! I will share with the hope more Libertarian voters will change their minds. My son was a 24 weeker. He happened to be born the year his hospital was celebrating an anniversary and ended up in an article in the local paper. A commenter on that article basically said these babies were too expensive to save and it wasn’t worth it. I’m appalled an actual PHYSICIAN spoke similar words to you. I love how people think they get to decide what the life of your child is worth.

    Posted by Stacey Foster Martz | August 4, 2016, 8:19 am
  13. If you believe in or want free healthcare, then libertarianism is not for you.

    If you simply want affordable healthcare then I believe Austrian economics and libertarian philosophy can fit the bill.

    Over regulation tends to increase likelihood of monopoly, higher prices and fewer options.

    For an expanded understanding of how this works, please check out the following article.

    https://mises.org/blog/how-government-regulations-made-healthcare-so-expensive

    Posted by Ben Truax | August 4, 2016, 10:19 am
    • Thank you!!! I don’t want free health care I want health care I can afford. I’m voting Libertarian!

      Posted by Jennifer Tew | August 5, 2016, 8:35 am
      • Actually, it’s not the government that created high healthcare cost. It is LACK of government regulation that created high healthcare costs. Without regulation and by subjecting your healthcare to the “free market,” vendors can demand whatever price they want for goods and services and you don’t have a choice but to pay it because your healthcare doesn’t give you a choice. Vendors have also colluded to keep prices high, so the poster above who claimed that government regulation causes monopoly does not know what he is talking about and clearly has not studied economics at a university level.

        Notice that those who are on completely socialized plans such as active duty military and their families, military retirees who utilize the VA, and the elderly on Medicare have extremely low to no personal costs. Those plans are aggressively negotiated with vendors so the lowest costs are obtained for goods and services.

        That’s also how it works in European countries and places like Canada and Costa Rica where their healthcare is socialized and available to everyone.

        Posted by Law (@partialshadow) | August 6, 2016, 8:28 am
    • Overregulation is not why our healthcare costs are high. They are high because of an economic concept called inelastic demand and the fact that healthcare providers do not negotiate vendor prices, they don’t have the collective power to do so like Medicare does or like they do in the UK.

      Posted by Law (@partialshadow) | August 6, 2016, 8:18 am
  14. My father had skin cancer as a child. My grandfather was a trucker and my grandmother didn’t work. They took him to one of the best hospitals in the world at the time and paid out of pocket.

    Today the government has created a system in which you would pay dearly.

    Today the government has created a chain of lies in which people believe that without government the cost of healthcare would be even higher and that the Frankenstein system we have today is somehow free market medicine.

    Gtfo with your lies.

    Posted by Nick | August 4, 2016, 11:13 am
    • So, your argument is that the story your father was told about his childhood, and a generation later shared with you, is more factual than all the evidence cited above? Was a unicorn playing a part in the story?

      Posted by William Olmstead | August 4, 2016, 12:41 pm
      • It’s a fact he had cancer.
        It’s a fact that he received care from a top of the line facility.
        It’s a fact that my grandfather was a trucker and grandmother did not work.
        It’s a fact that they had no insurance.
        It’s a fact that they paid out of pocket.
        It’s a fact that he survived.

        The drivel written by this doctor hardly contains a single fact.

        Healthcare is only expensive now because of MASSIVE government interference in the market.

        Why would free market medicine be expensive? You think having the choice of many many doctors giving a service that everyone needs would mean that it would be expensive?

        Look at technology. Always getting better. Always getting cheaper. (Except for cable and internet which are government created monopolies)

        You might want to take a basic economics class. High supply + high demand = low prices when you don’t have cancerous government destroying the process.

        Posted by Nick | August 4, 2016, 11:36 pm
      • I have taken econ. You don’t know what you are talking about. “Healthcare is only expensive now because of MASSIVE government interference in the market” is demonstrably false when Medicare is the cheapest plan available in the United States due to the power the government has to negotiate vendor prices.

        “You might want to take a basic economics class. High supply + high demand = low prices when you don’t have cancerous government destroying the process.”

        Wrong, prices can be set by the vendor however high they want when “high demand” involves no choice and no power on the side of the consumer. Prices are high because vendors can charge whatever they want and you don’t have a choice not to pay it when you’re sick. This is precisely why governmental regulation is absolutely necessary. The US market-based healthcare system is the perfect representation of predatory pricing.

        Think about how stupid it is that you want the same kind of bodies providing you healthcare as provided you the Ford Pinto. And then you turn around and argue that the Consumer Protection Safety Commission is actually the problem.

        Posted by Law (@partialshadow) | August 6, 2016, 8:34 am
  15. Wow, what a bunch of nonsense and emotional hysteria. Thank goodness I don’t have you as my doctor. The arguments presented here are on the same level as “vaccines cause autism” and “homeopathy cures cancer”; no critical thinking is applied to why the costs are so enormous when every other sector of technology sees falling prices nor do you figure the idea that catastrophic insurance coverage exists or has existed for decades without government intervention.

    You trot out thalidomide as if it were a rebuttal yet you can find dozens of other medications approved by the FDA but later recalled because of harm to patients. Little good the FDA has been in those cases. With current knowledge of genetics, we now know that even these dangerous medications can have significant positive impacts for certain people; those options are now gone for them.

    This is just the tip of the enormous amount of fallacies in this piece but I can see now why Dr Neil deGrasse Tyson pointed out that medical students rarely shone in his physics classes.

    Posted by Ricardo | August 4, 2016, 1:12 pm
    • Funny but no.

      There is no functioning medical system that is pure free market that includes care for the poor or medically disadvantaged.

      Medicare was introduced for a reason, unless you think politicians were just looking for something to do. Read the links.

      Charity care is part of the platform! I mean that’s a joke.

      I didn’t say the FDA is perfect. I have an example of how it saved lives. We actually need more regulation to prevent drug companies from withholding safety data.

      And insults mean you have no real argument.

      Posted by Dr. Jen Gunter | August 4, 2016, 1:17 pm
      • Nice straw-man. I never said we need a pure free-market in health care. I can grant you a means-tested program to help the poor. But that’s not what we have. We are asking young people, who tend to be poor, to pay for old people who tend to be wealthy. And in top of that we have an uncountable number of rules and regulations that only enrich special interest groups under the guise of helping the poor.
        Saying that Medicare “was made for a reason” opens you to having to acknowledge that the PATRIOT Act, the most offensive piece of legislation of the past two decades, was equally made “for a reason”. We must judge legislation on the basis of their outcomes and not their intentions. When looked in that perspective, the scorecard for Medicare is poor; increased costs, poorer health outcomes vs self-insured patients, less satisfaction, etc.

        The funny thing about private drug studies is that they are of better quality than publicly funded drug studies. You can easily get the poor outcome studies through the market when you withhold your money from them.

        I’m going to invoke Hitchens’ Rule: Arguments made without evidence can be dismissed without evidence. I saw very little evidence in your post, showed your lack of critical thinking on the subject, and dismissed it appropriately.

        Thank you.

        Posted by Ricardo | August 4, 2016, 5:38 pm
      • And might I add how dripping with glee is your title at the prospect of someone who you disagree with having to suffer through a catastrophic illness. Regardless of political or philosophical leaning, I would not hope illness and suffering on anyone.
        The question at issue is what is the best method of delivering health care to people and, without a doubt, the free-market has proven itself the best way to improve quality while reducing costs.

        The reality of this world is that there are scarce resources and we need to figure out the best way to utilize those resources.
        As Feynman pointed out after the Challenger disaster and is applicable to public policy, “For a successful technology, reality must take precedence over public relations, for Nature cannot be fooled. “

        Posted by Ricardo | August 4, 2016, 5:46 pm
      • your flat out wrong.

        Posted by Z | August 4, 2016, 6:17 pm
      • it’s “you’re”

        Posted by Dr. Jen Gunter | August 5, 2016, 7:02 am
      • I don’t know what the free-market would charge. I am not a fortune teller and neither are you. To claim that the costs would be high is to claim a power which no earthly human has.
        However, your question belies a hidden bias. You are assuming costs would remain the same. This is false. We have empirical evidence from other industries that an open market leads to reduced costs as I pointed out to Michele. The same can and does happen in the medical field as well. The most common illnesses and injuries for which most people see a doctor can easily be treated by nurses and other professionals. We see this in small clinics popping up everywhere. You would pay out-of-pocket for these simple services much like you would pay for an oil change at a mechanic. And competition brings the prices down.

        So in a free-market system, you likely would not be having insurance pay for such common and cheaply available services (just like you don’t pay car insurance for your oil change) but you would have insurance to cover catastrophic illness such as cancer.

        Insurance companies, as you well know, make money from actuarial tables to estimate their risk. Their plan is to simply win more than they lose. Obviously someone engaging in risky behavior or with extensive family history for certain problems would pay higher premiums than others but these are risks for they willingly take every day. And other insurances will come about to fill in the voids as was happening with the issue of pre-existing conditions.

        Healthcare is expensive but it can be reduced through market pressures. I would even state that it can be reduced to a point where even an extended stay at a NICU, where my daughter spent 6 weeks for being born Preemie (wonderful book you made btw), could be financed like one would a car; it’s not cheap but it’s more affordable than what we have today.

        Posted by Ricardo | August 5, 2016, 9:27 am
      • There are GoFundMe pages for people needing surgery who can’t afford the coinsurance. There are medical tourists because they can get surgeries done cheaper in other countries for cash than they can here with insurance.
        The existence of such pages does not negate anything as we don’t live in a perfect world and no amount of government intervention will save everyone’s lives. We are all familiar with the stories of people dying while waiting for certain diagnostic imaging procedures or surgeries.
        I think it preferable to have a system where you can get what you need immediately with money or charity rather than a system in which you are treated like cattle and must wait your turn.

        I had to pay $600 for surgery for my cat recently. Certainly not cheap but I was able to save up money for medical expenses and it paid off. Will this work for everyone, probably not. But insurance is now coming into the picture and helping cover for more expensive procedures.

        Posted by Ricardo Martinez | August 5, 2016, 3:46 pm
    • In your comment below (which doesn’t have a “reply” button) you say: “without a doubt, the free-market has proven itself the best way to improve quality while reducing costs.”

      Where? When? As the kids say these days “[citation needed]”

      Posted by Michele Sharik | August 4, 2016, 11:48 pm
      • Michele, it should be patently obvious and I’m quite shocked I have to point out easily observable examples, but here they are.

        Cell phones
        Computers
        Airlines
        Cars
        The Internet
        Televisions

        The list goes on and the historical record is clear; free-markets where entrepreneurs and businesses compete to provide the best service at lower costs do so. The industries where we see the most government intervention are education, housing, and banking/financing and we have seen what disaster has been wrought.

        And just to preemptively counter your next argument; the Internet was funded by government but it only became the World Wide Web once it was released to private industry. Otherwise the Internet would have remained for use by the military just like GPS was at one point.

        Posted by Ricardo Martinez | August 5, 2016, 7:52 am
      • So what premium would the free market charge to insure my children and the other 5% that account for 50% of health care spending?

        Posted by Dr. Jen Gunter | August 5, 2016, 7:58 am
      • That’s nice, but the topic here is health care. Do you have any examples of the free market providing good quality health care at affordable prices? That was really my question. Sorry that wasn’t clear.

        Posted by Michele Sharik | August 5, 2016, 9:49 am
      • LASIK surgery and dentistry and vision care

        Posted by mbrusa7676gmailcom | August 5, 2016, 1:51 pm
      • Michele, one example is direct care services. Atlas MD is one such example. Below is an article taking about their business model and practice.

        http://www.bizjournals.com/wichita/blog/2014/12/atlas-md-adding-second-wichita-location.html

        http://www.bloomberg.com/news/articles/2012-11-29/is-concierge-medicine-the-future-of-health-care

        Also, we can use veterinary medicine and cosmetic surgery as an analogue to healthcare. In both cases, with no insurance system to cover costs, we have seen decreases in prices over time and improvement in care.

        Education is also another analogue as it is typically assumed that only the rich could afford private education, yet we see low-cost schools for the poor outperforming public schools in third-world countries.

        Posted by Ricardo | August 5, 2016, 10:13 am
      • I see lots of Go Fund Me pages for people whose pets need surgery so not sure the pricing beyond preventative care and minor outpatient is reasonable.

        Posted by Dr. Jen Gunter | August 5, 2016, 11:21 am
      • I’ve seen Go Fund Me pages for boob jobs. If that is now the criteria for a health care need, are we going to make those covered also?

        This entire page is full of straw man arguments. Obamacare is over 10000 pages long. Are we really going to act like a single web page is going to encompass all of the points of a market based health care system?

        A logical middle ground was written in this 2009 article, but ignored by our ever growing government: http://www.theatlantic.com/magazine/archive/2009/09/how-american-health-care-killed-my-father/307617/

        Posted by Steve Ross | August 5, 2016, 3:33 pm
      • Steve Ross, that Atlantic article is fascinating. Thanks!

        Posted by Mark Andrew Hamilton | August 5, 2016, 6:43 pm
      • “Cell phones
        Computers
        Airlines
        Cars
        The Internet
        Televisions

        The list goes on and the historical record is clear; free-markets where entrepreneurs and businesses compete to provide the best service at lower costs do so. ”

        LOL!! There is no such thing as a completely free market.

        There are pricing regulations and consumer safety regulations on every single one of the above products, as well as heavy licensing and training regulations on the airline industry. The market is also government regulated against monopolistic behavior and collusion. Cell phones are a good example of this; your costs on your phone would be far lower if there were more providers but as you will have noticed, companies like to buy other smaller companies that are competing with them, creating fewer choices, and that way vendors can jack up the prices as high as they like. The government often has to tell companies to stop doing that.

        Remember, the supposedly “free” market brought you the Ford Pinto. Read the memos. Ford actually decided that wrongful death lawsuits were cheaper than an $11 fix for each car manufactured to make them safer.

        The market is NOT!! about making sure your health and safety come first. It is about money first and foremost and that is why it has no business in the healthcare field.

        Posted by Law (@partialshadow) | August 6, 2016, 8:43 am
      • Wrong again!

        Posted by mbrusa7676gmailcom | August 6, 2016, 10:33 am
      • “Cell phones
        Computers
        Airlines
        Cars
        The Internet
        Televisions”

        Uh…what? Every single one of those industries you name has been found guilty multiple times of price fixing. Especially the cell phone and computer industry. Apple and Samsung and Intel and AMD and Western Digital and Nvidia and so many more continually gouge consumers. Companies left to ‘free market’ tend to do one thing, set up regional monopolies. Try to get Comcast in a TWC region or vice versa. Airlines have jacked the hell out of their fees/prices in the past 2 years, despite fuel costs plummeting. Free market businesses tend to not pass their savings on to their customers, because they have absolutely no motivation to do so.

        Posted by overfiend1976 | August 6, 2016, 3:16 pm
      • Hi Overfiend1976:

        Historically, local governments have often in the US granted exclusive franchises to certain organizations in what they claim are natural monopolies. There is no such thing because when they do allow competition, the prices do go down. In Sacramento, California in 1987, the city had to end its exclusive franchise with Scripps Howard, and when they did, Scripps Howard lowered its monthly price by 33% and began to offer free startup and three months free where it had competition. https://mises.org/library/myth-natural-monopoly

        Unfortunately, today, the ‘exclusive franchise’ is often granted to companies in exchange for airtime for the city’s politicians, donations to city politicians’s favored causes etc. you know the game. In some cases, the ‘exclusive franchise’ tag is unwritten, implied, but a potential competitor will find out it’s very much in force when they try to enter the market and are denied access by the government. Three legal cases showing this are: Community Communications v. City of Boulder 455 U.S. 40 (1982), Central Telecommunications, Inc., Appellee, v. Tci Cablevision, Inc.,(8th Cir. 1986), and Berkshire Cablevision of RI, Inc. v. Burke (1982). Former FCC Chief Economist Thomas Hazlett wrote “we may characterize the franchising process as nakedly inefficient from a welfare perspective, although it does produce benefits for municipal franchiser.” https://mises.org/library/myth-natural-monopoly https://mises.org/library/question-cable-monopoly

        So governments, in written or unwritten ways, created that lack of competition in cable.

        As for the “price fixing,” one example will show what you are saying is just not so. Amazon was pricing its e-books at $9.99 early this century, and Apple and other publishers wanted to price their ibookstore books higher. Hey, they thought their software was better than Amazon’s. If they thought that, and they turned out to be right, busting them for price fixing hurt the consumer because the consumer wanted ibookstore, not Kindle, a perfectly reasonable choice imho. If the consumer didn’t think their software was better, then Apple and others would just have to lose money into infinity–no harm done.

        Let millions of consumers make the decision about what’s price-fixing (freeeeeeedom!) not a few government bureaucrats who can be bribed and then use force.

        All blessings and love🙂.

        Posted by Mark Andrew Hamilton | August 7, 2016, 6:01 pm
      • Hi Overfiend:

        What you are saying about price fixing is just not so. Apple, for instance, and a bunch of other publishers, wanted to charge $5.00 more than Amazon for its e-books; hey, they thought they had better software than Amazon. The market would have told them whether they were right or not. If consumers thought Apple’s software was $5 better per book than Amazon, they would have bought lots of ibookstore, and price fixing laws would have been unnecessary, in fact, would have prevented the consumers from making the choice. If they didn’t buy ibookstore as much, Apple and its publishers would have lost money ad infinitum, but nobody would have been harmed, and the consumer would have had the choice. Freedom where the billions of consumers are allowed to choose is so much better than a few government bureaucrats, who can be bribed, choosing force. Btw, Amazon used the government to get a $450 million judgement against Amazon–typical, businesses use government to hurt other businesses and decrease competition.

        Re: cable situation just know ‘exclusive franchise.’ It’s often given to cable companies by politicians (who receive free air time, donations to favored charities, you know the game) with the excuse of natural monopoly, but when ‘exclusive franchise’ is taken away companies like ‘Scripps Howard’ in Sacramento in 1987 have to drastically cut their prices where there’s competition (see link below). Often, exclusive franchise is on unwritten terms, as companies found out when they apply for a license and are denied. Three court cases illustrating this are: Community Communications Co. v. City of Boulder, (10th Cir. 1981), Central Telecommunications Inc. v. TCI Cablevision, Inc 8th Circuit 1986, and Berkshire Cablevision v. Burke, 1983. I can give you the sources for that if needed, but these cases are easily accessible online. There may have been more recently. When there is no exclusive franchise, competition does its work. “As former FCC chief economist Thomas Hazlett, who is perhaps the nation’s foremost authority on the economics of the cable TV industry, has concluded, ‘we may characterize the franchising process as nakedly inefficient from a welfare perspective, although it does produce benefits for municipal franchiser.'”

        https://mises.org/library/myth-natural-monopoly

        https://mises.org/library/question-cable-monopoly

        All blessings and love.

        Posted by Mark Andrew Hamilton | August 7, 2016, 6:19 pm
      • Dr. Gunter: I have an excellent, short reply to Overfiend but cannot post!

        Posted by Mark Andrew Hamilton | August 7, 2016, 6:20 pm
      • Hi Overfiend:

        What you are saying about price fixing is just not so. Apple, for instance, and a bunch of other publishers, wanted to charge $5.00 more than Amazon for its e-books; hey, they thought they had better software than Amazon. The market would have told them whether they were right or not. If consumers thought Apple’s software was $5 better per book than Amazon, they would have bought lots of ibookstore, and price fixing laws would have been unnecessary, in fact, would have prevented the consumers from making the choice. If they didn’t buy ibookstore as much, Apple and its publishers would have lost money ad infinitum, but nobody would have been harmed, and the consumer would have had the choice. Freedom where the billions of consumers are allowed to choose is so much better than a few government bureaucrats, who can be bribed, choosing force. Btw, Amazon used the government to get a $450 million judgement against Amazon–typical, businesses use government to hurt other businesses and decrease competition.

        Posted by Mark Andrew Hamilton | August 7, 2016, 6:23 pm
      • Re: cable situation just know ‘exclusive franchise.’ It’s often given to cable companies by politicians (who receive free air time, donations to favored charities, you know the game) with the excuse of natural monopoly, but when ‘exclusive franchise’ is taken away companies like ‘Scripps Howard’ in Sacramento in 1987 have to drastically cut their prices where there’s competition (see link below). Often, exclusive franchise is on unwritten terms, as companies found out when they apply for a license and are denied. Three court cases illustrating this are: Community Communications Co. v. City of Boulder, (10th Cir. 1981), Central Telecommunications Inc. v. TCI Cablevision, Inc 8th Circuit 1986, and Berkshire Cablevision v. Burke, 1983. I can give you the sources for that if needed, but these cases are easily accessible online. There may have been more recently. When there is no exclusive franchise, competition does its work. “As former FCC chief economist Thomas Hazlett, who is perhaps the nation’s foremost authority on the economics of the cable TV industry, has concluded, ‘we may characterize the franchising process as nakedly inefficient from a welfare perspective, although it does produce benefits for municipal franchiser.'”

        https://mises.org/library/myth-natural-monopoly

        https://mises.org/library/question-cable-monopoly

        All blessings and love.

        Posted by Mark Andrew Hamilton | August 7, 2016, 6:23 pm
      • Hi Overfiend:

        Re: cable situation we have ‘exclusive franchise.’ It’s often given to cable companies by politicians (who receive free air time, donations to favored charities, you know the game) with the excuse of natural monopoly, but when ‘exclusive franchise’ is taken away companies like ‘Scripps Howard’ in Sacramento in 1987 have to drastically cut their prices where there’s competition (see link below). Often, exclusive franchise is on unwritten terms, as companies found out when they apply for a license and are denied. Three court cases illustrating this are: Community Communications Co. v. City of Boulder, (10th Cir. 1981), Central Telecommunications Inc. v. TCI Cablevision, Inc 8th Circuit 1986, and Berkshire Cablevision v. Burke, 1983. I can give you the sources for that if needed, but these cases are easily accessible online. There may have been more recently. When there is no exclusive franchise, competition does its work. “As former FCC chief economist Thomas Hazlett, who is perhaps the nation’s foremost authority on the economics of the cable TV industry, has concluded, ‘we may characterize the franchising process as nakedly inefficient from a welfare perspective, although it does produce benefits for municipal franchiser.'”

        https://mises.org/library/myth-natural-monopoly

        https://mises.org/library/question-cable-monopoly

        All blessings and love.

        Posted by Mark Andrew Hamilton | August 8, 2016, 2:57 am
      • Hi Overfiend:

        Comment section is wonky–won’t let me post substantial comments. Exclusive franchise, often implied not written, is the problem with cable monopolies. Please see

        https://mises.org/library/myth-natural-monopoly

        https://mises.org/library/question-cable-monopoly

        Posted by Mark Andrew Hamilton | August 8, 2016, 4:57 am
      • Comment section wonky; no substantial comment allowed. https://mises.org/library/myth-natural-monopoly https://mises.org/library/question-cable-monopoly

        Posted by Mark Andrew Hamilton | August 8, 2016, 4:59 am
      • Uh, I don’t spend all day approving comments.

        Posted by Dr. Jen Gunter | August 8, 2016, 9:12 pm
      • No post allowed now, even extremely short ones?

        Posted by Mark Andrew Hamilton | August 8, 2016, 5:00 am
      • Ricardo Martinez

        >> I’m quite shocked I have to point out easily observable examples, but here they are.

        My god, you’re a dense little troll, aren’t you?

        Cell phones: Batteries and radiation are regulated, just for starters. 911 access.

        Airlines: Are you a total idiot? Black boxes, emissions, seat width, pilot training, attendant training, cockpit doors, air travel routes, emergency oxygen, cargo hold conditions, the TSA.

        Cars: LOL WHUT. Emissions. Electronics. Seatbelts. Engines. Window glass. Window glass tinting. Windshield wipers. Brakes. Brake lights. Headlights. Tail lights. Turn signals. Emergency lights. Dome lights. License plates. ALL CARS HAVE SERIAL NUMBERS. ALL CARS MUST BE REGISTERED. ALL CARS MUST BE INSURED.

        Internet: See the “fast lane”/”series of tubes” nonsense. “Libertarian” business interests are trying to make it legal for them to throttle your access to unpopular sites, or for them to extort money from sites so those sites don’t see their connections crippled.

        Televisions: …I really hope you’re 14 because if you’re 15 or older, you’re too ideologically blinded to learn. Look up old data on CRTs, look up the government regulations of oldschool TV/radio broadcasting frequencies.

        Also: I counter with “doing GREAT with government regulation”:
        Electricity.
        Water.
        Gas.

        Posted by Lurky McLurkerface | August 8, 2016, 8:07 pm
      • Hi Jen:

        I’m really sorry. I would delete the unnecessary ones if I could😦.

        Posted by Mark Andrew Hamilton | August 9, 2016, 2:36 am
  16. Thank you for this appraisal of the fallacies of unregulated healthcare.

    In 2013 I collapsed at a gym and hit my head. Hospital bill was 5k. Including a $42 Tylenol.

    The reason for this is, IMO is that insurers and hospitals are conspiring to drive up the cost of healthcare. Hospitals prefer patients who are insured, for obvious reasons. You’d assume insurers would prefer to pay as little as possible for each treatment, and you’d be right. But they don’t want to force the cost of healthcare down to the point where ordinary people can just afford it (this might not be possible but hear me out) so they agree to pay inflated ticket prices, but get a bulk reduction. There is no such bulk reduction for the uninsured. This leaves getting treatment for impoverished adults in non expansion states to be a serious challenge. So hospitals get to write off all their tax liability by bankrupting/destroying the credit of uninsured people who are too poor to afford the healthcare prices which keeps insurers able to prey on the 85% of folks who can get insurance, leaving them free to slam us with insane deductibles and premium rises. Everybody wins. Except patients.

    The problem with Obamacare is that it didn’t go far enough and bowed to the selfish demands of insurers – who btw are not going bankrupt, the major players are worth 4-5x what they were when Obama came into power. They’re pulling out of the exchanges because they don’t want to cover the poorest people, who coincidentally are a disproportionate number of the sickest. They want rich healthy people who they can leach off of.

    The refusal not to cover ABA therapy as an EHB, cut out the public option, and later to close the ‘risk corridors’ have all been terrible moves for Obamacare.

    Posted by Leon H | August 4, 2016, 1:28 pm
  17. I am neither an economist nor an MD but my observations of healthcare and costs from the mid1950s while my family was being formed (and their families) seemed to also correspond with the change in insurance companies from nonprofit mutual companies dedicated to their memberships while hospitals changed from nonprofit corporations to healthcare industries. We cannot turn back time (and I wouldn’t want to) to those days of cheaper medicine. I am a recipient of Medicare and feel damn fortunate to have it, I just don’t understand why we limit it to seniors – everyone deserves it.

    Posted by Dick Pilgrim | August 4, 2016, 2:31 pm
  18. I’m convinced that all Libertarians are immature little children (mostly boys) that never outgrew the “you’re not the boss of me!” phase, and/or narcissists that think they are perfect and know everything. Sure, it might work in a perfect utopia where people aren’t people, they’re robots who never use emotion and never make bad decisions. I am SO sick of these twits thinking their opinions have any validity or sense to them.

    Posted by OwlGryphon | August 4, 2016, 2:42 pm
  19. I know I wouldn’t ever have been able to afford my care in the US – haemodialysis and transplantation. Then I wouldn’t have been given the chance to work full time as a medical librarian. Thankfully, it was all covered by the public system we have in Australia, and even my drugs are more affordable albeit still pricey. Universal healthcare does have it’s problems (bloat – happens to all, just listen to all the disinvestment discussion going on in Europe) but it seems a better option than the current one. Who knows, perhaps the health tax would end up being much less than current insurance premiums.

    Posted by Catherine Voutier | August 4, 2016, 4:42 pm
  20. Most here are cynical and lack any thoughtful analysis. You simply say things are the way they are and in fact to get them to be better lets just do more of the same. You will never be able to afford medical costs if you continue what is being done. More ACA will not lead to better or less expensive care, but simply rationed care. You can not contain cost and provide adequate care through an insurance system. An insurance system will always shift money in a pool from some who pay and don’t use the service to those that don’t pay enough for the services they use. Rates will always reflect the usage of the pool. Clearly the writers of ACA understood that because they counted on young healthy people to sign up and underuse their insurance to afford to pay for sicker people in the pool. It is math and it is why ACA premiums going up and many exchanges going broke. Reality has a way of always creeping in. So we have a situation under the ACA that forces people to participate and fines them if they don’t. Libertarians don’t believe in the use of force against others property. As one person said it is utopian and Childish to think that way. So to that person and most of the others here remember that you believe in coercion and force to get what you want. You really don’t care about others as long as you get what you want. Then you rationalize that you are on the moral high ground when you are not. There are solutions to the medical cost and care delema, however most here and the blogger are too into their narrow views to understand other possibilities and too much into force to want to understand

    Posted by mbrusa7676gmailcom | August 4, 2016, 6:50 pm
  21. Hi Dr. Gunter: I just wanted to throw out this libertarian case study: Martin Shrekli was able to charge $750 per Daraprim dosage because the FDA granted him “the rights” to be the sole distributor. He knew no other generic versions were in the pipeline which gave him for some time, on the drug, a virtual monopoly in the US, where overseas generic versions cannot be imported. In India, a generic version of the drug costs 10 cents per dose because generic drug approval is nowhere near as difficult as in the US.

    Michael Accad MD argues that licensing laws since the 1910s are when prices in the US began to rise drastically. In fact, there was even a committee formed in 1925, not long after, called Committee on the Costs of Medical Care, because of rapidly increasing costs.

    If the Martin Shrekli case study is true, which it is, wouldn’t a free market with an emphasis on personal responsibility create much lower prices, like India lower prices? As Accad argues, medical licensing laws and other government restrictions create a virtual medical monopoly. And when you have a monopoly (which governments usually create) wouldn’t the government be the problem here, not the free market, which doesn’t exist?

    I look forward to your thoughts.

    https://niskanencenter.org/blog/martin-shkreli-show-us-how-regulation-drives-inequality/

    Posted by Mark Hamilton | August 4, 2016, 6:51 pm
    • I do believe the PATENT on that medication is granted by the Patent Office, while the FDA just declares it fit for sale and use by humans.
      Sorry Mark, but the FDA has nothing to do with patents, which are those little things that prevent other people from making and selling your product. Unless it’s a literary or other media work, in which case it’s Copyright, and those are handled by the Copyright Office I believe. Either way, it’s not the FDA that prevents other companies from making or selling pharmaceuticals, unless they are deemed unsafe, in which case NOBODY can distribute them.

      Posted by Meerling | August 5, 2016, 3:45 am
    • “Martin Shrekli was able to charge $750 per Daraprim dosage because the FDA granted him “the rights” to be the sole distributor.”

      No, he was able to charge $750 because his victims, the consumers of that drug, did not have a choice but to pay it.

      In the case of healthcare, because Shkreli’s drug was the only existing drug of its kind (which is not the fault of the government), he could charge whatever price he wanted to because there was no market ceiling. The consumers of that drug had no choice. This is predatory and that is why the government had to step in and fix it.

      Free markets do not create lower prices; in fact the natural tendency of a completely unregulated market is towards high prices borne of monopolies and predatory behavior that victimizes consumers. This is why markets have to be heavily regulated by the government and why bodies like the Consumer Protection Safety Commission exist.

      India’s prices are lower because they don’t have to pay the R&D costs on drugs that were not developed in their country.

      Posted by Law (@partialshadow) | August 6, 2016, 9:00 am
      • Hi Law:

        It was the government patent which keeps the free market from copying and imitating the original good. Canadian generics, for instance, aren’t allowed in the United States because of patents. Libertarians do not believe in the force that is behind patents period. Neither the car nor the airplane were successfully patented, and this is why they had so much innovation and lower cost prices in spite of all the other government problems affecting them.

        All blessings🙂.

        https://fee.org/articles/how-henry-ford-zapped-a-licensing-monopoly/

        Posted by Mark Andrew Hamilton | August 6, 2016, 10:19 am
      • Wrong, wrong, wrong in so many ways.

        Posted by mbrusa7676gmailcom | August 6, 2016, 10:35 am
  22. Start fixing the insurance system by mandating it be non [not for] profit. The Swiss model works well. The libertarian system is what exists in much of the world where there is no insurance. Got money, you got health care. No money? TDB.

    Posted by Steve S. | August 4, 2016, 8:50 pm
  23. Alright, as a libertarian, I am going to refute your very simplistic view of a “free market healthcare systems” with an example of an *actual* free market healthcare system by giving Hong Kong as an example. Hong Kong is the freest economy in the world. In this system, government-run hospitals, which provide healthcare to the majority of its citizens, compete with private hospitals that are paid for by patients, either out of pocket or by insurance coverage. Unlike Obamacare, there is no mandated insurance. In fact, only 12% of people have health insurance. There is near-universal to universal health care access, and the life expectancy of the people exceeds the United States by around 5 years. Libertarianism is not about excluding the government. It is about choice and competition. Citizens in Hong Kong all have access to healthcare, but they get to choose the healthcare they receive…either government-delivered or private. So yes, a free market healthcare system can actually work.

    Posted by Ryan Chan | August 4, 2016, 8:59 pm
    • Hong Kong has a publicly funded health care system as well as private. The Hong Kong Health Authority manages 41 public hospitals and 122 out patient clinics. There are 13 private hospitals, so it would seem that more care is given in public hospitals versus private. Here’s a link: http://guides.wsj.com/hong-kong/guide-to-hong-kong/health-care/

      41 public hospitals versus 13 private doesn’t sound very Libertarian to me. It sounds like a two tiered system with government provided care and the option to buy private. Many health care systems work like that.

      The Libertarian webpage seems to implicate Medicare and Medicaid as part of our woes, but hey if a ratio of pubic to private hospitals that Libertarians would support through taxes is 41 to 13 then I would love to read more about how that would look! That is certainly way more publicly funded health care than we have currently, so it just doesn’t sound very Libertarian.

      Posted by Dr. Jen Gunter | August 5, 2016, 7:11 am
  24. I’ll be voting Libertarian, as I’ve done for the last 2 elections.

    I guess that makes me an angry male?

    Disillusioned maybe.

    I am one of those people who has been damaged (and certainly NOT helped) by the medical model. Which I believe first and foremost is a business model. A way to make a good living regardless of patient outcome (doctors get paid regardless of the outcome – a family doc is worth $90 for 7 min consult? really? that’s how much my doc charges per pt visit – cash). And unless gross negligence has been demonstrated beyond the shadow of a doubt (judged of course by their own peers), then ZERO repercussions. Except for a nice house and a nice car and a comfortable lifestyle. And an ego to match. Maybe that’s why suicide rates are higher for doctors? Who knows.

    But as you have said, Obamacare isn’t perfect (couldn’t agree more, didn’t vote for it, don’t want it), but like you say it’s the first rung on a 100 rung ladder??

    Personally I think the individual mandate of the ACA is a travesty of justice. They had to change the wording to even make it somewhat ‘constitutional’. Penalty vs. tax.

    Forcing people to buy health insurance from a private corporation??? (that dictates medical policy? coverage?). That’s insane. In a supposedly free country?

    The implicit suggestions are really insidious. That the AMA is all powerful. So what if I want to see a chiropractor under the ACA? what about massage therapy?? No, it’s just MEDICAL. No quackery. Medical is the HOLY grail. It’s the standard of care. Medicals doctors are gods or goddesses. They’re professionals. They’re REAL doctors. They went to school for a long time. They’re smart. They know better. They’re scientists.

    Hahahaha. The implicit arrogance of the doctor mindset is just shocking.

    I don’t be a part of the medical model. Short of emergency medicine, it’s pretty much worthless to me. That should be and WAS my right. To NOT participate. In the US. But no longer apparently??

    So like Obamacare, maybe Libertarianism is far from perfect. However, it’d be a place to re-start (maybe a cleaner slate), and with regards to the free market healthcare, it’d be a first rung on a 100 rung ladder. A process. Admittedly, with significant room for improvement.

    However the current system / administration isn’t working well either.

    If you’ve ever heard Gary Johnson (the former governor for 8 years in New Mexico) speak, then you’d know he wouldn’t come in and just level the whole playing field. That’s not even possible. There would be small incremental changes over time. And that’s what you have congress for anyway. Negotiations. So that one power isn’t too strong.

    But that didn’t stop Obama from cramming down nearly 50% of the voters throats (who didn’t want it). Not a single Republican voted for Obamacare. That’s not representational of the whole. That’s not building a bridge. Is it any wonder Republicans want to repeal it as well?

    Why are we limited to 2 people? to a 2 party system? And pigeon-holed into their beliefs?

    I believe the main reason many people (up to 12% now) are voting Libertarian this time is essentially the disillusionment of the 2 party system. It’s a monopoly. Reinforced financially by corporations (like Health Care companies) or other powerful monopolies (like the AMA). Somehow the AMA actually even managed to supersede the right to free speech??

    I have ZERO trust in medical professionals at this point. So to integrate healthcare with law and government? With two systems that aren’t even competent?

    The mother of my daughter is a family doctor. And I wouldn’t let her diagnose, treat or cure me for the common cold.

    And while you’re busy bashing libertarians in your tweets and online account (which is your first amendment right)…then maybe you might want to consider the following:

    1) The nearly 20 TRILLION dollars of debt the US is now facing. Up 8 TRILLION since Obama took office. Not down a trillion or anything in 8 years? But UP.

    2) If the economy is so strong then why are they terrified to raise interest rates? Why did the Gov’t have to resort to quantitative easing to prop up the stock market? Just to kick the can down the road?

    3) Obama is KILLING innocent people (who haven’t even been put on trial) with the use of DRONES in far away places with collateral damage (women and children have been KILLED by this wonderful president?). That makes me cringe at being an American!! Seriously?? You think this is a good guy?? And you’re going to bash Libertarians?? Who don’t want to use drones to kill people in 3rd world countries??

    I guess he’s keeping us safe by killing people thousands of miles away that haven’t attacked this country for their own beliefs, including religious. Like that won’t keep stirring the hatred and anger these people have for us. Is it any wonder? Just keep the fear and the surveillance and the industrial military complex going – that’s good for the economy. Let’s just keep bombing people and killing them and their families. God Bless America. And God Bless the industrial medical complex. Both are big business.

    3) Obama made promises he hasn’t kept, like Guantanamo. Or student loans. Not to mention what the hell we’re doing in Afghanistan. Still. Or little things like…you get to keep your doctor. Not that I do.

    So yeah, I am okay with voting Libertarian. It isn’t perfect. It’ll never be perfect. But it’d be a place to start. And working with congress through a 3rd party leader might be able to begin to make it a better system. One can hope.

    I don’t have health insurance. I don’t go to doctors anymore. Short of emergency/trauma medicine, we don’t have a good system of healthcare in the US. It’s not even rated very high in the world. And based on the doctors I’ve met, it’s no wonder. They certainly have been woefully unable to deliver on what their ego’s (and the AMA) advertises.

    We can help you. We’re doctors. Uh. No. No, you didn’t. In fact I now nerve damage I didn’t have originally because of you. Oh. No problem. You signed a waiver and understood the risks. So you’ll just need to take this product, I mean ‘medicine’ for the rest of your life to manage it. So much for the hypocritical oath.

    And I’m being FORCED to participate in this bullshit?? Or pay a penalty? I mean tax. Seriously?

    Lately I’ve even been leaning towards medical science as more of a religion than an actual science (with some grandiose claims/advertising to match). And I do believe in the separation of church from state. As well as the right to freedom of religion (including medicine). But the medical model is not a church I want to go to. Been there and done that. And I certainly don’t want to donate money to it.

    To force people to participate in a such a ‘belief system’, no thanks. Not interested. Of course it’s self serving for the health ‘care’ workers. Or is that more like ‘disease’ crisis management workers. Cause I don’t think it has much to do with health. Or care.

    What we have now isn’t working. 20 trillion in debt is not working. You can’t have a system that spends money we don’t have indefinitely. Including ACA. But hey, we’ll just change the numbers. We’ll just buy some more mortgage backed securities. We’ll attack Canada cause they have weapons of mass destruction. It’ll be ok.

    So while you’re busy bashing Libertarians and the progress that their/my party is making over the last decade, you might just want to be a bit more concerned that Trump might actually win this thing, because of angry male republicans. Despite the liberal media’s attempt at assassination. He’s still doing well in the polls.

    Of course, being an angry male libertarian and all. Or an instigating self-righteous female liberal. Just saying.

    Posted by Bob | August 4, 2016, 10:11 pm
    • Drones and many of the things you wrote about have nothing to do with health care. If you notice I didn’t bring other aspects of Libertarianism isn’t to the health care argument.

      I’m bashing the idea that a free market will take care of the health of the poor and the medically fragile. It won’t and hence the idea that I hope if that model is put in practice that you never get sick.

      Posted by Dr. Jen Gunter | August 5, 2016, 7:23 am
      • You again repeat a simplistic “straw man” and believe that is a reasonable argument. It is not. I was part of a health group that was founded because of increasing insurance cost and continues an effort to provide affordable health care. The group is governed by management and employees. In fact employees have a great opportunity in this organization for input and decision making. It is based on an insurance modle and therefore the cost of providing coverage has been increasing for over thirty year history of the organization. The group leadership constantly invited groups to explore ways to contain cost. Theses groups represented various points of view and approaches. What consistently came out in the conversations were two things: 1. You will never control costs if the consumer were separated from the expenses of health care by a third partiy payer. 2. There are huge amounts of spending being done that is either dangerous to patients or unnecessary. There was an example of a study that examined 7 million events, actions with patients, it found that over two thirds of the events were either dangerous or unnesassary based on the studies standard of care. The cost of those events were 800 million dollars. The lion share of those costs were in hospitals. As I recall over 500 million was for the hospitals involved even though hospitals reflected only 6% of the events. That number represented only one of more than a dozen or so procedures examined. There is a huge pool of money spent on dangerous or unnesassary procedures that I think even the doctor would agree doesn’t make much sense. That creates the environment of ever increasing costs.The current hospital system is a beast o Medicare/government intervention. I would think the doctor would find that interesting data and a potential pot of money that would be better used. Except the doctor, in part benefits in the corruption the intervention creates. So the moral high ground is not with those that support coercion and force. The corrupted system supports the producers of medical care not the consumer, the patient, of medical care. A free market always supports the consumer not the producer. So I hope you are a better Doctor than you are an economist. The system you support is what hurts consumers. More of the same perpetuates the ever increasing cost spiral. The reality is that libertarians don’t want coercion, force, or theft of property. All those things you support. I also think your story of the doctor’s comment is not true. I also don’t believe the doctor truly understands what libertarianism because he would not have said that if he did. That comment, if truly made, would only indicate his shallow and simplistic view of the economics and philosophy of libertarianism. I do not accept your belief that you hold the moral high ground. Especially that you wish illness on those that disagree with you. As a doctor do no harm and don’t wish harm either. I am searching for a system that helps people you advocate a system that helps a specific group of people, in many cases at the expense of other people. So no you do not hold the moral high ground. You may want too, but your means clearly controls the low ground. You should open your mind to other possibilities and people that want a better outcome too, but don’t agree that your means works. It obviously does not work.

        Posted by Mike | August 5, 2016, 9:51 am
      • Dr. Gunter I agree with you on your points. Free markets in American Medicine do NOT exist in this country. Look at any industry in this country…there are only 4-5 providers to choose from. Laws that have been pushed through our Legislatures at the State and Federal levels by behemoth Corporatists that have set up an Oligarchial system with monopolistic tendencies. Mergers in healthcare have resulted in fewer providers for Insurance, higher costs for RX drugs, consolidated hospitals.

        Even with Medicare my costs of drugs go up every year. I am lucky to be healthy but even a modest drug regimen can cost you a couple of grand per year.. Our Congress has legislated against Medicare negotiating bulk drug purchasing with Big Pharma. Why? Because Big Pharma finances these politicians ability to run for office every day. Big Pharma also has most of its research underwritten by our tax dollars. Big Pharma spends more of its profits on Advertising than research. With an aging population, Big Pharma has a gold mine. They also manipulate the generic manufacturing of drugs by tinkering with a drug compound and extending their patent rights.

        Insurance companies are there to take your premiums and then limit their payouts for medical care. They have clerks who now dictate to medical professionals what care I get…tests, procedures, etal. The savings they garner are then given to CEOs in the form of obscene and excessive pay packages. They operate to take every bit of risk out of their world while placing more risk on every premium paying American. If you have insurance a catastrophic illness like cancer you can be bankrupted. If you have No insurance you will be bankrupted. It’s insane!

        Hospitals are in the business of maximizing their profits and healthcare is treated as a commodity. When we made our healthcare system “for profit” then we took the idea of quality medical care for all off the table. The patient became merely a consumer of a commodity in the eyes of business and Wall Street. He/she was only due what he/she could afford to pay. Until costs are reigned in and Medical care is redefined for something besides a “money making machine”, then costs will go upward with no immediate relief in sight. The Politicians and Big business have created this untenable situation and as long as Big Business calls the shots in our Government with their Army of Lobbyists the consumer/patient and the system will suffer. We need fair and well thought out Public Policy that is not totally driven off of a “for profit” business model that maximizes profits over the very life and death of its citizens.

        A Libertarian President will no more be the fixer of this system than a Democrat or a Republican. We live in the United States of America, LLC! Until we get $$$$$$$$$ out of politics this will not change.

        Posted by NCGran | August 5, 2016, 2:24 pm
    • So, if you don’t want to pay in, are you willing to die at home without expensive treatment if you are seriously injured or require care for cancer or heart disease? Or, are you just freeloading, gambling that you will be the exception, confident that people like me will foot the bill? Perhaps health care free loaders should wear a bracelet or get a tattoo, identifying you as someone who should just be taken back home if you arrive at the hospital, unable to pay. Healthcare freeloaders (people who can pay for insurance but chose not to pay) never think this through.

      Posted by Chris Brackett | August 5, 2016, 9:06 am
  25. You have admirable restraint in the face of someone telling you your child should die in his libertarian paradise. I’d have lost it if someone told me that.

    I think what isn’t discussed with Obama care is that Healthcare costs are expensive in part because of the free market system. Doctors pay exorbitant malpractice fees and Bill be service so there’s a incentive to run up costs and avoid lawsuits. A single payer system would cut costs

    Posted by Jess | August 5, 2016, 4:07 am
  26. So, you admit you spent far more on your children’s healthcare than you could afford, “Medicaid covered close to $500,000 in intensive care costs alone.” You make all kinds of moral arguments for why this was a good thing, and certainly it was a good thing, for you and your children. The moral issue you conveniently ignore, however, is the fact that Medicaid doesn’t have any money to pay for your child’s care that it didn’t first take from someone else. You disparage charity, where people voluntarily part with a portion of their wealth to help others need while advocating for a coercive system that takes from others by threat of force for your benefit. Every argument you’ve made here is entirely self-serving. As a physician you should know that healthcare isn’t free. Your argument that coercion is morally superior to charity because you benefited from it more is not convincing.

    Posted by Geoff | August 5, 2016, 8:31 am
    • I think you missed the entire point of the article. We need government in healthcare or many people can’t afford care and will die.

      I have actually provides lots of “charity care” in free clinics. I will assume you tithe your time similarly.

      One day you will likely have care you can’t afford. Let’s chat then.

      Posted by Dr. Jen Gunter | August 5, 2016, 8:56 am
      • “We need government in healthcare or many people can’t afford care and will die” is progressive doublespeak for “Healthcare is a right and we need government to take by force the wealth necessary to pay for it.” Problem is healthcare is NOT a right. As a physician you should know that. Healthcare is the entire collection of goods and services related to and contributing to human health and wellness. You should also know that all those goods and services are the personal, private property of the people who produce them. They (you) deserve to be compensated for them. No one has any more right to them than they have to your car or your kidney. By the same token the plumber and the lawyer and the car dealer and all others have exclusive rights to the wealth they’ve created. Theft is no less immoral because you promise to use your ill-gotten gains for some noble purpose.

        Posted by Geoff | August 5, 2016, 10:01 am
      • In response to Geoff:

        The humane thing is to construct society such that healthcare is a right, because letting people suffer and die when the knowledge and technology to save them exists is cruel. (You do realize that any society can declare anything to be a right? Healthcare becomes a right if we make it so.) Given that, we figure out how to provide that care. Your comparison of life-saving treatments to property shows you have no sense of humanity. The libertarian ideology is an inhumane immoral mess.

        Posted by Anat | August 5, 2016, 10:49 pm
      • Hi Anat: No, it’s quite the opposite. Ron Paul (a libertarian doctor) served Medicare/Medicaid patients for free. I, personally, believe it’s immoral not to serve a truly indigent customer who really needs the help, and I’m sure many libertarians would agree. However, the use of violent, government force to get us to serve indigent customers creates vastly more problems. First, the violent government forces of licensing laws, government patents, taxes, then Medicare and Medicaid (funded by taxes and money printing) are what has made medical care so expensive in the first place.

        Second, there are some indigent customers who really need help, and there are customers who we are being enabled or abusing the system. Government historically has had a difficult time distinguishing between the two. Private individuals, private charities etc. can do a much better job. I know a man personally who was denied welfare, and to this day credits his success in life to having to get a job the next day where *some*, other welfare patients he knew coming back from Vietnam who weren’t denied got trapped in a life of welfare, drugs, and alcoholism. He was denied by my grandfather, and he shared that story at my grandfather’s funeral almost two weeks ago. Do some people truly need a little help to get on their feet? Yes, but we are the best judges of that, seldom the government.

        Violent force (the threat of jail for not doing what government wants) destroys lives, but freedom and personal responsibility makes better human beings. We will give more because we can’t just say the “government will do it;” it’s up to us. Do you see how this is actually a very coherent and compassionate philosophy? All blessings, Anat🙂.

        Posted by Mark Andrew Hamilton | August 6, 2016, 4:57 am
      • ” I’m sure many libertarians would agree. However, the use of violent, government force ”

        Enough with this right-wing nonsense. So-called conservatives are CONSTANTLY whining about the “force” that is used when taxes are demanded of them, but they never talk about their consistent and daily use of the civilization that was brought to them with that money that certainly no one violently forces them to use. It’s not “violent force” when you pay your garbage removal bill, or your cell phone bill, because you received a good or service.

        You owe society. Simple as that. You take advantage of it, you benefit from it, you owe it. Better people than you built it. Your tax money is a pittance and is a BILL that you are obligated to pay for services rendered.

        No man is an island and civilization was not brought to you by rugged individualists. It is decidedly uncivilized to argue that your “private property” that you gained through advantages brought to you by the civilization that others built should even be a consideration when human lives are the cost.

        That’s not civilization.That’s not civilized. It’s not even acceptably human.

        Posted by Law (@partialshadow) | August 6, 2016, 9:38 am
      • I don’t agree with you. What right do you have to take action that makes me do what you want. If I have to do what you want against my will that is force and violence. That is regardless of your good intentions. You are a totalitarian and there is no such thing as society.

        Posted by mbrusa7676gmailcom | August 6, 2016, 10:39 am
      • “Private individuals, private charities etc. can do a much better job.”

        There are Charity Watch outlets that monitor how effective many charities are – because a great number of them are scams. Not surprisingly, you are wrong.

        http://www.forbes.com/sites/carolynmcclanahan/2012/04/23/is-charity-the-answer-to-healthcare/#4faac1e243b6

        Posted by Law (@partialshadow) | August 6, 2016, 9:42 am
      • In response to Anat: “You do realize that any society can declare anything to be a right? Healthcare becomes a right if we make it so.” So if we all get together as a “society” and vote that any person on dialysis who matches your tissue type has a right to your kidney it would be moral for us to take it from you by force? After all, anything can be a right if we make it so.

        Posted by Geoff | August 6, 2016, 11:30 am
      • To Geoff: It would be a legal right. Moral rights are for individuals to determine for themselves, legal rights are for societies to determine. No god has the power to define rights absolutely and enforce them.

        Posted by Anat | August 6, 2016, 11:34 am
      • Ah, moral relativism. The age-old refuge of the unthinking, feel-good progressive. “Nothing that makes me feel good could possibly be immoral!” SMH.

        Posted by Geoff | August 6, 2016, 12:03 pm
      • To Geoff: Is there any other kind? Consequentialist moralities are relative to which consequences are considered more desirable and which less so. Virtue moralities are relative to which traits are considered more virtuous (especially when different virtues collide). Divine command moralities are relative to the interpretation of the command and how it applies to specific situations, relative to which authority is held more legitimate to define and interpret commands.

        Posted by Anat | August 6, 2016, 3:04 pm
  27. I’ll be voting for Johnson/Weld in November. My state’s solid blue, and I agree most closely with the Libertarian platform. That is NOT to say that I agree with every aspect of their platforms – but I doubt that most Dems or Republicans actually bother to read their party platforms, much less agree with every aspect of them.

    My middle class family is worse off after the ACA than we were before it. My Fortune 500 employer very neatly dumped their PPO plans and replaced them with a high deductible plan with HSA, trumpeting that employees were now in control of their own health care spending. The premiums are slightly less but when you add in the HSA contribution, our total “cost” of insurance is more than it was on the PPO or EPO options in the past. On top of it we now get to pay out of pocket for everything up to our $6800 deductible, which means that in essence we’re paying hundreds of dollars a month for what amounts to only catastrophic coverage. We have a $13K out of pocket max – so not enough to bankrupt us if the stuff hit the proverbial fan, but enough that we’d be paying off hospital bills for years. My husband and I just don’t go to the doctor anymore when we’re sick or hurt, because every time one of the kids gets sick the pediatrician visit is $150, when one of them needs a specialist it’s $300+. One of our kids’ prescription drugs is over $2000 for each refill (yes, that’s two thousand dollars – not a typo) and pharmacies don’t set up payment plans the way hospitals and doctors usually will.

    The Democrats basically have all of us beholden to the damned health insurance companies now because of the ACA – a nice gift for their cronies in charge of Aetna, Cigna, United, BCBS, etc. who are raking in record profits (both corporate and personal). Yes, more people are insured. Yes, there are some good aspects of the ACA (doing away with the pre-existing condition issue, among others). But it comes at a cost to middle class America that earns too much for subsidies AND gets hosed on the costs of employers choosing to switch to high deductible plans.

    Do physicians forget that most of their patients don’t earn the kind of income that they do? How am I supposed to afford bearing most of the burden of our own health care PLUS pay premiums for what amounts to catastrophic coverage PLUS pay more in taxes?

    I’m for single payer or not-for-profit universal health care all the way, likely including optional private coverage. It can’t be worse than what we have now. There are a number of libertarian thinkers (note the lower case ‘L’) who feel the same way.

    Posted by KS430 | August 5, 2016, 11:02 am
  28. Libertarians think given free reign corporations & businesses would be generous, frugal & treat employees & customers well. They’d always be seeking ways to make everything cost less. The only problem with everything they propose is that it doesn’t factor in GREED! Think about GREED & their idealogy is hysterically funny & morbidly unfair to all but the 1%. Even reading between the lines of their ideas is GREED. They believe they will have more in a free range market. Not one of them would be a libertarian if their child became seriously ill or their house burned down or they became disabled. You know why? GREED! It’s okay for everyone else to pay but when their pockets get emptied it’s a different story. But they arrogantly believe nothing bad happens to them.

    Posted by Dan | August 5, 2016, 12:51 pm
    • GREED is expecting someone else to pay for your healthcare.

      Posted by Geoff | August 5, 2016, 2:49 pm
      • And, BTW, Geoff: the abject worship of personal property rights is a religion. And, like most organized religions, it is based on an unrealistic and unproven premise, and exists to manipulate and subjugate people. Greed is actually believing you own everything you touch or think of. This is the seed that leads to the belief that you are superior to someone else, and eventually, to the belief that you can own human beings – slavery (or animals, for that matter), or land, which gives you the right to take form others “by force” a payment for its use. Some comments, here, have mentioned taxes as “taking the property or wealth of others by force.” How is expecting people to pay a fee to remain healthy or avoid death by illness or injury not doing the same thing? The poor are not inferior beings too stupid or lazy to accumulate personal wealth. Poverty is not indicative of a character defect. The sick, injured and critically ill did not choose their conditions. Who gets up in the morning saying to themselves, “I’m going to go out and get broadsided by a delivery truck on the way to work this morning? – or – I think I’ll get cancer today?” The response of many libertarians – and fans of Ayn Rand – would probably be something like: Just one of things, I guess. After all, traffic lights are oppressive government interference invented to control the weak-minded. We have to protect the freedom and liberty of motorists to ignore red lights and drive as fast as they feel they need to.)

        Most so-called libertarians use the term “free market” when what they really mean is “unregulated market” where any attempt to restrain the primal predatory urges of the players is seen as inherently evil. The so-called “law of the jungle” or “survival of the fittest” is a fallacy created by the greedy to justify taking as much as they can from anyone not in a position to fight them over it. Don’t get sick, or if you do, you’d better hurry up and die to make room for your betters who have property and money to avoid illness. The players in a “free market” will NOT focus all their attention and effort on delivering the best possible product at the lowest possible price to serve the customer. They will focus, as they have done throughout history, on maximizing profit by cutting cost using any means necessary – which includes ensuring that any competition is eliminated – succeed by making others fail – again, by any means necessary (“any means necessary” is code for whatever can be gotten away with based on the end justifying the means).

        The society based on this pack of lies is not “free”. It is a nightmare prison for most of its citizens. A prison we began building when we allowed the holders of the most wealth to stop making things for people and, instead, make only money for themselves That is greed – not the poor wanting to survive and knowing they might not simply because because they are poor.

        Posted by Richard Wolcott | August 6, 2016, 2:36 am
      • Thank you so much, Richard, for your post!!!

        Posted by Law (@partialshadow) | August 6, 2016, 9:49 am
    • Bravo, Dan! Someone finally has the guts to use the “G” word.

      Posted by Richard Wolcott | August 6, 2016, 2:34 am
  29. Thank you! Excellent – and very true – essay on the dangers of libertarian healthcare.

    For those who say that Obamacare is “killing the healthcare industry”, I say nay nay. I live in a city of about 65,000 with two hospitals (one Catholic, one Lutheran [recently bought by mayo], and both are for-profit, and just north of us is a city with about 30,000 people and one hospital (not sure if it is for-profit or not, but I imagine it is).

    These three hospitals serve an area of maybe 200K people, perhaps a bit more. In 2014, they had a combined *profit* of $150 million. The Catholic one had $70 million of that. That’s three hospitals, $150 million PROFIT.

    That’s completely immoral. And that’s under the so-called “oppressive, profit-killing yoke” of Obamacare. Imagine what those hospitals would be earning in profit in a Libertarian society! I hate to think of it.

    If you vote Libertarian, I suppose you better also buy a crapload of stock in a hospital.

    There is a very good reason that we socialize the costs of healthcare by spreading it out over a large population, whether via Obamacare or the private insurance companies. And that reason is: that’s a moral society does.

    Posted by David Huber | August 5, 2016, 1:54 pm
    • Hi David:

      Just to throw out there, libertarians in many ways would also be critical of these profits because they come–not from a free market but, rather–from regulation which privileges big companies over small companies (who can’t meet the cost of the expensive regulation and so have to fold). We think that freedom leads to more competition and so higher quality and lower costs, but government (here crony capitalism) decreases competition by creating only big companies who only need to fulfill the government’s regulatory requirements, get the government to regulate their smaller competition out of business, to make a killing and don’t have to worry about pleasing the customer. All blessings, David🙂.

      http://www.zerohedge.com/news/2015-10-12/crony-capitalism-real-cause-societys-problems

      Posted by Mark Andrew Hamilton | August 5, 2016, 5:26 pm
  30. A critique from a probablitarian

    I will lay down my arguments for why i think it is ok to vote libertarian , democratic , republican or for that matter to not vote at all . I happen to be a doctor too & i’m from india . I’ll get back to the medical aspects in a little while , before that let me explain why i think voting for anyone or not voting at all are perfectly ok .

    First an individual vote has an extremely close to zero chance of influencing any election & for arguments sake even if we assume this particular vote is the deciding vote , what happens when someone with ideology A is elected in a democracy ? as a matter of fact once in power, ideology plays almost no role in what policies one will espouse . Once in power a person or interest group is confronted with a complex web of reality in which different interest groups pull in opposing directions and the outcome of those tense interactions is that the most probable outcomes will prevail . History is replete with examples of power holders executing things that are diametrically opposite to their core values , So someone having a value system is no guarantee that his/her ideals will prevail . Reality can humble the most hardened of idealogues .

    Secondly , no ideology is perfect when taken to it’s logical extremes and no ideology is completely worthless either . If ideologies are broadly categorized as collectivist and individualist , there are merits and demerits to both sides . Collectivism is good at dealing with problems for which there exist inadequate profit incentives and individualism is good for exactly the opposite kind of problems , hence its necessary for both to prevail and for both to be constantly at each others throats for meaningful change to occur .

    Coming back to medical care , several questions arise . Does every medical problem have a profit incentive ? Does no medical problem have a profit incentive ? the answer to both is ” No ” . There is a ton of grey area to be addressed with nuance , analysis and empiricism . Now idealogy is not inherently good at dealing with grey areas because loyalties are tribal and not exactly amenable to reason , This is where empiricism is vital to provide direction . A lot of todays medical advances have come from the more individualistic societies , If all the world was like the former soviet union i’m not sure how much of todays medical technology would be in existence . You did disparagingly point out flying to India as an option for the desperate ( Though there are demonstrable pockets of excellence in India where care and safety comparable to the west is delivered at shockingly low prices ) but had to leave out countries where fully socialized medicene has provided worse outcomes than the admittedly poor Indian outcomes . Full socialization provides no guarantee of sturdy outcomes or even steady technological progress . This begs the question does having access to unlimited resources guarantee superior societal health and breakneck techno progress ? Well rich societies do have an obesity problem which is essentially an issue of too much resources , this in turn increases the burden of heart disease , diabetes and a myriad of other associated problems , now is this society better or worse for having these resources . Coming to technological progress throwing more and more money at something isnt guaranteed to produce a breakthrough and neither is absolute abscence of resources guarantee that no breakthrough will ever happen . The story of technological progress is the story of random accidents as much as it is about focused effort by individuals or collective organizations . Coming back to provision of medical care , If i had a magic wand that would solve all our problems i would wave with without a seconds thought , but do we have one ? We don’t . My understanding is that the present system of training and producing doctors isnt fast and efficient enough to create enough competition . As much as i want everyone to get health care i also passionately believe cheaper care is a noble thing too . There are many fighting for more resources but almost no one fighting for cheaper and more efficient care . There is a cardiothoracic surgeon in India called Devi shetty who built a cardiothoracic chain of hospitals which performs a Triple vessel cardiac bypass for 2000 USD a patient and his mortality and morbidity rates are comparable to american rates . If Indians can do it for 2000 Why cant americans do it for 10000 or even 20000 ? Is it a bad thing if care is cheaper ? . These are questions that need pondering over . Perfection will always live in tommorrowland .

    More political choice even if its driven by less than perfect ideologies is not a bad thing , a libertarian vote isnt a crime and a democratic vote isnt a magic bullet .

    Posted by sitaramaraju | August 5, 2016, 8:38 pm
  31. If Obamacare is the first rung, as you say it is, what exactly are the other 99 rungs to perfect it?

    Posted by John Knetemann | August 6, 2016, 1:00 pm
  32. Only “first world” nation that doesn’t have Universal Healthcare. You want lower cost well the more people that pay into the pot the less it will cost everyone. That what the insurance companies did when you were healthy they put you in a bracket. Oops you broke your leg and you need a pin in your knee move you to a higher bracket oh you can pay that much here sign this waiver and well put you back in your old braket but if anything is wrong withbyou knee we won’t be liable

    Posted by Gene E | August 6, 2016, 10:26 pm
  33. I’ll have to check with my dad on this one, but as a child of the 60s, I don’t remember my parents having health insurance or having to pay a great big bill for my sister’s C-section birth. Mom was in the hospital for about a week, but came out without a bunch of drugs or a huge bill, that I remember. I got my physicals every time the school required it. I saw a doctor when I needed to–like when I burned my arm on the pot-belly stove we used to heat our farm house. I didn’t see an dentist unless I needed to, nor an eye doctor. My dad even had his appendix removed without complications and a huge worrisome bill.

    SO, I’m not sure where you got the idea that medical costs were so expensive for the average person back in the 60s. I’ll tell you about my own current insurance issues only you’d shoot them down with “facts” that don’t apply to me. I was better off insurance-wise 10 years ago than I am today. I used to be middle-class…..

    Posted by Ruby | August 7, 2016, 6:49 am
  34. My husband did get sick and charity paid for almost all of his care. If government health care was not the worst possible solution they wouldn’t need to mandate participation.

    Posted by Patty | August 7, 2016, 12:25 pm
  35. Absolutely false. The whole reason medical expenses are so high is because the government sticks it’s big fat nose into it! If we get rid of all of the nonsense patents, licenses, etc. the price of operation goes way down! Then the doctors can charge less. If we make it an entirely free market, then there will be higher competition, driving prices down and quality up. This stuff is basic economics! It’s the same with college. If the government didn’t provide so much federal aid, the price of tuition would go down because the schools would be making more money. They could drop tuition when the government stops giving half of it away.

    Posted by Nathan | August 7, 2016, 2:18 pm
  36. Great post as usual — lots of great comments!

    The Libertarian platform and Libertarian policies make the most most sense; at least in the big picture of “fiscally conservative” and “socially liberal”.

    Unfortunately, the Libertarians are dead wrong about health care (hey, no political party is perfect and this in and of itself is the biggest reason we need a 3+ party system and consensus govt). The proper model for effective and cost effective health care has already been established — the Swiss and Germans pretty much have it right (again, not perfect, but certainly good enough). In a very brief nutshell — They have a 2 tiered model with rationed basic and catastrophic care for all sponsored by taxation, Govt ability to negotiate with surgical / pharmaceutical companies regarding product pricing and more extensive, private care for those who can afford it.

    I am voting Libertarian

    I will not support their platform on management of the health care crisis. It is mind bogglingly stupid for such an otherwise smart party

    And if Obamacare represents the first rung of a 100 rung ladder…I’d suggest staying off that ladder. Actually, it would be better to take the ladder and smash it with a sledghammer

    Posted by Andy | August 7, 2016, 10:50 pm
    • Obamacare is modeled on the Swiss system you praised. Unfortunately, this being the USA, we have for-profit insurers rather than the non-profit model the Swiss use for their basic coverage.

      Posted by Steveh46 | August 19, 2016, 10:46 am
  37. Thank you for this. My grandson is a million-dollar baby (actual cost $1.2 million when his continuing care is added), entirely paid for by Medicaid. He was born 8 weeks early when his mother, my only daughter developed pre-eclampsia. Under a Libertarian system, both of them would have been left to die.

    ‘Obamacare’ may not be perfect, but it’s a hell of a lot better than the alternative.

    Posted by auntienenna | August 8, 2016, 10:12 am
  38. I am a pharmaceutical biochemist and I can talk on the Propranolol claim. It was developed by a British scientist in 1964 and was on the market by 1965. As you said it has been available as a generic for some time now.

    There are plenty of other medications that take 10 years to go from discovery to market. In fact, in this day and age, that time frame is not uncommon. We certainly COULD reduce that to a year or two if we didn’t have FDA regulations. So that would skip all the expensive studies of long-term effects. We would have no human trials and just allow the public to choose to be experimental subjects. As a bonus, drugs would become much less expensive and you wouldn’t have the booklet describing common side effects, mechanisms of action and maximum dosage. In fact, everything would be available over the counter and pharmacists would be obsolete. No reason to keep them around if we don’t even know safe dosages and common interactions to watch out for.

    I would certainly be out of a job. We do the third-party verification of the active ingredients of marketed drugs. If the public doesn’t mind not knowing of the drug they are taking is effective against their ailment, I’m sure they don’t care if they are actually getting the product advertised in the dosages on the package.

    Sounds good, eh?

    Posted by Ranna | August 8, 2016, 2:46 pm
    • Hi Ranna: Thank you🙂. Could a third party free market entity verify active ingredients, ala Consumer Reports as well? I’m just curious about this?

      Posted by Mark Andrew Hamilton | August 9, 2016, 2:39 am
  39. His answer, “Maybe we shouldn’t be saving those kids.”

    He said that to you!!! To your face after he’d seen your kids?? You are a better person than I am because I would have punched him in the mouth.

    Posted by Steveh46 | August 19, 2016, 10:44 am
  40. Libertarianism, or Classical Liberalism, begins by placing Liberty at the top of a nation’s values hierarchy – the greatest good. If this isn’t true for you than I wouldn’t expect you to agree with the libertarian perspective on healthcare. But even if security and constancy trump liberty for you, ACA remains the greatest demonstration of libertarian principles in our day. It’s a grand scheme to solve all the problems, it just can’t work in a real, dynamic world.

    Posted by cedricmgr | August 22, 2016, 8:42 am
  41. What about, say, rental housing here in Seattle or in San Francisco or any other big city along the U.S. West Coast? Parallel to health care, should a basic apartment (including a private toilet, shower/bath, etc.) ALSO be legislated as a basic “right”? These innovations have done more to improve “public health,” since circa 1900, than ANY purely medical drugs or devices, EVER invented by Western “medicine”! (I lost my 30+ year growth of “dreadlocks,” last Summer [2015], due to a lice infestation contracted while living in Seattle-area “Transitional” Housing–w/o any private bathroom! Western conventional “medicine” could do NOTHING to save my hair! Naturally, my “dreads” did not survive long, under the assault of sharing toilets, showers, etc.–with chronically “homeless” drug addicts [mostly] who will simply NOT maintain themselves!) Also–if health care is a “right”–then can we constitutionally draft undergraduates, to enroll in Medical School–if not “enough” top-notch college students volunteer–similar to U.S. Military “Selective Service”?If not, why NOT–if Mr. or Ms. A’s medical care is a legal “right”–which, by the statist logic of ObamaCare, the U.K.’s revered NHS, Canada’s National Medicare, etc., B, et al., supposedly “must” provide!

    Posted by Joel Holmes | August 31, 2016, 3:56 pm
  42. As a fellow medic (just retired after too many years in the NHS in the UK) I have to disagree with you. Yes, medical treatments are expensive but this is why we plan and organise insurance schemes to deal with potentially catastrophic bills. I could face a bill for millions if I kill someone in a car accident and accordingly I have taken out insurance. All sensible people and societies will arrange a combination of saving and insurance schemes to meet these costs. I don’t know about your american libertarians but I do know that here in Europe our state controlled systems under-perform consistently the mixed economy systems in other European countries. Promoting free trade and limiting central regulation will prove beneficial. I looks like in the USA you need to make a complete root and branch revision of your health care as it seems cost heavy and much more weighted to the providers of healthcare rather then the consumers.Be careful of further state intervention which will just serve to amplify this.

    Posted by henacynflin | October 23, 2016, 3:41 am

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