Socialized Medicine vs. Libertarian Medicine? (Re: What if?)
Matthew Montchalin
|"Daniel Hansen" <deadb...@hotmail.com> wrote in message
|news:td6i52d...@corp.supernews.com...
|> Socialized Medicine,
|
|As opposed to turning people away at Emergency Rooms?
When the state prevents people from playing 'doctor,' there are
a lot fewer hospitals, I suppose. Is it a good idea to PREVENT
people from building and operating substandard hospitals, or
staffing them with substandard doctors, or part-time doctors,
as the case might be?
Bill Shatzer
On Tue, 10 Apr 2001, Matthew Montchalin wrote:
-snips-
> When the state prevents people from playing 'doctor,' there are
> a lot fewer hospitals, I suppose. Is it a good idea to PREVENT
> people from building and operating substandard hospitals, or
> staffing them with substandard doctors, or part-time doctors,
> as the case might be?
Actually, the state allows all sorts of decidedly substandard doctors.
But, for some reason, they don't choose to open chiropractic,
naturopathic, or Christian Science hospitals.
Peace and justice,
Bill Williams
I had to track this one down from alt.politics.libertarian to find
the originating thread, which was a fantasy based on the election
of the Bore instead of the Shrub, and with an 80% DemaGOP
majority in the federal Parliament of Whores. It seems obvious
now that I've read the preceding posts. Socialized Medicine
would be an obvious consequence of such an electoral out-
come, as the health care industry -- particularly the pharmaceu-
ticals sector thereof *and* the overwhelming majority of physicians
in these United States -- are decidedly no more a part of the
DemaGOP constituency than was the Jewish population of
*Grossdeutschland* a constituency of the National Socialist
German Workers' Party.
But I'm surprised to find that anyone would think that the
state undertaking measures to "prevent people from playing
'doctor'" would *decrease* the number of hospitals. If any-
thing, overbedding (too many hospital beds for the population
in a service area) has been the *result* of government inter-
vention in the medical marketplace, and is in no way con-
nected with the various state governments' assent to (or
denial of) licensure to health care practitioners of any sort,
whether allopathic (M.D.), osteopathic (D.O.), naturopathic,
homeopathic, chiropractic (D.C. -- and why the hell would
pure "crunch" practitioners *want* hospitals of their own?),
whatever.
Is it your intention to kick off a discussion of a completely
free market in the provision of health care services versus
the ever-more-stultified politicization of medical practice as
the officers of government intervene more and more de-
structively to Nationally Socialize that 17% of the gross
domestic product involved in the treatment of the sick and
the infirm?
--
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Matthew Montchalin
|But I'm surprised to find that anyone would think that the
|state undertaking measures to "prevent people from playing
|'doctor'" would *decrease* the number of hospitals.
If just "anybody" could play "doctor," then surely the need
for hospital beds would soon increase, wouldn't it? Since
supply is usually increased to meet demand, we would find
ourselves with more hospitals, wouldn't we?
|If anything, overbedding (too many hospital beds for the
|population in a service area) has been the *result* of
|government intervention in the medical marketplace,
Hmmm. I think hospitals would have fewer beds if doctors
and hospitals hadn't been required by insurance companies.
|and is in no way connected with the various state
|governments' assent to (or denial of) licensure to health
|care practitioners of any sort, whether allopathic (M.D.),
|osteopathic (D.O.), naturopathic, homeopathic, chiropractic
|(D.C. -- and why the hell would pure "crunch" practitioners
"Cap'n Crunch" practitioners? The ones that get their
licenses out of breakfast cereal boxes?
|*want* hospitals of their own?), whatever.
I think the patients would buy into a hospital bed if it
were as cheap as a typical "motel room."
Bill Williams
<mmon...@OregonVOS.net> wrote:
>On Wed, 11 Apr 2001, Bill Williams wrote:
>|But I'm surprised to find that anyone would think that the
>|state undertaking measures to "prevent people from playing
>|'doctor'" would *decrease* the number of hospitals.
>
>If just "anybody" could play "doctor," then surely the need
>for hospital beds would soon increase, wouldn't it? Since
>supply is usually increased to meet demand, we would find
>ourselves with more hospitals, wouldn't we?
You're mistaken in your definition of "demand" in this case.
It's not that the demand for hospital beds goes up *only* (or
even primarily) with the number of health care practitioners
capable of admitting to inpatient services in a given area.
Hospital beds are a relatively inflexible capital expense
(though in my time I've proposed solutions which would
permit hospitals to "flex" bedding according to variable
demand, only to be told by administrators that HCFA and
other government regulatory bodies wouldn't allow such
measures). This capacity -- the number of inpatient beds
maintained by a hospital -- requires not only high expen-
ditures to establish, but also a big chunk of operating
expenditure to maintain. Idle personnel and equipment
must still be paid for.
Were the officers of government involved in profes-
sional licensure to collectively shoot themselves in
the head (a consummation devoutly to be desired,
and to which I would gladly buy tickets so that I
could bring friends to watch), and were occupational
licensure of all sorts to be discontinued (as it ought),
the impact upon hospital bedding levels would not
be significant. This would be the case not only
because the governmental regulations imposed
upon hospital operations wouldn't be affected but
also because it takes a genuine economic demand
-- a real *need* for hospital beds -- to make new
hospitals or the expansion of existing hospitals
financially feasible.
The extent to which the health care sector of the
economy can be freed of the inhibitions and arti-
ficial incentives involved in a mixed-economy
regulatory environment (as presently obtains) is
precisely that extent to which health care practi-
tioners, hospitals, and other providers of medical
goods and services will be able to directly act upon
unmasked market demand, and match the production,
delivery, and prices of medical care most efficiently
and economically to the real demand in the popula-
tion.
>|If anything, overbedding (too many hospital beds for the
>|population in a service area) has been the *result* of
>|government intervention in the medical marketplace,
>|and is in no way connected with the various state
>|governments' assent to (or denial of) licensure to health
>|care practitioners of any sort, whether allopathic (M.D.),
>|osteopathic (D.O.), naturopathic, homeopathic, chiropractic
>|(D.C. -- and why the hell would pure "crunch" practitioners
>|*want* hospitals of their own?), whatever.
>
>Hmmm. I think hospitals would have fewer beds if doctors
>and hospitals hadn't been required by insurance companies.
Incorrect. If anything, third-party payors in the health care
market would want far *fewer* hospital beds if they could
manage that outcome. The existence of hospital beds,
all other things being equal, is a relative invitation for phy-
sicians to admit patients, particularly in the present-day
professional liability environment.
Think about it. I've got a patient who's kinda "teetering
on the edge" of being admissible. I *could* treat her at
home, making use of reasonably intensive outpatient
nursing support to provide IV medications and other skilled
nursing care therapeutic and diagnostic measures, but
she wouldn't get 24-hour-a-day monitoring and the
emergency responsory capacity that a code cart and
a hospital nursing team could provide if she were ad-
mitted to the house.
I'm in a medicolegal bind. If there are hospital beds avail-
able, and I decide *not* to admit her, I'm taking a helluva
risk -- effectively dangling my unzippered private parts
over the piranha tank of the plaintiff's bar. If there are *no*
hospital beds available, however -- all the local hospitals
are on "divert," and I couldn't unstick a bed with high
explosives -- then I've got a pretty good reason to get
in touch with the home nursing people and arrange for
this person to be treated as an outpatient. The third-
party payor in the case (HMO, PPO, Blue Cross, whatever)
is delighted, as the cost of this patient's care is going to
be comparatively lower. So will the quality of care, but
they don't really give a damn about that.
>"Cap'n Crunch" practitioners? The ones that get their
>licenses out of breakfast cereal boxes?
No, of course not. Chiropractors, however, are (when
they're doing what they *should* be doing) practitioners
of manual manipulative therapy, in which Osteopathic
physicians are also trained (and from which profession
the chiropractors "branched off" many decades ago,
their founding father -- Palmer -- having been a student
of the founder of Osteopathy, A.T. Still). There is no
need for hospitals devoted to the delivery of chiroprac-
tic manual manipulative therapy. The Osteopaths *had*
to have hospitals of their own because when they
began to undertake hospital-level medical care (in-
cluding surgery) more than a century ago, we in the
allopathic profession refused to allow them onto the
medical staffs of *our* hospitals. Big mistake. The
Osteopaths had patients for whom they were both
primary and secondary health care providers, and
they demonstrated a genuine need for hospital beds
to serve their patient population by going out and
building the hospitals, raising the money themselves
and often working small wonders on shoestring
budgets in the days before the government began
offering bread-and-circuses, turning the taxpayer's
wallet into the medical profession's cornucopia.
>I think the patients would buy into a hospital bed if it
>were as cheap as a typical "motel room."
If hospitals were permitted by government regulatory
agencies to "flex" the level of their services so as to
better meet a genuine demand for such accommoda-
tions, they would *certainly* attempt to provide austere
hospital bedding to deliver care for such "betwixt and
between" cases as I'd discussed above. As a
matter of fact, it would be *perfect* if hospitals were
not prevented from offering a spectrum of in-house
services ranging from intensive care all the way down
through skilled nursing facility (SNF), extended care
facility (ECF or Nursing Home), and assisted living
facility levels. If infectious disease considerations
can be addressed (and I hold that they can) so as
to minimize nosocomial problems, it would be ideal
insofar as economically efficient continuity of care
is concerned. I wouldn't mind admitting such a
patient as was described above to an SNF bed
attached to a decent community hospital, knowing
that I could provide a lower-cost set of options and
still retain the ability to transfer the patient swiftly
and safely -- no goddam ambulance ride involved
-- to a hospital-level nursing floor should problems
arise.
But government regulations forbid the development
of such a capability, limiting hospitals to inefficiencies
and stupidities with which you may thank ghod you
don't have to deal directly.
Bill Williams
<mmon...@OregonVOS.net> wrote:
>On Wed, 11 Apr 2001, Bill Williams wrote:
>|But I'm surprised to find that anyone would think that the
>|state undertaking measures to "prevent people from playing
>|'doctor'" would *decrease* the number of hospitals.
>
>If just "anybody" could play "doctor," then surely the need
>for hospital beds would soon increase, wouldn't it? Since
>supply is usually increased to meet demand, we would find
>ourselves with more hospitals, wouldn't we?
You're mistaken in your definition of "demand" in this case.
>|If anything, overbedding (too many hospital beds for the
>|population in a service area) has been the *result* of
>|government intervention in the medical marketplace,
>|and is in no way connected with the various state
>|governments' assent to (or denial of) licensure to health
>|care practitioners of any sort, whether allopathic (M.D.),
>|osteopathic (D.O.), naturopathic, homeopathic, chiropractic
>|(D.C. -- and why the hell would pure "crunch" practitioners
>|*want* hospitals of their own?), whatever.
>
>Hmmm. I think hospitals would have fewer beds if doctors
>and hospitals hadn't been required by insurance companies.
Incorrect. If anything, third-party payors in the health care
>"Cap'n Crunch" practitioners? The ones that get their
>licenses out of breakfast cereal boxes?
No, of course not. Chiropractors, however, are (when
they're doing what they *should* be doing) practitioners
of manual manipulative therapy, in which Osteopathic
physicians are also trained (and from which profession
the chiropractors "branched off" many decades ago,
their founding father -- Palmer -- having been a student
of the founder of Osteopathy, A.T. Still). There is no
need for hospitals devoted to the delivery of chiroprac-
tic manual manipulative therapy. The Osteopaths *had*
to have hospitals of their own because when they
began to undertake hospital-level medical care (in-
cluding surgery) more than a century ago, we in the
allopathic profession refused to allow them onto the
medical staffs of *our* hospitals. Big mistake. The
Osteopaths had patients for whom they were both
primary and secondary health care providers, and
they demonstrated a genuine need for hospital beds
to serve their patient population by going out and
building the hospitals, raising the money themselves
and often working small wonders on shoestring
budgets in the days before the government began
offering bread-and-circuses, turning the taxpayer's
wallet into the medical profession's cornucopia.
>I think the patients would buy into a hospital bed if it
>were as cheap as a typical "motel room."
If hospitals were permitted by government regulatory
John
___>^..^<___
"Bill Williams" <Bill_W...@MailAndNews.com> wrote in message
news:GE3VOiZajlZOtq...@4ax.com...
> On Wed, 11 Apr 2001 13:22:42 -0700, Matthew Montchalin
> <mmon...@OregonVOS.net> wrote:
>
>
> >I think the patients would buy into a hospital bed if it
> >were as cheap as a typical "motel room."
>
> If hospitals were permitted by government regulatory
> agencies to "flex" the level of their services so as to
> better meet a genuine demand for such accommoda-
> tions, they would *certainly* attempt to provide austere
> hospital bedding to deliver care for such "betwixt and
> between" cases as I'd discussed above
Most of your post was rambling and not that clear, but here it sounds like
you're advocating the kind of 'deregulation' that got California into their
power problems. If hospitals just size themselves to handle normal loads,
they'll not be able to respond to civic emergencies.
Bill Williams
Hm. If you found my post "rambling," it's probably because
you're not living in (or familiar with) these United States,
and haven't had to deal with operands in the health care
marketplace as it's presently operating in the mixed economy
environment of governmental regulation. You've really got
no idea about what the hell I wrote, do you?
By "flex" in the brief passage you quoted, I meant the
ability of hospital administrators to vary the level of services
so as to convert a nursing unit's worth of beds from one
level of care -- say, that of a telemetry "stepdown" unit
-- to one requiring less in the way of skilled nursing services
so that patients who need a lower level of care can be
treated within the same hospital but at a lower cost.
Hospital "bedding" involves a complex of services,
equipment, and personnel. The various government
regulatory agencies (particularly HCFA, the Health Care
Finance Administration) piss all over you if you try to
"flex" your services so that a three- or four-hundred-bed
hospital temporarily converts a twenty-bed nursing unit
to something along the lines of a Skilled Nursing Facility
level of service when there's a genuine demand in the
community for such services as an alternative to sending
patients home from the regular nursing floors (or from the
Emergency Department) to rather more risky intermittent
"visiting nurse" forms of care.
Response to large-scale emergencies are structured
according to in-house, local, and regional disaster
planning, and have nothing to do with normal operating
capacity factors such as the number of nursing beds.
I've not only run disaster drills but have also handled a
few big-time disasters IRL, during which the govern-
ment regulators were conspicuous in their absence
both during the shit-hitting-the-fan phases as well as
in the aftermath. We simply did what needed to be
done and cleaned up the mess afterwards. The
boobs from within the Beltway kept out of our hair,
knowing that if they *did* give us too much bother,
we'd treat 'em like the lice they are.
Not unexpectedly, things worked better (and people
proved more helpful and ingenious) during the real
thing than they ever did during the drills.
As for the California situation being due to "de-
regulation," you're even more thoroughly ill-informed
about that little screw-up than you are about medical
economics and the gormlessness of government
meddling. Believe me, there is *no* deregulation
involved in a situation where a vendor is forbidden
by law from passing along the cost of doing business
to those who purchase services from him. The
Granola State is just doing what it always does:
giving the rest of the nation yet another perfect
example of what happens when people connive at
statist stupidity.
John
___>^..^<___
"Bill Williams" <Bill_W...@MailAndNews.com> wrote in message
news:JmLWOuz+U3iCu6ZLWVxhgn=lQ...@4ax.com...
> On Thu, 12 Apr 2001 16:59:40 -0700, "John" <jk...@anon.net> wrote:
>
> >"Bill Williams" <Bill_W...@MailAndNews.com> wrote in message
> >news:GE3VOiZajlZOtq...@4ax.com...
> >
> >> On Wed, 11 Apr 2001 13:22:42 -0700, Matthew Montchalin
> >> <mmon...@OregonVOS.net> wrote:
> >>
> >>
> >>>I think the patients would buy into a hospital bed if it
> >>>were as cheap as a typical "motel room."
> >>
> >> If hospitals were permitted by government regulatory
> >> agencies to "flex" the level of their services so as to
> >> better meet a genuine demand for such accommoda-
> >> tions, they would *certainly* attempt to provide austere
> >> hospital bedding to deliver care for such "betwixt and
> >> between" cases as I'd discussed above
>
> >Most of your post was rambling and not that clear, but here
> >it sounds like you're advocating the kind of 'deregulation'
> >that got California into their power problems. If hospitals
> >just size themselves to handle normal loads, they'll not
> >be able to respond to civic emergencies.
>
> Hm. If you found my post "rambling," it's probably because
> you're not living in (or familiar with) these United States,
You're dead wrong on this one.
> and haven't had to deal with operands in the health care
> marketplace as it's presently operating in the mixed economy
> environment of governmental regulation. You've really got
> no idea about what the hell I wrote, do you?
Isn't that what I said. Question is, do you have any idea what you wrote?
>
> By "flex" in the brief passage you quoted, I meant the
> ability of hospital administrators to vary the level of services
> so as to convert a nursing unit's worth of beds from one
> level of care -- say, that of a telemetry "stepdown" unit
> -- to one requiring less in the way of skilled nursing services
> so that patients who need a lower level of care can be
> treated within the same hospital but at a lower cost.
In other words, you want to screw the skilled personnel.
> Hospital "bedding" involves a complex of services,
> equipment, and personnel. The various government
> regulatory agencies (particularly HCFA, the Health Care
> Finance Administration) piss all over you if you try to
> "flex" your services so that a three- or four-hundred-bed
> hospital temporarily converts a twenty-bed nursing unit
> to something along the lines of a Skilled Nursing Facility
> level of service when there's a genuine demand in the
> community for such services as an alternative to sending
> patients home from the regular nursing floors (or from the
> Emergency Department) to rather more risky intermittent
> "visiting nurse" forms of care.
In other words, you want the hospitals to drive the nursing homes out of
business.
>
> Response to large-scale emergencies are structured
> according to in-house, local, and regional disaster
> planning, and have nothing to do with normal operating
> capacity factors such as the number of nursing beds.
> I've not only run disaster drills but have also handled a
> few big-time disasters IRL, during which the govern-
> ment regulators were conspicuous in their absence
> both during the shit-hitting-the-fan phases as well as
> in the aftermath. We simply did what needed to be
> done and cleaned up the mess afterwards. The
> boobs from within the Beltway kept out of our hair,
> knowing that if they *did* give us too much bother,
> we'd treat 'em like the lice they are.
Oh, really?! I gues that, if you've got those beds filled up with
'lower-level care' patients, you can just dump them on the street.
> Not unexpectedly, things worked better (and people
> proved more helpful and ingenious) during the real
> thing than they ever did during the drills.
>
> As for the California situation being due to "de-
> regulation," you're even more thoroughly ill-informed
> about that little screw-up than you are about medical
> economics and the gormlessness of government
> meddling. Believe me, there is *no* deregulation
> involved in a situation where a vendor is forbidden
> by law from passing along the cost of doing business
> to those who purchase services from him. The
> Granola State is just doing what it always does:
> giving the rest of the nation yet another perfect
> example of what happens when people connive at
> statist stupidity.
> --
Ah, yes - "statist stupidity" - that makes you a libertoon. The power
suppiers were indeed allowed to pass along the cost of doing business - and
they did -- and more. You see, there were -two- markets there - one was
deregulated (power generators) and one was not (utilities). What happened
in the deregulated market shows what deregulation is all about - gouging the
customer. You libertoons come in with your deceptive soundbites and
half-baked ideas that play right into the hands of big business.
Paul T. Ireland
suppiers were indeed allowed to pass along the cost of doing business - and
they did -- and
>more. You see, there were -two- markets there - one was deregulated (power
generators) and one was not (utilities). What happened in the deregulated
market
>shows what deregulation is all about - gouging the customer. You
libertoons come in with your deceptive soundbites and half-baked ideas that
play right into the
>hands of big business."
Why not look at the deregulation that happened with the long distance
companies. It's been more than 20 years since Ma Bell broke up and long
distance prices are lower than they were before. If deregulation is as evil
as you say, how come it worked so well? The case of the power companies is
different. Right now you can choose which long distance carrier you want
and they will be use the local wires regardless of who actually installed
it. If power were truly de-regulated the consumers would be able to choose
whomever they wanted to supply their power. This is not the case. I can't
call DWP and say, "I've been having problems with Southern California
Edison, I'd like to switch to DWP." Until this happens there will be no
competition and prices will continue to rise. As long as the power
companies know that you are powerless to switch providers (because the
market hasn't been truly de-regulated) they will plan properly and build the
necessary power plants. Then they'll be able to raise the rates and claim
there's a power shortage like now. When consumers have the power to choose
you can bet your ass that rates will drop and new powerplants will spring up
everywhere.
If you knew anything about politics or economics you would know that a free
market doesn't benefit big business. A free market where politicians
haven't been manipulated by wealthy corporations and individuals is a level
playing field. Small companies will be able to effectively compete against
large companies. This creates more innovation, safety features, and lower
prices due to higher competition in the marketplace. Currently large
businesses bribe politicians to make it more difficult for other companies
to compete. This means that the large company doesn't have to pay their
workers as much because they don't fear competition. When we remove these
artificial trade barriers and everyone plays by the same rules the market is
alive with fair competition. With more competition in the marketplace,
skilled labor is in higher demand and the salary of these workers rise.
Higher competition also ensures that companies will take a smaller profit
margin and won't pass on the higher labor costs to the consumers.
This in conjunction with removing all unconstitutional aspects of federal
government including the unconstitutional social programs (welfare, social
security, public education, etc.) will allow the federal government to run
solely on tariffs and excise taxes (which will be a flat 2% for everyone to
ensure that the market stays fair). This would allow us to get rid of
income tax all together. Americans are the most generous people on the
planet. They donate more money to charity than anyone else on earth. And
that's despite the fact that they work nearly half of the year as a slave to
the government. Just think of they could keep 100% of their income.
Instead of the government forcing money from the people, charity would be
voluntary and more effective. Only 20 cents of every dollar that the
government takes for these unconstitutional social programs actually makes
it to the intended recipients. Compare that to the 86 cents per dollar that
non-profit charities typically get to the intended recipients? This means
that even if people only gave 25% of the money that is strongarmed from them
by the government, the poor, elderly, and infirmed who currently recieve
help from the government would actually get more than they already do.
Think about that. We wouldn't be using force and the people who needed help
would actually get more of it. Not only that we'd have more of our hard
earned money to keep for other things. I don't know about you but for the
money I pay in taxes I could get the best health insurance on the planet
(heck I could almost get a new kidney every year!). I could send my children
to the best schools that taught things that I wanted them to learn. I could
have more than a million dollars for my retirement if all I paid was the
same amount I already pay in social security instead of zero dollars which
is what I will get.
Why do socialists fear personal responsibility so much? Do they think that
the government is more generous than the American people? Do they think
that George Bush knows better than their doctors which medicine they should
take? Do they think that George Bush will take better care of their
families than they will themselves? Do they want the government to tell
them what their children should learn? Do they want the government to tell
them what they can or can't do with their own bodies?
Personally speaking, I am for freedom. Freedom and Responsibility are
inseparable. You can't have one without the other. I want to be free to
choose for myself how to invest my money, which charities I want to support,
which schools my children will attend and what they will learn, what health
plan is best for me, what I will do with my body and what goes into my body,
what I will own and what I won't, etc... I'm willing to take responsibility
for my own life and my own actions. I realize that many people fear
responsibility.
For the people who really want someone else to run their lives and spend
their money, I'm sure they'll be able to find someone more than willing to
do it. But don't force me to join that club. Allow me to choose freedom
instead of oppression. Allow me to run my own life anyway I want as long as
my actions don't harm another person or their property. Allow me to make my
own decisions about my own life and I promise I'll do the same for you.
Paul T. Ireland
Libertarian