The system is currently in a tizzy and can’t decide what to do–it is every bit the proverbial dog that finally managed to catch one of the cars it’s been barking at and chasing for years, now sniffing around the tires and just generally trying to find out “What the fuck.” After pointless gestural votes showing their support for repealing the Affordable Care Act, House and Senate conservatives now have the ability to put some actual weight behind those votes, but instead are seemingly doing everything in their power to not do that.
I discussed that idea briefly in this podcast:
It’s a long one, at nearly an hour, so get comfortable. Also be aware I’m not doing any more podcasts in that voice, because I inexplicably sound angry, due to how I edit out most of the silence. While recording, I actually speak almost exactly like Obama did, and when you remove the gaps the result is what sounds like a continuous angry rant.
Anyway, that’s just there if you’re interested.
It’s a little weird that I have the solution to America’s health care crisis, but the people we’ve elected to solve such problems have no idea what to do. Actually, it’s not weird at all: the solution is for them to do nothing, because they’re absolutely useless anyway, and we have this strange idea in the United States that the government should do stuff and try to solve problems. Politicians don’t just believe that bullshit; they are the primary peddlers of it, because if people knew that politicians can’t solve problems, then politicians would be out of a job and out of power. It’s far better for them to look like they’re doing something productive–such as repassing the Affordable Care Act under a different name–than to do nothing at all and run the risk of the masses figuring out that a law wasn’t necessary in the first place.
Imagine, for example, if computer problems had the observable habit of fixing themselves. To be clear, they don’t–they may be intermittent problems, but a computer problem does not just go away or fix itself. However, let’s pretend that they do. My job, of course, is to fix people’s computer problems. It’s in my best interest to do anything that I can to attempt to fix the computer problems, and it’s obviously against my best interest to do nothing: if I do nothing, then your computer problem will fix itself, and you’ll realize how unnecessary I am to the process. Ideally, my tinkering with the system would actually make the problem worse–fixing one problem by creating two more–and then you’d need me to fix those two new problems. Would you ever notice that you would have been better off if you’d never gotten me involved? Perhaps once the one problem had morphed slowly into nine hundred and sixty problems, you would be raising your eyebrows.
In the real world, it wouldn’t get anywhere near that far. If you called me out to fix your computer problem, and I temporarily resolved it, only for it to return a little while later and be even worse than it was before I touched it, you’d only give me a few more chances to actually fix the issue before you called someone else. “You were supposed to fix my Internet!” you might say. “Now Outlook doesn’t even open and my computer crashes five times a day! Fix it or I’m calling someone else!”
Imagine, though, that you couldn’t call someone else, because I was in charge of all computer problems and fixing them–there was no one else to call. If I implemented a solution, then no one could undo that solution and no one could work against that solution–if they did, their act of working against that solution would be illegal, and they would face fines and incarceration for doing it.
Do you see how, in this scenario, I have you by the balls? I can do anything I want to your computer, and you can’t do anything about it. Perhaps every four years we have a vote to either give me the power to fix your computer, or to give another person the power to fix your computer, but when it comes time to vote everyone always chooses me or this one other person. Neither of us ever actually fix your computer, and your computer goes from “working but with intermittent issues that fix themselves” to being a total clusterfuck of contradictions and problems. And there’s nothing you can do about it, because you’re not even allowed to call someone else or to keep us from tinkering with your computer.
That’s the government.
We can’t just call another government to fix our health care system–we only have the one, and whether that government currently consists of Republicans or Democrats doesn’t much matter as far as the health of your computer is concerned. Whether we’re Republicans or Democrats just determines how we screw up your computer; it determines the fixes we attempt to implement, and the mechanisms we use to make the problem worse. Believe it or not, our analogy also gets worse than what I just outlined.
The government isn’t just trying to fix your computer. No, quite bizarrely they promise that they can fix everything in your life. They can fix your house, your health care, your vehicles, your electricity, your food, your computer, your fridge, and any other problem that you might have. At least with a dedicated specialist, you could ask for their qualifications and shop around until you found someone who you felt was qualified to fix your problem. In the case of government, we have people who realistically know almost nothing about these areas attempted to fix problems in those areas.
No one is capable of repairing a fridge and a computer, monitoring a coal or nuclear power plant, and determining how much rubber a vehicle’s tires should contain. No one enjoys such a sweeping array of specializations and talents. We all know this intuitively. If your fridge repair guy offered to disassemble your motor and replace your head gaskets, you’d probably be a little hesitant about letting him do it, and if he then offered to provide you with recommended [mandatory] regulations for the plumbing in your home, you’d definitely be cautious and unlikely to take him seriously. But when it comes to government, it’s “Nope. These guys and girls can do everything, because they know everything.”
This is why we hate it so much when a politician dares reveal to us that they don’t know something. Our entire system is built on the assumption that politicians are omniscient and omnipotent. When Gary Johnson asked, “What is a leppo?” people turned against him more than if he’d said, “I just think that we don’t need government telling us that we can’t marry little kids.” How dare Gary Johnson reveal that he didn’t know something?! That’s unacceptable to western society. We make a token effort of criticizing Politician’s Answers, when they go on lengthy tirades about something unrelated to anything that was asked of them–just watch the presidential debates and count how many times Trump brings up Isis or immigration while answering a question that has nothing to do with either, and how many times Hillary brings up Russia while answering a question that has nothing to do with them. We’ll accept anything except “I don’t really have the answer to that.”
Saying “I don’t have the answer to that” would destroy a candidate’s chances of winning, and that’s because we need that conceit. We need to believe that our politicians have all the answers, because somehow we’ve convinced ourselves that government has all the answers.
So what about health care, then? What is this solution that I profess to have?
It’s simple: get the government out of it. Repeal every law and every regulation.
And that’s a kneejerk reaction. Clear your mind of that emotional reaction, and then proceed.
Unsurprisingly, most people aren’t really sure what laws and regulations are even on the books, so they have no way of knowing what the effects would be if those laws were repealed. It’s beyond the abilities of anyone to give a comprehensive list, but here are some things that would go away:
- Pharmacies would no longer be regulated and could fill prescriptions written by anyone, and could even pass out “prescription drugs” without prescriptions.
- Doctors would no longer be required to be certified–rubberstamped–by the government.
- Doctors would no longer be required to attend 8+ years of school.
- Anyone with the startup money could open up a medical practice or a pharmacy.
- The doctor could purchase drugs directly and fill your prescription instead of sending you to a third party.
I haven’t so lost touch with the average person that I’m unaware of how horrible all of that sounds. Each of those sounds like a terrible idea. This, too, is a kneejerk reaction that only focuses on the negative consequences. I don’t deny that there would be negative consequences. There would also be positive consequences.
If anyone could open a medical practice, then we would have quacks opening up doctors’ offices in their basements and garages, and then attempting to diagnose people and write them prescriptions. We would have pharmacies who were willing to give anyone just about any drug in exchange for money, with no hesitation about turning people into drug addicts. We might even have people dying because the quack they went to see misdiagnosed their pneumonia as a common cold.
Let’s take those in reverse order. It’s not exactly hard to diagnose pneumonia. A stethoscope is all that’s necessary, and anyone can watch a YouTube video to learn what pneumatic lungs sound like–they have fluid in them, which is pretty easy to listen for. If you went to a doctor because you had pneumonia and he didn’t even take the time to listen to you breathe, and then he told you that you had a cold, you would almost certainly ask to see that doctor’s credentials. If he couldn’t provide them, you’d probably request a refund and would go see another doctor. We even do this today, with our spiderweb of regulations and oversights meant to eliminate quacks, because often we don’t trust a doctor’s diagnosis and want a second opinion.
A pharmacy that would sell anyone whatever drugs they want is nothing more than a drug dealer with a brick-and-mortar building. That’s… not really a problem. Trying to keep people from securing drugs they want to take has observable and severe consequences. It has also never worked. Prohibition has never worked. If you eliminate someone’s ability to do something openly, but they still want to do that thing, then they will invariably find ways to do that thing in secret. Alcohol Prohibition didn’t stop the manufacture, sell, and consumption of alcohol. The regulations and laws didn’t keep me from getting addicted to pain killers. Marijuana prohibition hasn’t stopped people from smoking pot. Abortion Prohibition didn’t stop people from getting abortions–
And let’s discuss that last one for a moment, shall we? Because we know it for a fact, and it’s an argument in liberals’ toolkits in favor of legalized abortion. Even the most diehard liberal will admit that prohibiting abortion didn’t prevent abortion from happening; it merely chased it into the black market, into society’s shadows, where standards of safety and decency were non-existent. Prohibition doesn’t work.
So this pharmacy develops a reputation as being a drug dealer, and that causes them to lose the business of the “respectable people.” The soccer moms, Catholics, and other “upstanding citizens” wouldn’t be caught dead going into that pharmacy, because anyone who saw it would say, “Oh… She’s a drug addict?” and the gossip and rumors that would result would sink that person’s reputation. This is an observable thing already. “Why is our youth minister cruising Brooks Road at midnight? Is he seeing prostitutes?”
Who cares that drug addicts will have an easier time getting drugs? That’s a good thing. And it would be even better because the addicts could just buy heroin, crystal meth, crack, and whatever else from a pharmacy, out in the open, and not in danger. They wouldn’t have to worry about the person running off with their money when they were supposed to be right back. They wouldn’t have to worry about heroin laced with lethal chemicals to kill them because they were suspected of being informants, because there would be no one to inform to. See? These “negative consequences” that people inherently have a kneejerk reaction to… are actually positive consequences.
These are all good things. We may or may not like it that the coke addict up the street suddenly has an easy and affordable way to get his fix, but that coke addict was getting his fix anyway. Our laws and regulations weren’t stopping him. And even if we did bust him and send him to prison, there are a thousand more ready to fill his place. I shouldn’t have to go into the inherent dangers of the black market, and how it creates violence and people like Al Capone. When was the last time Budweiser was in the news for breaking the kneecaps of its competition? When was the last time that Bayer was in the news for putting fentanyl in its hydrocodone to punish people for buying from Watson?
Never, that’s when.
And it’s an observable fact: black market drug dealers don’t ask for an ID. I never met a drug dealer who told me that they wouldn’t sell to me because I wasn’t 18 years old. Legalizing drugs reduces the number of teens using drugs. If we had a pharmacy repeatedly being called out for selling percocets to fifteen year old kids, that community would rally together and shut down that pharmacy quickly.
And what of the people who have no qualifications at all for treating people’s illnesses? Well, we have those already! There is no scientific evidence to support homeopathic medicine, acupuncture, and similar things, but they exist today, and have ardent defenders who fight tooth and nail against attempts to restrict them. We do have people dying because they think they can pray their illness away, or pierce it away with needles, or flush magical toxins from their body with enough fucking wheatgrass. These people exist already, and not only can you not protect them from their bad decisions, they resist every attempt for you to protect them from their own bad decisions. They don’t want you to tell them that they’re being idiots and playing with their health.
Neither do you have the right to. As loyal as I am to scientific methodology, and as much as I reject homeopathic medicine, the Placebo Effect is a real thing, and something that we have only begun to understand. We know that it’s possible, if someone believes that drinking carrot juice will cure them, they may very well walk away cured. This is why every drug ever synthesized stacks its effectiveness against the Placebo Effect, and things like aspirin provide a noticeable improvement in headache reduction over placebos. But this doesn’t mean that a person can’t take Vitamin E and have their headache cured. If the Placebo Effect and homeopathic remedies [sic] are enough to cure them, then let them have the cure they want.
Besides, we don’t have the right to tell other people what they can and can’t do. This gets murky when we’re talking about children, but I’m not even going to touch that one, because the issue persists today and would continue to persist regardless. This means it’s irrelevant to the discussion at hand.
We don’t need the government breaking into people’s homes and arresting people for using hair dryers in the shower to prevent people from using hair dryers in the shower. If they’re irresponsible and reckless enough to do that, then it’s senseless to try to spare them the consequences. It can’t be done, and attempting to do it means that everyone has their homes broken into by the police several times a day in the attempt. Liberty and privacy are destroyed for everyone in our misguided attempt to protect reckless people from the consequences of their own poor decisions.
If someone is reckless enough to just take the word of an unqualified and untrained doctor, we can’t protect them from that. Worse, it could very well be the case that there are people out there more than capable of diagnosing the flu, the cold, pneumonia, and other things, but who lack any formal training. These people obviously wouldn’t be able to charge as much as a doctor with an 8 year degree. If they came across something that they couldn’t diagnose, they would direct you to someone who was more qualified.
You know, like what already happens today.
“I don’t know about that mole,” your general practitioner might say. “It’s irregularly shaped. You should go see a dermatologist about it.”
Obviously, the dermatologist will charge you more than the general practitioner, because the dermatologist is better qualified. So the girl with a two year degree in Physical Fitness and the guy with a four year degree in Human Physiology may not be able to diagnose your cancer, but they would be able to diagnose a lot of things, and they would not cost nearly as much money.
And that is the key.
No one would pay $150 per visit to go see a doctor whose only qualification was a 2 year degree in physical fitness. They would, however, pay that doctor $20 for a visit, to get a yearly physical and checkup, or to get a prescription for their pneumonia or whatever. Neither would anyone pay $150 per visit go see a doctor with a 4 year degree, but they would probably pay $50 to get a more accurate assessment and physical, or a diagnosis.
This increases our options. It’s no longer just “I need to go see a doctor over this relatively minor thing, but each one is going to charge between $100 and $150 for a visit, so… I’m just screwed, I guess. Let’s see, that’s www.webmd…”
I know lots and lots of people who abuse the Emergency Room precisely because they refuse to pay $150 to have their flu diagnosed and to receive a few prescriptions. This not only increases ER wait times, it’s always a loss for the hospital, because those bills never get paid. The hospital can’t turn people away, and they didn’t turn people away before we made it illegal; doctors and medical people have always taken the Hippocratic Oath seriously, and it wasn’t until we forced them to that they began shirking it. A fair number of these people, however, would spend $20 to be looked at by someone capable of diagnosing the flu.
The system would work just fine.
Sure, there would be occasions when someone died because they went to see a quack, or because they believed in homeopathic medicine that proved incapable of treating their leukemia. Lawsuits brought by family members against these reckless institutions would be in order, and those who were reckless would quickly be put out of business. If you die because I told you that you had the cold and you had pneumonia, then that’s on me for overstepping my qualifications, for putting my arrogance and desire for money above your life, and your family has a legitimate lawsuit against me for recklessly playing with your life in pursuit of profit.
This doesn’t do you any favors, but your family should have tried convincing you to go see someone else about the time you started coughing up blood, too. Let’s not deny your own responsibility to your health, or your family’s responsibility to talk some sense into you.
But if you let this fear of the consequences motivate you to let the government try to fix something with a law, then this health care mess is the result. Why are doctors so expensive? Because they’re protected from competition by people who could easily compete with them at lower price points. A doctor can charge you $125 for a visit because I can’t undercut him by saying, “You don’t need to go see him and pay that much. I can diagnose the flu, and here’s the 4 year degree that proves I’m probably capable of diagnosing such a common illness. Pay me $40 and I’ll take a look at you.”
Voila! We reduced the cost of your visit to the doctor from $125 to just $40. We cut out two-thirds of the price. And we didn’t need the government for it to happen. We didn’t need insurance companies to jump into bed with one another and with doctors and pharmacies and drug companies. We didn’t need price controls. We didn’t need monopolistic insurance industries. All we needed was to get the government out of the way and let people be free.