Supply-and-demand
doesnt apply in medicine declared a headline in the
Honolulu-Advertiser. The soaring cost of medical care in the
United States has moved most pundits to call for some kind of
government health insurance. And, in typical fashion, politicians
have joined the crowd by offering solutions that increase their power
rather than to examine ways that government created the problem in
the first place.
The
government has already demonstrated gross incompetence in the
management of insurance. Mandatory government retirement insurance,
the Social Security System, has never been operated as real
insurance. Instead, todays workers are taxed to pay for
todays retirees. According to Dr. Gary North, author of Social
Security: The Coming Implosion, the system has more than $15
trillion dollars in mostly unfunded liabilities that cannot be paid
off without massive future tax increases.
Similarly,
government insurance for the thrift industry left taxpayers holding
the bag for a $150 billion financial disaster...so far the largest
such disaster in world history. Government insurance penalized wise
finanical institutions by compelling them to pay premiums to
guarantee, and thus encourage, the folly of poorly run institutions.
The
government tried to salvage some of the taxpayers money by
selling off the assets of bankrupt companies. But this, too, led to
scandal when it was discovered that the so-called rescue
agency, the Resolution Trust Corporation, was selling assets to many
of the original culprits, at a fraction of the market value, and
losing all record of a billion dollars in the process.
Special
interest groups, on the other hand, know exactly what politicians are
good for and they pay handsomely for those services. The American
Medical Association (AMA) is one of the biggest lobbies in the United
States, having made $6 million in contributions during the last
campaign.
They
havent spent that kind of money trying to get politicians to
leave them alone in a free market of supply-and-demand. Indeed, the
AMA has been busy, since well before the turn of the century, in
building a government enforced cartel. Cartels seek to eliminate
competitors in order to raise prices. And government force has been
the legal tool for achieving this.
Orthodox vs. Heterodox Medicine
According
to historian Ronald Hamowy, medical practices that were officially
endorsed prior to 1850 were known as the heroic therapies.
These therapies relied heavily on the symptomatic treatment of
bloodletting, blistering, and the administration of massive doses of
compounds of mercury, antimony, arsenic, other poisons. Critics of
the profession accused them of killing more people than they cured.*
Medical
licensing laws were established during Americas colonial era in
order to eliminate rivals to the heroic, orthodox practitioners. But
most of these laws were finally repealed in response to competition
from two new forms of medicine: eclecticism and homeopathy. By 1870,
these heterodox philosophies accounted for one out of every eight
physicians in America.
Eclecticism
was developed by Samuel Thompson in 1813 as a system of medicine
which relied on botanical remedies, steam baths, and rest. Thompson
sharply criticized the heroic therapies as instruments of
death. His approach was to introduce a measure of common sense
to health care that could be easily understood and broadly applied by
the public.
In
1825 Samuel Hahnemann founded homeopathic therapy which also stressed
the natural healing powers of the body, advocating fresh air,
sunshine, bed rest, proper diet, and personal hygiene, advice that
orthodox practitioners, then as now, considered of little or no
importance. Hahnemann also stressed the importance of extremely
small doses of herbal and drug remedies at a time when orthodox
physicians were administering increasingly massive doses of
medicines.
Entry
into the market during this time, 1870-80, was open and there was an
abundance of private medical schools. Students could easily gain
admission even to the best of these schools because of the low costs.
Consequently, the number of medical graduates in the U.S. in 1880
equalled the combined output of medical schools in Britain, France,
Austria, and Germany.
Under
the guise of protecting ill-informed patients, the clear
intention of the AMA was to raise the income of their own members.
A report by the educational committee at the founding convention of
the AMA in 1847 stated, No wonder, then, that the profession of
medicine has measurably ceased to occupy the elevated position which
once it did; no wonder that the merest pittance in the way of
remuneration is scantily doled out even to the most industrious in
our ranks...
Economist
John Goodman observed that the targeted rivals of the AMA were
probably of less harm to their patients than the orthodox
practitioners of the day. Furthermore, standards that were
recommended by the AMA were so stringent that few of their own
convention delegates could have met the requirements and nearly every
medical school in the country would have been forced to close its
doors.
3-Pronged Attack
According
to Hamowy, the AMA conducted a three-pronged attack to solidify its
control over the practice of medicine in the U.S.: 1) to establish
medical licensing laws in order to restrict the number of new
physicians and thereby secure higher incomes for their members; 2) to
destroy the proprietary (profit) medical schools and replace them
with fewer non-profit institutions requiring much more extensive
training over a longer, more costly period of time to fewer students;
3) to eliminate competing philosophies of medicine.
Under
intense pressure from the AMA, and not in response to public demand,
four hundred state statutes were passed in the latter half of the
1800s which placed the AMA in control of the regulation of
medical practice. Hamowys exhaustive research found that these
laws always included grandfather clauses that exempted
older AMA physicians from meeting the requirements. Indeed, in 42
states the refusal or revocation of a license was based, not on
incompetence, but on violations of the AMA code.
This
code forbade such things as advertising or cooperating with heterodox
practitioners. The ban on advertising made it impossible for
consumers to make informed judgements about physician records of
performance, success, or even prices. Indeed, one could get more
information about a can of peas than he or she could get concerning
the variety of medical practitioners who might be asked to save a
life. And the ban on working with irregular practitioners froze
eclectics and homeopaths out of the approved hospitals.
Soon,
all other forms of healing for compensation were outlawed. According
to Hamowy, among those forbidden to heal for pay were not only the
eclectics and homeopaths but also numerous Christian Scientists and
healers by prayer, mental healers, osteopaths, chiropractors,
vitapathic healers, neuropaths, naturopaths, and those who heal by
the laying on of hands. The courts ruled that such treatments were
forbidden even if the patients knowingly accepted the mode of
treatment or even if they benefitted by the treatment.
From
1881-83 the availability of physicians was cut by 40% in Minnesota.
Commenting on these measures, the vice-president of the AMA said,
The people have awakened to the fact that there are twice as
many practitioners of medicine in this country as are commensurate
with its legitimate wants. And in 1891 the Journal of the
American Medical Association boasted that, in Illinois, The
total number of physicians in the State is less now than it was
twelve years ago.
Stranglehold on Schools
A
cornerstone of the AMA strategy was to require graduation from AMA
approved schools. AMA examinations, regardless of their relevance to
healing, were required by states in order to be allowed to practice
medicine. Passing scores were often changed from year to year in
order to control the number of applicants who would be admitted into
the profession. Then came a ploy to eliminate half of the medical
schools.
Abraham
Flexner was appointed by the AMAs Council on Medical Education
to inspect all medical schools for certification. Goodman reports
that Flexner was not an expert in medicine nor medical education. He
had earned an undergraduate degree in the arts from Johns Hopkins
University and he operated a private preparatory school in Kentucky.
But his brother was the medical dean of Johns Hopkins medical school,
which was to be his model of comparison for all other schools.
Flexner
made a grand inspection tour of all medical schools, sometimes
evaluating an entire school in an afternoon. There was no attempt
to measure the calibre of the graduates, only the equipment and
teaching techniques, which, according to economist Roger Leroy
Miller, is like assigning grades on the basis of how many hours
a student spends studying for an exam rather than on the basis of his
actual performance on the exam.
Once
the AMA evaluated all the schools on its own criteria, it obtained
legislation from all state legislatures which denied the licensing
examination to people not graduating from approved schools. The
result was disastrous to many schools. The number of medical schools
plummeted from 192 in 1910 to 69 in 1944. Even Flexners own
brother was a graduate of one of the medical schools that was closed
as a result of Flexners recommendations.
In
1928 the former head of the AMAs Council on Medical Education
said, the reduction of the number of medical schools from 160
to 80 (resulted in) a marked reduction in number of medical students
and medical graduates. We had anticipated this and felt that this
was a desirable thing.
The
number of physicians dropped during this time from 157 per 100,000
population to 132. But ethnic minorities and women were particularly
affected by these policies. The number of Black medical schools
dropped from seven to two. And the number of women physicians
actually declined over that 30-year period.
The
overall reduction in student admissions was 17%, but the number of
Blacks and Jews declined by 30%. It was so difficult for Jews to get
into an American medical school that many of them had to study
abroad. Indeed, 90% of Americans studying abroad were Jews. Even in
recent years, approximately 27,000 applicants to medical schools in
the U.S. are turned away annually.
Using
similar methods of control, says Goodman, private proprietary
(profit) hospitals declined in number from an estimated 2441 in 1910
to 1076 in 1946. And though there had been a rapid growth in the
overall number of hospitals in earlier years, this trend came to a
sudden standstill. The total number of hospitals in the country
hovered at just under 6900 for the next forty years.
Soon
the power of the AMA reached into every niche of the medical care
industry, from pharmaceuticals to insurance. Although doctors only
keep 20 cents out of every dollar spent on health care, they control
how 80 cents of every dollar is allocated. Caring for the health of
the nation has been undertaken with as much sensitivity as a surgeon
with a chainsaw.
Learning Responsibility
But
what about protecting consumers? Doesnt something have to be
done? Of course something has to be done, but it is absurd to expect
that politicians are the ones to do it. Responsible behavior is
needed and it cannot come from politicians.
Responsible,
mature behavior is something that each individual learns by
considering choices and by experiencing the resultant rewards and
penalties. That is the way that human beings grow. It is illogical
to expect that politicians can make wise choices for other people.
While politicians reap only the rewards, the taxpayers and consumers
are the ones who suffer the penalties of politically imposed
mistakes. And so, maturity is stifled.
For
several generations now, the populace has only been allowed to seek
advice from physicians who are philosophical devotees of surgical and
chemical treatments. Is it any wonder, then, that the bulk of the
population has become dependent on injections and drugs, both legal
and illegal, to treat every ailment or mood?
The
AMA could have certified its own physicians and left the
consumers free to decide for themselves what price, quality, and
philosophy of service to hire. But it was clear that the powerful
AMA was losing this battle with the public and concluded that it had
to eliminate options rather than to trust freedom of choice. The use
of force to eliminate rivals is a clear sign of insecurity, not
confidence.
Therefore,
by raising the price of physicians, low income patients were unable
to afford professional care of any kind and had to resort to
self-treatment. For middle and upper income patients it was also the
beginning of bad times--a step back to the Dark Ages. Though these
patients might be able to afford the higher prices, they had to
accept the legal fiction that there was only one correct way to be
cured.
Only
now is the medical establishment grudgingly accepting the idea that
the paths to recovery and good health are as numerous as there are
human beings. Some of the simple natural cures that were once
dismissed as quackery are now embraced with enthusiasm. How many
people had to die in this century, waiting for the medical elite to
accept successful alternatives that common folk had tried to choose a
hundred years before?
Unfortunately,
medical professionals have used politics to turn the marketplace on
its head, so that the servant, rather than consumer, is king.
Instead of doctors seeking to persuade and to please their customers
with housecalls, caring attention, helpful education, and a proven
record of success, physicians hide their record and make customers
plead and pay through the nose for a few minutes of their time.
The Broader Issue
Greater
personal responsibility is the key to increased maturity and a
healthier population. Politics can never protect us from that fact.
The
Castle Medical Center in Hawaii states in its brochures that 80% of
its patients are in the hospital for lifestyle related
diseases, meaning that people could have prevented these diseases by
making different choices in their manner of living. These choices
involve such activities as smoking, drinking alcohol, stress, not
wearing seatbelts, lack of exercise, poor nutrition, etc. Victims
of this kind of self-abuse are also responsible for the rising cost
of services to those who are hospital victims by chance.
AMA
physicians do not prevent lifestyle diseases, they only
deal with the consequences of such unhealthy behavior. And requiring
health-wise people to pay the medical bills of health-risktakers will
do nothing to change that behavior. People have to learn that they
are responsible for their own lives, that they will not live longer
simply by turning decisions over to politicians or god-pretending
physicians.
Government
protection is destroying the ability of people to think for
themselves. People frequently assume that anything on the grocery or
pharmacy shelf is OK to consume, because if there was any potential
harm it would surely have been banned by the Food and Drug
Administration. Indeed, the opposite conclusion is just as valid.
The overwhelming majority of deaths are caused by what has been
allowed by government, while drugs that might have saved thousands of
lives have been prohibited.
So
who gets to decide? Well that depends on who you think owns your
life. If you own it, then you should decide. But if you just rent
your life from the government, then you should obey the rules and
take care of the body as your owner sees fit.
Who Cares?
If
the politicians really cared about your health as much as they claim
to, they could immediately cut 30%-50% of the costs of health care by
simply eliminating all the taxes on health care providers. They
could allow you to deduct all your health care expenses from income
taxes. Politicians could even allow you to set up medical savings
accounts that would be tax-free savings like IRAs. They could
allow you tax credits for contributing to the medical savings
accounts of others as a charitable contribution.
The
problem with all of these ideas is that they reduce the power of
politicians over your life. One thing that is constant in politics,
mainstream politicians always offer solutions that increase, rather
than diminish, their own power.
*This
article is largely based on the excellent treatment of the subject in
Ronald Hamowy, The Early Development of Medical Licensing Laws
in the United States, 1875-1900, Journal of Libertarian
Studies 3, no. 1 (1979): 73-119; John C. Goodman, The
Regulation of Medical Care: Is The Price Too High? CATO
Institute, (1980); Roger LeRoy Miller, The Economics of Public
Issues, 8th ed., Harper & Row (1990); and Dallas
Cooley, M.D., How Do You Know Your Doctor Is Not a Quack?,
Reason, August 1980, 30-31. For a treatment of current
practices in medicine: Mary Ruwart, Healing Our World, Sunset
Press; John C. Goodman and Gerald Musgrave, Patient Power: Solving
Americas Health Care Crisis, the CATO Institute.
Remark: This article had been prepared by Prof. Schoolland for a talk he gave in 1994 in Lithuania, when he was asked to quickly write it out so that it could be distributed to the conference participants. It was never published (in print or online) since. And the Internet was still in its infancy. Therefore the underlined book titles or headings were not meant to be or become hyperlinks. The webmaster decided to leave them as is. But this having been a speech, it could be that some of the wording taken from the sources is lacking quotation marks in the quickly written out transcript at the webmaster's disposal. This is being ascertained at the moment, and, if necessary, will be corrected in a couple of days. So please do not assume plagiarism. The webmaster wanted to put the essay online as quickly as possible, as it has not aged at all (unfortunately, one should say!), thus is very topical, for the medical part of it, but also and above all for the marvellous general libertarian part of it. Two days before New Year's Eve it offers us plenty of ammunition to make 2005 a better year...
Mac users: Due to an HTML code error I take full responsibility for, the above page looked completely distorted to Macintosh users for a number of days. It is corrected now. I had been too much in a hurry at year's end and in a situation of great turmoil regarding my health, a situation which orthodox medicine was indeed mostly responsible for. My apologies to the Mac crowd (though that is not exactly the right word for it), but not to the state licensed crowd.
C.B.
For the article: Copyright © 1994, 2004 Ken Schoolland
You own yourself! Or do you want to be a slave owned by your government? Or increasingly by international governments? The bureaucRATS are working on it round the clock... Sorry, rats of the animal kingdom, C.B. owes you an apology!
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