There is an unstated context behind the health care debate. Those who prefer government management of medicine have a wider agenda: they hate the idea of a free market in medicine because they hate the idea of free markets in anything.
Of course, an actual free market in medicine disappeared long ago. What remains is so heavily regulated by the federal and state governments that it is beyond recognition. The U.S. government directly pays for, and therefore controls, half of medical care today. We are only fighting over the remnants of a bygone era.
All the more reason for a vigorous fight.
The private medical practices and partnerships that remain today are, at their core, small businesses. They struggle to survive under more government-imposed burdens than most businesses. Medicare and Medicaid regulations place an enormous administrative load on even the smallest practices. Add to that similar regulatory regimes in 50 states. And those regulations have established a pattern for private insurance companies. This has imposed a growing and costly burden on private practices. Any physician who cannot manage a complex accounting operation and legal compliance with more than 100,000 pages of regulations cannot remain in practice.
Unfortunately, not all physicians resent this. A few even embrace the idea of a total government takeover of all medical payments. A supposed opinion poll reported a few years ago by a comedian, about young people starting their working careers, explains this. Half said that the greatest threat to achieving their career goals was the government. The other half said that they had no goals but wanted a job working for the government. In the case of physicians, those who want to toss away their own freedom to practice medicine in return for obedience to the new government masters of medicine must not be allowed to take the rest of the profession with them.
Most physicians are small businessmen. If they are to survive, it must be as businessmen. That is why those who hate business hate physicians in private practice. Before Obamacare passed into law, an editorial in the New York Times attacked private physicians as “unabashed profiteers” because they (instead of the government) “decide what medical or surgical treatments are needed.”
The threat of the absorption of all medical care into the loving arms of politicians, whom we all trust so much, is made possible by a fundamental economic error and a fundamental moral error.
The economic error is the illusion that the government can create medical care.
The government cannot provide medical care or anything else to anyone that it does not first expropriate. It can seize the practices of physicians and replace their decisions about patients with those of government boards. It can pay medical bills only with money taken from individuals and employers–or by imposing reimbursements that do not cover a physician’s or hospital’s costs.
Ultimately, business activity must finance all medical care.
But the most important error is moral. The right to make medical decisions is destroyed by the deception of a “right” to medical care. That false right requires that medical care not be allowed except by government permission. What the government cannot create, it can only take, regulate or forbid.
The quality and growth of medical care requires that physicians be left free to literally mind their own businesses. I know that, though I am not a physician, because I am an American businessman. Like my fathers before me.
Richard E. Ralston
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