From: starr@genie.slhs.udel.edu (Tim Starr)
Subject: Re: health care industry woes
Organization: UDel, School of Life & Health Sciences
Date: Sat, 21 Nov 1992 12:49:34 GMT

In article <1992Nov20.194512.24719@u.washington.edu> roth@math.washington.edu (John Roth) writes:
}Leaving pricing to the parties involved is an alternative.  Mind you, I don't 
}have particular philosophical affection for government involvement in the 
}health insurance business.  But it has happened, and were not going to 
}our collective mind, so let's make it work.

But whether or not it can possibly work is precisely what I challenge.

}However, Libertarianism is an already tried-and-failed philosophy of health
}care in general.  I'm not saying there is at all a plain need for governement
}insurance, but there is an obvious need for licensing of physicians and 
}regulation of drugs and treatments.  Medical fraud is widespread now, it is at 
}least avoidable by carefully choosing a liscenced physician.  One can be sure 
}that prescribed drugs are proved safe and effective.  There is no alternative 
}to government standards for medical practice, except to educate everyone as a 
}physician.

This need for licensing and regulation isn't obvious to me at all, and I
prefer not to take such things for granted, given some knowledge of history.

Fraud is unlibertarian.  We have laws against it, and they should be strength-
ened if they're inadequate to optimally minimize the offense.

However, licenses are no guarantee against fraud.  It's possible to defraud
the agencies which grant the licenses, or to forge the licenses themselves.
The burden of proof here is to show that licensure does a better job of
minimizing fraud than free-market means (including the legal system for
the sake of argument), and that unlicensed but potentially qualified
physicians are properly obligated not to offer their serivices on the
free market.

There isn't any such surety that prescribed drugs are safe and effective,
either.  AZT is fatal.  There are no long-term survivors of AIDS who are
on it.  Yet it's prescribed for AIDS patients, isn't it?  If it hadn't been
for bureaucratic delay, Thalidomide would have been marketed and damaged
babies despite this ostensible guarantee.

Furthermore, by what right are those who know what drug they need prohibited
from buying it the same way they buy cars - through mutual consent with
a seller to mutual benefit?  Why should any paternalistic authority have
to be consulted?

The case against prescription laws seems easier to make to me than the
one against licensure, although I believe both can be done successfully.

To claim that there is no alternative to goverment-mandated medical practice
standards other than educating the public strikes me as an exagerration.
I can see no reason why the application of force and fraud through government
should result in better standards than peaceful methods, and can think of
many reasons why they should result in worse ones.

For one thing, just as truth is the first casualty of war, so is knowledge
a casualty of force on a micro-level.  If the government maintains that
allopathic treatment for an illness is the only safe one, and it keeps
others from practicing homeopathic treatments by force, it doesn't prove
itself right, it only restricts the flow of information.  Government fiat
needn't correspond to reality.

Tim Starr - Renaissance Now! - Think Universally, Act Selfishly
starr@genie.slhs.udel.edu

"True greatness consists in the use of a powerful understanding to enlighten
oneself and others." - Voltaire
Newsgroups: talk.politics.medicine