Healthcare Contrarianism in an Age of Consensus

It was once hip to question authority, partisan allegiances be damned. Among those who once chanted "Hey, hey, LBJ/How many kids did you kill today?" in protest against the Vietnam War, at least a few were left-of-center types more likely to be lumped in with Johnson's Democratic party than with the Republican one. In our modern political climate, however, loose political coalitions sink campaigns. In an age when "spoiler" candidates like Ross Perot and Ralph Nader are almost universally decried as having "taken votes" from their rightful, major-party recipients, the level of intra-party criticism is ebbing ever lower.

Years after the rise of George W. Bush to the presidency, I recall seeing many proud Republicans driving cars sporting "W: The President" stickers, apparently indifferent to the fact that Bush grew government faster than Clinton had, dwarfed Clinton's military expenditures, and threatened other nations with the reckless abandon of the too-drunk friend who you try to whisk out of the bar before he gets himself into trouble. Now, well over six months into the Barack Obama administration, the new president's devotees are likewise still devoted, wearing Obama t-shirts, sporting his campaign stickers on laptops and cars, and denouncing opponents of Obama's policy proposals as partisan, possibly racist no-goods who in the words of Obama himself "created this mess" and ought not "do a lot of talking."

Just as Bush supporters did when they claimed that opponents of the Iraqi and Afghani wars were "with the terrorists," Obama and his supporters pose a false choice: either you give carte blanche to the people in power on Capitol Hill or you are a war-mongering, possibly fascist, indigent-hating Republican. This false dichotomy ignores the fact that millions of Americans have steadfastly opposed government cartelization of the healthcare industry for years, criticized Bush's approval of a massive prescription drug bill, and were just as eager to march against Republican wars in Iraq as they were to protest Democrat-led adventurism into Eastern Europe and Northern Africa.

One doesn't have to be a pro-war neoconservative to see that the further bureaucratization of the medical services industry, especially where price controls are likely, will result in fewer choices for consumers, less flexibility in treatment regimens, and another reason for our benevolent government overlords to further regulate what we eat and drink and smoke. However, by allowing a market rather than a panel of bureaucrats to set prices, shortages could be mitigated in the short term and eliminated in the long term. In a market where prices are a function of supply and demand, prices rise as supplies become more scarce. Free market prices act to prevent wasteful usage of scarce resources, like that of Medicare patients who call an ambulance scores of times for minor or imagined maladies, because such overusage would break the bank for the wasteful patient. Likewise, where there is a more fundamental supply issue, rising prices both encourage entrepreneurs to devise more efficient ways of serving patients and bring more service-providers into that sector of the market.

Although there is much wrong with the healthcare plan being pushed by the majority party right now, it is important to note that this does not mean that the status quo in the United States represents a "free market." Nothing could be further from the truth. Even without the Democratic plan, we have a medical labor cartel, the American Medical Association, in place to artificially limit the supply of medical services and raise their prices. We have lengthy pharmaceutical patents that prevent competitors from reverse engineering drugs sooner and from devising cheaper ways to bring those drugs to market. We have an incredibly onerous drug approval process that is so expensive as to frustrate the business plans of all but the largest of drug companies and keeps possibly life-saving drugs out of the hands of desperate patients who ought to be allowed to do their own risk/benefit analyses when their lives are the ones on the line. Huge entitlement programs like Medicare and Medicaid, while burning through money like almost nothing else besides the military, ensure that the poorest segments of the population will receive substandard care and annoyed looks from paperwork-hating triage nurses.

It is true that the United States has a healthcare system, at present, that is marginally more free than those of many other nations. Although there are price ceilings for certain patients under certain government entitlement programs, there is still a private market in healthcare that allows prices to adjust to their natural levels. For this reason, many foreign medical professionals immigrate to the United States, where their expertise will be better compensated and utilized than under the mess of bureaucratic red tape in their countries of origin. The fact that the United States is effectively alone among industrialized nations in not instituting a single-payer healthcare system is no argument for such a policy. Political keeping-up-with-the-Joneses is lazy and irresponsible in public policymaking.

The United Kingdom's National Health Service (NHS) is often raised as an example of a single-payer healthcare success story, but the NHS's own statistics show that the number of general practitioners per capita in Britain has fallen dramatically since the imposition of the NHS monopoly. Despite long waiting lists, substandard facilities, and doctor shortages, Britons will have to put up with their bureaucratized healthcare system until the whole British house of cards comes down, because the NHS is now the largest single employer in the United Kingdom and one of the top five employers in the world. With that many people drawing a government check from NHS, the program is entrenched, its miserable failure notwithstanding.

Here in the land of the free and the home of the brave let us actually expect a little personal responsibility. Individuals should plan financially for foreseeable medical expenses and remember that medical insurance is best reserved for catastrophic medical events. Eliminating the administrative costs associated with bureaucracy (and preventing the imposition of more such costs) means prices must fall eventually, all things being equal. Lower prices would mean that voluntary charities could better afford to serve more individuals, but without causing the distortion in the market that government bureaucracies do.

Pretending that we can totally abandon personal responsibility because we have a "right" to the labor of doctors, nurses, and hospital administrators only confuses the issue, discourages talented individuals from pursuing medical careers, and insures that the American healthcare system will continue to decline. Government monopolies didn't carry the now-commonplace heart bypass procedure from experimental to routine, the market did. There is no room for the government in healthcare.

(Also published in the Orientation 2009 issue of Dicta, the Suffolk Law paper.)

West Palm Beach police rescue elderly from affordable dentures

On Wednesday, April 25, Roger Bean of West Palm Beach, Florida was arrested and charged for providing a service to customers who were apparently satisfied. He is a criminal without victims, at least according to those that the government claims that he victimized. Unlike other victimless criminals, though, Mr. Bean's dealings were not in prostitution, gambling, or illegal intoxicants.

For some time he had been fitting customers for dentures in his garage, manufacturing the dentures himself, and then providing them to customers for around $200 per set. This service, which usually costs somewhere in the neighborhood of $2000, was provided to elderly customers who were also Bean's neighbors and friends.

From the news reports, Mr. Bean hardly seems like a scam artist. According to the 72-year-old head of the neighborhood watch program, "He's helping the old people who don't have a few dollars. I think the world of him." Unlike back-room plastic surgeons who we occasionally hear about having horribly disfigured some hapless customer during a cut-rate corporeal upgrade, there is no evidence that Bean was performing invasive procedures, or, in fact, medical procedures of any kind. He was simply fitting clients for dentures and then manufacturing dentures for them.

Bean's "crimes" were against the American Dental Association, whose Commission on Dental Accreditation has been tasked with granting (and denying) accreditation to dental schools since 1979. This ADA commission enjoys a monopoly position as the only dental school accreditation agency recognized by the federal Department of Education.

Roger Bean and others like him are being persecuted for daring to compete with those dentists favored by the powers that be. After all, who were Roger Bean's crimes against? Did he defraud his customers? Or is this just economic protectionism for licensed dentists against a competitor who is providing a substitute for their services at a tenth of the price?

When it comes to transportation, not everyone needs a Cadillac. They are nice, to be sure, but many, many people can do without the luxury features of that high-end brand and instead make it from point A to point B in a Honda Civic or another, more affordable vehicle. To be sure, there are many benefits to the presence of top-shelf brands on the market. Many features now only available to the wealthiest customers will filter down to the buyers of economy-class cars in a matter of years. The purchasers of luxury brands make all of us better off in the sense that they subsidize the research and development of new products and features, effectively helping the relevant industries determine what to include in future product lines.

As with cars, not every consumer of dental services needs a dentist with a DDS or a DMD. Some people might choose to have their needs met through a less costly alternative. Unfortunately for bargain-seekers, the ADA cartel limits the number of dentists who can compete with its membership, and so it lobbied the feds to declare it to be the gatekeeper for entry into the dental profession. When service providers like Bean are arrested, it isn’t protecting the elderly, or the toothless, or the stupid. No, such heavy-handed enforcement is carried out with little regard for these “victims” and the plain fact that each one found himself, thanks to Mr. Bean, either able to afford dentures or, in other cases, able to direct their saved funds towards other ends, perhaps including life-saving or life-lengthening medical care.

The ADA has historically provided many useful services, including its evaluation of dental hygiene and health products. Just about everyone who has purchased a tube of toothpaste or a new toothbrush has seen the organization's familiar logo. The ADA endorsement has been a helpful metric for consumers in determining which products may be best suited for their dental hygienic needs. However, the real value of their "stamp of approval," just as with any other similar organization, plummets as soon as the evaluators are effectively granted a monopoly. While another, competing organization could theoretically be formed to test and rate dental health/hygiene products, the ADA would still benefit from its government-ordained appellation of "official" provider of this information. And with regards to the accreditation of dental schools, the ADA is the only (legal) game in town.

As soon as such an organization depends on government edict rather than consumer confidence for its authority, there is a much lower incentive to provide the most useful information to the public, and ultimately the public suffers. While this, the real crime against consumers goes on, the heroic Roger Bean sits in a jail cell, waiting for the criminal justice system to mete out his punishment for saving his friends and neighbors thousands of dollars.

How to lower healthcare costs

(This Letter to the Editor was submitted to the Opelika-Auburn News on 24 March 2006 in response to this editorial.)

Dear Editor,

In your 22 March 2006 edition, a staff editorial called for an "overhaul of national health care." While I agree with your staff's call for change, I must differ as to what kind of change is needed.

It is true that many Americans cannot afford the healthcare of the highest quality, but government intervention is a major cause of the problem, not a solution. The high cost of drugs is a consequence of ever-lengthening drug patent terms and the almost insurmountable cost of getting a new drug approved by the FDA. For a single drug, this can run anywhere from tens of millions to hundreds of millions of dollars. This high level of regulation discourages new companies from engaging in just the sort of competitive innovation that could seriously lower drug costs in the long-term.

The "strong lobbying influence" wielded by the pharmaceutical industry is a direct result of the public policies that have made the government itself the industry's most important customer. If individuals were to pay for their own healthcare, there would be far less opportunity for companies to seek special favors from politicians and bureaucrats.

Finally, the government's guarantee of health care to all removes an important incentive for living a healthy lifestyle—the real monetary cost of poor health. No one wants those in poverty to be neglected medically, but a sense of entitlement to taxpayer-sponsored health services is sure to encourage overeating, smoking, and other unhealthy lifestyle choices among those least able to afford the consequences. The real solution to the healthcare crisis is liberty and personal responsibility, not government.

Dick Clark
Candidate, Alabama House of Representatives, District 79
www.CitizenClark.com