With the election of President-elect Obama and the likely appointment of Tom Daschle as Secretary of Health and Human Services, it seems likely that there will be some effort to nationalize health care, at least certain aspects of it.
Of course, as I will show below, health care in the United States is already substantially nationalized, when one considers who is paying for it.
How many times have you heard a politician say, "I favor the free market, But...
"? I hear it all the time.
You probably do, as well.
Our politicians are statists.
They believe, above all else, in the government.
This is why government always gets bigger, never smaller, regardless of which of the two major parties are in power.
It got bigger when George Bush and the Republicans were in charge; it will get bigger under Barack Obama and the Democrats.
Consider health care.
Imagine you have gone to an expensive restaurant with three strangers.
The three strangers know you will get the bill, and there are no prices on the menu.
What do you suppose your tablemates will order - the Blue Plate special, or the Lobster? This is the situation we have with health care.
Over time, and perhaps with the best of intentions (or perhaps not as we will see), the government has taken over the majority of health care expenditures and has worked in concert with certain special interests to stamp out competition.
And the true cost of the care we receive is almost always hidden from us.
It is a recipe for disaster, and disaster is where we are headed.
Health spending in this country now exceeds 17 percent of Gross Domestic Product.
And yet we hear the cries of, "Let the government take over the whole thing!" There is an alternative.
If libertarianism is to grow in opposition to statism, we must demonstrate that we have a framework for assessing the current situation and offer a compelling alternative, one that will enable solutions to emerge.
That alternative is called Freedom.
Below I list some action steps that will increase freedom in health care, lift the dead hand of government, improve competition, and enhance the quality of life for millions of people.
Hospital Competition.
The vast majority of hospitals face no real competition, and have virtual monopolies in the areas they serve.
People do not want to travel great distances when they need hospitalization.
Even in some cities where there is more than one hospital, the hospital management is part of a network and you are dealing with essentially the same institution.
What incentive for efficiency or price reduction does a monopoly provider have, do you think? And yet, when people attempt to create specialty hospitals to treat specific conditions, the major hospital networks lobby the legislatures at the Federal and state level - fueled by some well placed campaign contributions - to stamp out the competition even before it begins in some cases.
Up until 2006.
specialty hospitals were not eligible to receive Medicare and Medicaid payments, for example.
Further, reports are often heard of physicians being denied referrals and staff privileges for using specialty hospitals.
A good first step would be to continue to allow specialty hospitals to receive Medicare and Medicaid payments.
Entrepreneurs will then continue to move in to this market and create institutions that focus expertise on particular conditions.
Removal of Licensing Restrictions.
Occupational licensing is usually promoted (by those being licensed, of course, as well as their supporters) as being a mechanism to "protect the consumer".
In practice, licensing artificially inflates the incomes of those being licensed, and restricts peoples' access to professions where compensation is above average.
There are also more subtle distinctions within occupations as to who can perform what kind of service.
Further, insurers often limit service reimbursement to "licensed" providers.
Another libertarian reform would be to remove the licensing restrictions in the medical field, to a considerable degree if not totally.
Providers should receive their compensation based on efficacy and the response of the market, not on the possession of a piece of paper.
How will we ensure quality? you may ask.
Well, how do we ensure quality in other products we purchase? Quality review groups, analogous to Underwriters Laboratories and Consumers Union will emerge, to assess providers.
Plus, a novel approach could be employed: people could ask their providers for their credentials and experience, and perhaps for references, and decide for themselves accordingly.
A New Form of "True" Health Insurance.
When was the last time you asked a healthcare provider how much a particular service cost? Do you know the "list price" of the medications you take, or just your copay? We are totally insulated from the true cost of the medical care we receive.
And if you do not know what something costs, you are prone to overspend on it and over-use it.
Think back to my restaurant example.
We do not know what medical services cost, and frankly many of us do not care what they cost.
We are not wise consumers of the services.
The health care choices of wise consumers would differ from those we see today.
What we call "health insurance" today is really more analogous to "health cost insulation".
Because our employers, or the government, pay most if not all of the cost on our behalf, we never really see what the true cost is.
We typically do not see what our office visits, prescriptions or hospitalizations really cost either.
A libertarian approach would create a transparent, market-based protection product.
Under this proposal, a person would receive a lump sum that would vary by diagnosis and severity.
They would then be able to choose what type of care they wished to receive, or no care at all.
I can hear people say, But what about emergency care? We could treat emergency care separately.
Much health expenditure today, however, is elective and discretionary.
You do not need to have it on a particular day, with time of the essence.
Then the statists will say, People are not intelligent enough to make wise choices in regard to their health care, only the State has the wisdom to decide what is best for us.
Libertarians strongly disagree, and trust that people can make the right decisions for themselves, even if their decisions are not the same as everyone else's.
We believe in the primacy of the individual, not the primacy of the State.
Medical Marijuana.
Most libertarians have strong opinions regarding the drug laws in this country.
But even non-libertarians who are not currently in favor of full decriminalization should be sympathetic to allowing the medically supervised use of cannabis.
Real people derive real benefits from cannabis use.
I know some of them.
There are chemicals your doctor can tell your pharmacist to give you, that can kill you if improperly used.
To my knowledge there has never been a documented case of death from cannabis use.
And for people with certain medical conditions, it seems to be the only thing that gives them relief.
Who owns your body anyway? End of Life Care Issues.
Who owns your body, indeed.
Suppose you are terminally ill and wish to end your life by medical means.
In practically every state, this is prohibited.
The State prevents medical professionals from ending your life, even if that is your wish.
Meanwhile we know that a huge proportion of medical expenses occur in the last year of a person's life - as much as 77 percent of Medicare costs, for example.
A libertarian believes that a person's life fundamentally belongs to them, and that if they wish to end their life by medical means, they should be permitted to do so.
Of course safeguards would have to be put into place - the opinion of a mental health professional to ensure the person was of sound mind and not suffering from depression, for instance.
Can it happen? you may ask.
Well, this is the season of miracles, after all.
It can happen, if people are willing to take control of their own lives and own destinies, and not look to government or others to solve their problems.
The result will be a freer and, yes, healthier society.