Forget Tech, the Real Anti-Competitive Market is Health Care

With the most recent round of ObamaCare enrollments about to begin, more Americans will soon be faced with the reality of a growing doctor shortage. The Wall Street Journal reports that, for the first time in two generations, the number of doctors per person is declining, a situation that will result in decreased access to health care and rising costs even beyond what we have already seen.

While the direct impact of ObamaCare has been widely discussed, what most people don’t realize is the ways in which our medical bureaucracy goes out of its way to discourage competition and limit the supply of doctors in the marketplace. While Google and Microsoft get slapped with high-profile lawsuits for alleged anticompetitive behavior, however, the medical industry’s affronts in this regard have gone largely unexamined.

The rules for the practice of medicine in America are largely determined by state medical boards. Ostensibly private entities, these boards actually function similarly to regulatory agencies run by unelected czars. With immense power to affect medical provision, but no incentive to pay attention to political pressure from the grassroots, these boards have been given monopoly power by state governments to be the sole arbiters of medical care, immune from competitive pressure. Doctors are thus left with a monolithic set of “take-em-or-leave-em” rules that they must obey, or else risk being fined or having their licenses revoked.

Defenders of this system will no doubt argue that, since the boards are run by doctors, we can trust their decisions to be sensible and well-informed. The problem with this is that doctors, just like everyone else, are driven by self-interest, and thus have an incentive to protect themselves and their colleagues from competition, even if this comes at the expense of patients.

Indeed, at every turn we see policies, set either by state medical boards or by the American Medical Association (AMA), that seem expressly designed to limit patient options and keep costs high. For example, the AMA has lobbied heavily against the spread of retail clinics in pharmacies and supermarkets, as well as giving greater latitude to nurse practitioners and physician’s assistants to operate independently.

These services are perfectly capable of addressing a wide variety of routine medical complaints, thus freeing up physician – and expensive emergency room – time for more specialized treatment. Midwifery, once a common profession in the United States, has been all but destroyed by lobbying from the medical establishment.

Meanwhile, the training of new doctors remains prohibitively costly and time consuming, largely due to restrictions directly introduced by the medical community itself. There are currently only 129 accredited traditional medical schools in the United States, with a limited number of students. But it is difficult for more schools to open in order to meet demand, due to a lengthy accreditation process, overseen by the Department of Education, which can take up to eight years.

Although some policy analysts are now advocating for a reduction in the length of medical school from four years to three, noting that the fourth-year elective courses are largely inessential for general practitioners, but the number of residencies available is still limited. Congress is responsible for manipulating the amount of funding for medical residencies through the Medicare program, meaning that there are currently only about 110,000 slots available.

This problem is compounded by the fact that about 15 percent of these positions are taken up by foreign medical graduates, many of whom are regarded as fully qualified in their home countries. Since there is no system of recognizing the qualifications of even the most eminent physicians from Europe or Asia, they are all forced to go through lengthy residencies that could go to American medical students.

By artificially limiting the number of doctors who are able to practice, state medical boards, empowered by government-granted monopolies, are aggravating the problems created by the Affordable Care Act, and contributing to a potentially catastrophic shortage of medical professionals in the years to come.

http://www.sacra-pizza-man.org/g-k-chestertons-prophetic-look-at-national-health-care/

G.K. Chesterton’s Prophetic Look at National Health Care

G.K. Chesterton considered himself a member of the Liberal Party until 1912. As he would later say, he did not leave the Liberal Party. It left him. He believed in something called liberty, the idea that people should be able to make most decisions for themselves, especially the most basic and most important decisions, and not have such decisions made for them by anyone else, especially by the government. He believed, as a liberal, that the State’s role was to preserve liberty, not take it away.

What happened in 1912? The Liberal Party, which held power in Parliament, passed The Health Insurance Act. Every working man was required to have part of his wages withheld to pay for a national health insurance. The funding was to be further supplemented by a tax on every employer. Sound familiar?

Chesterton’s objections to the Insurance Act were threefold. First, it was anti-democratic in practice. The vast majority of the English population was against it. It was being passed against their will, but—so the argument went—for their own good. Second, it was anti-democratic in principle. It divided the populace into two permanent castes: those who labor, and those who pay for the labor. Chesterton called this what it is: slavery. Third, Chesterton saw the Act as paving the way to the State seizing more power, more influence, more interference in everyone’s daily lives. Sound familiar?

About a century later, here in America, we are looking at essentially the same thing that Chesterton was looking at. We watched as a National Health Care program was passed in utter defiance of public support, rammed through the legislative process by one party rather than by any sort of consensus. We have also watched the reinforcement of a system comprised of employers and employees, of wage-earners rather than independent, self-sufficient and truly “self-employed” citizens. And we have also watched the unimaginable growth of government as it has insinuated itself into every aspect of our lives.

One of Chesterton’s strongest objections to the Insurance Act was the increase in taxes to those who could scarcely afford to have any of their income taken from them, even if it was to be used for something specific like health care. The tax prevented a man from paying for other needs he had that might be just as important as medical care. He was being forced to pay for medical care that he might not need. What other things that he did not need would the State decide he must also pay for?

Chesterton pointed out that a compulsory Health Insurance Act was first passed in Germany. It followed another compulsory act that was also first passed in Germany: compulsory education. Chesterton was a vocal opponent of state-sponsored compulsory education, for the same reasons he was against a national health insurance. It was an attack on freedom. It gave the government too much power, and it took away a basic freedom from the citizen. The liberal argument was that the State was providing a valuable service. Chesterton’s counter-argument was that though the State was providing education, it was the State’s education. Though it was providing medicine, it was a forced medicine. With a compulsory insurance, he argued, people were being forced to pay to be protected against themselves. People are often willing to trade freedom for security. But the problem is that it is usually someone else trading our freedom for our security.

Although Chesterton found himself allied with the conservatives on the issue of health care, he might point out now that one of the reasons we have gotten into the present mess was that health care became an industry, controlled by large corporations rather than independent practitioners, and every industry tends to grow till it forms an alliance with big government. When health care started becoming too expensive, the solution was supposed to be health insurance. But insurance quickly made health care even more expensive. On the one hand, the medical industry stopped worrying about being affordable; on the other, a new layer of private bureaucracy and overhead was added that also needed to be paid for. Is there a solution? Yes. There is one drastic solution.

But sometimes issues of health require drastic measures. The health care system needs radical surgery. The honest thing to do is do away with health insurance. Doctors and hospitals and clinics should start selling a product that people can afford, and that they should not have to buy unless they actually need the product. It should not cost a thousand dollars to treat an ingrown toenail. But it does. It should not cost $30,000 to set a broken arm. But it does. Ours is a system that cannot be sustained. That is why the government feels justified to step in.

Chesterton prophesied this very scenario. He warns that the State cannot become a Universal Provider without becoming just another big shop. The one thing we’ve seen about big shops is that they collapse. We can avoid the big collapse if we start getting small again. We might even get healthy again.

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