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11A133
Fitness
by Jim Davies, 10/28/2011
None of the present applicants for tenancy of the White House are nearly as well qualified to speak about health care as Ron Paul, for he has been a physician all his professional life. He knows the American health care system from the inside, so is particularly well fitted to the task of reforming it. His web site page about the subject gets the headers exactly right: "DO NO HARM" and "FREEDOM NOT FORCE." Under the former head he spots the key to proper reform; he says he "ensur[ed] his patients received the best care he could give them, even if they could not afford it." This is the way physicians used to provide their services, before government entered the scene in the late 19th Century. They charged fees directly (and without any paperwork other than a one-line handwritten invoice such as "To professional services rendered on October 25th") and if they sensed the patient was indigent, they waived that fee. One might think that would leave these highly skilled professionals short of moolah, but it's not so. Their expenses were light; few would employ more than one assistant, and frequently none at all; and they had to account to no bureaucrats or insurance companies for what they did. So the fees they charged were close to gross equals net; they could afford to donate their help occasionally, pro bono publico, without heavy impact on their living standards. Further yet, they had no monstrous student loan to pay off, for training was simpler and often on the apprentice model. Finally they had no need to make expensive provision for malpractice insurance, because juries of that time empathized with their local doctors and knew that it's human to err; the humongous damage "awards" of recent years would not have been contemplated. That system of health care was not perfect; ill-educated "quack doctors" gave poor quality service and provided the excuse for government (State ones, at first) to intervene with requirements that none practice medicine without a license. It's gone downhill (or rather, uphill in terms of cost) ever since. The enormous present cost of staying healthy results first and foremost from government participation in the process. At 16% of GDP, Americans spend much more than people in any other country - and two thirds of that spend comes from government, ie taxpayers. It results secondly from the fact that with insurance (of any kind) the apparent cost of obtaining care is much less than the total cost. The primary reason for the growth of health insurance is again the fact of government intervention, but that is its effect; when an office visit costs $20 out of pocket instead of $100, there are a lot more office visits - it's simple price and demand. Health insurance entered the scene big-time because employers competed for labor with tax-free benefits, half a century ago, and this was a big benefit because health care had already become expensive due to licensure, as above. Since then, it's grown like a fungus and now is provided largely at taxpayer expense (meaning that it's not truly insurance at all) - which brings us to Ron Paul's second header, above.
It remains to ask whether Dr Paul's presidential proposals do that. Unfortunately, they do not. His two headers, above, are fine; and the goodies he lists under them are fine too, as far as they go. But they don't go very far. His ten "bullets" are all good, and will each bring about small improvements and cost savings as he promises; but all ten of them apply to the overall system as it is. There is no word about the huge, wholesale reform required and described above - even though (for one example) as Chief Executive he could readily begin the process by instructing the FDA to handle applications for new drug approval in three months instead of several years. When all ten are implemented, America will still be spending about 16% of GDP on health (instead of, say, 1% or 2%) and about two thirds of it will still be borne by the taxpayer. In other words, Force will still be in charge, not Freedom. Ron Paul must know that this critique is accurate. He is a student of Misesian economics, he has bravely resisted every increase in government power during his long tenure as Congressman, he once won the Libertarian Party's nomination for President, he has inside experience of the industry - and he gets his headers just right; he knows the need to (as he says) "put you back in control of your health care decisions." So why does he fiddle, while America burns? I don't know the answer to that. All I know is that his proposals for health care reform are trivial, that he is missing a major opportunity, and that his platform in this area as in some others is a big disappointment. The failure adds further proof, if any were needed, that freedom can not be obtained by voting for it but only by taking it. 
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The cure for this raging fever is
therefore simple to see: the force of government must be replaced
by the freedom of the market - before the health care industry
chokes up altogether and expires. Taxpayer funding of health care
must end, as must the practice of income taxation (recall,
employers began the insurance circus so as to reduce its impact)
and licensure, reporting requirements, FDA control of drugs and
other expense-imposing government mandates must be terminated so
that even private health insurance becomes largely unnecessary,
the costs being as insignificant as they were prior to about
1900.
