From: hrubin@pop.stat.purdue.edu (Herman Rubin)
Subject: Re: health care industry woes
Organization: Purdue University Statistics Department
Date: Mon, 23 Nov 1992 19:57:20 GMT

In article <1992Nov20.194512.24719@u.washington.edu> roth@math.washington.edu (John Roth) writes:
>In article <1992Nov19.105115.24695@genie.slhs.udel.edu> Tim Starr writes:

>>In article <1992Nov17.210153.27422@u.washington.edu> 
>>roth@math.washington.edu (John Roth) writes:
>>}Those who say we need more GP's must put forward some acceptable alternative
>>}to fee-for-service.  And sell this alternative to providers, payers and those 
>>}who believe doctors are not to be trusted.  Anyone seen such a proposal?

>>Why must we provide this?  Why must we have the government mandate a one-
>>size-fits-all policy for medical pricing?  Why not leave it up to the parties
>>to the contract, the providers, payers, etc.?  What business is it of the
>>government's to meddle with this?

>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.

>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.

The last few statements are, each and every one of them, wrong.  There is not
a need for licensing, but for information.  It is unfortunately NOT the case
that a licensed physician is actually competent in a given situation, nor
that an unlicensed person is incompetent.  Libertarians consider fraud as
actionable, but right now we have government-sanctioned lack of information
about medical competence.  It is next to impossible to get any quantitative
information about the medical competence of a given person in a given area.

As to drugs, if one is willing to believe that there is such a thing as a
safe effective drug, one is either ignorant or stupid.  There must be a
continual balance, and the balance depends on the individual consumer, not
just on those of a governmental body.  Again, information is needed, and
the FDA puts roadblocks into obtaining the information.  As to the appropriate
action for an individual, that individual should have access to the information,
not just a go/nogo decision on the part of someone in the government.

The alternative is to educate everyone, or at least those willing not to
be serfs, in evaluating their individual risks and benefits and requiring
health providers to "lay the cards on the table."  And more information is
needed; physicians need to be evaluated as to judgment, ability to handle
routine cases, surgical expertise, and knowing what to do when they do not
know enough.  Right now, we have no expert diagnosticians, nor are we likely
to get any as long as government standards operate.
-- 
Herman Rubin, Dept. of Statistics, Purdue Univ., West Lafayette IN47907-1399
Phone: (317)494-6054
hrubin@snap.stat.purdue.edu (Internet, bitnet)  
{purdue,pur-ee}!snap.stat!hrubin(UUCP)