This is not about refuting the entire Libertarian philosophy, it’s merely about the flat assertion that governments should have no right to regulate what we do at home, in public or in our places of business. I disagree. I think that so long as the choices we make affect those around us, the group should have access to some mechanism to to encourage or discourage behaviors that harm the group. We can decide, as a community, what the consequences are for these actions. That might involve strict guidelines, prohibitions, or just education and awareness. The point of this video isn’t which approach is most effective, but merely that the group should be able to demand social justice when one person’s dangerous action endanger the rest of the community.
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Well all I have to say about that is BULL$h!t {= http://www.youtube.com/watch?v=l6WITuzkS_g
As I pointed out on the video site, your arguement presumes that the nonworker is nevertheless cared for on the island. In fact, under a Libertarian system, no work = no pay. “Ron Paul” in your scenario can go live on the island without helping only if he is independently self-sufficent. There’s no requirement for the others to feed, house or alert him as to any rescue. Moreover, if “RP” doesn’t want to do X, maybe the group should discuss and bargain as to who does what and if any jobs should be rotated. I wouldn’t want to be 100% the “latrine person” while someone else did the fishing if I was reasonably competent at fishing. Libertarian does not mean “never cooperates” and “never compromises”. It means never FORCED to do so. As for insurance, the basic principal of insurance is that you will spend more money on the insurance than they will spend on you in the long term. Insurance companies are not there to lose money. Spreading risk means an individual can get more than they pay if the group still spends more (and an Insurer will take on a greater risk in an individual if the overall group still brings a profit). If there is NO insurance, and the Govt opts to “pay as you go” and charge via taxes for the cost, then inevitably, some people will pay more than they would otherwise and some will get more benefit than the $ they put in. The issue is then, how much risk should the group pay for and how much responsibilty should the individual bear? All the possible health impacts on babies based on what their mother did — should we charge her for it? Smoke? Should we then pay for your cancer treatment? Should we ban skateboarding or skiing because of injury risk? How much care does the “lifeboat” provide and how much control? In a libertarian system, you form your OWN groups instead of the Government imposing them. Each group makes up it’s own internal rules on payments, risks, coverage.
Wow! I really hope the comment format changes. This could get ridiculous!
I want to explain why I have no faith in the chart you show at 5:17.
I went to the ER a few years ago with a case of acute bronchitis. It was a Sunday. I began getting ill on the previous Thursday. I coughed blood on Saturday. I could tell that something was wrong with my right lung. It hurt when a breathed. I woke up Sunday morning feeling like death warmed over. I had a fever and I wasn’t breathing well. I was scared. I had no idea what was ailing me. I was afraid I had lung cancer.
I arrived at hospital ER and was given an EKG. I knew I wasn’t having a heart problem. The EKG was perfectly normal. They took blood and didn’t tell me what they would do with it. I got a lung x-ray. Was given some oxygen, and walked out with prescription for an inhaler and antibiotics. The total time in the emergency room was less than one hour. I recovered quickly from the bronchitis.
About two weeks later I was billed $4,500 from the hospital. I called them and explained that I didn’t have that kind of money. Much of the bill was for lab work on my blood to see if I had a heart attack, but my vital signs and EKG were perfectly normal. The hospital billing person told me that I could receive a discount if I paid early. I asked how much I needed to produce and she told me 15% of the bill and I would be clear. I went to the hospital and cut them a check for $650 on the spot. I was also billed for the x-ray. This cost $40. I wonder if the $4,500 – $650 balance is included in the total on your pie chart.
I then received a bill from the ER doctor. He wanted $950 for his services. I thought this was gouging. I wasn’t at the ER for more than an hour. I know he wasn’t on the case the entire time. He looked at an x-ray an ekg and some lab work and wrote me a prescription. I called his billing people but they would not negotiate the price down. I offered him $300 for his services. They won’t take the offer. It was $950 or nothing. I went back to hospital and the social worker was able to forgive the bill. I asked for documentation on the invoice the word “charity” was written, so I know that $950 is included on the total on your pie chart.
My assessment from this experience is that hospitals and providers who work in hospitals over bill people who have no insurance. I understand that medical degrees and malpractice insurance cost money, but the rate I was billed at was completely insane. The procedure that involved the most expensive equipment was the x-ray. It only cost $40.
Since that hospital visit a had cataract removed by a first rate ophthalmologist. When I called him they quoted a price of $225 for the initial examination and $2500 for the cataract removal. The $225 brought me about 90 minutes of doctor face time and examination on several extremely expensive looking pieces of equipment. The $2500 brought me an outpatient procedure complete with anesthesia. I have a DVD of the procedure. It took about 20 minutes, but it is very exacting and risky work. I also got two follow up visits included in that price. I didn’t negotiate the price at all. They advertised it. I paid it.
I think the over billing is the more important issue to deal with than getting everybody insured. I think there is a kind of unholy preferred customer alliance between hospitals and insurance companies. I’m sure that if I had insurance when I had the bronchitis they wouldn’t have paid the hospital $4,500 and the doctor $950.
Hospitals bill only very loosely based on the cost of materials and equipment needed. The reasons that bills for the same procedure can vary so widely from hospital to hospital is that hospitals have a lot of overhead, nurses, lab techs, managers, sanitizers, cleaning staff, laundry, sterilization, etc etc, and that overhead is worked into the bill based on formulas that vary from hospital to hospital. As to why the doctor charged you so much…I have no idea. Also, it’s possible for there to have been a heart attack, and the ekg after to show normal…hence the enzyme studies.
No way in hell what they did for me was worth $4,500 dollars.
I was on a bed in the ER with a disposable sheet. I didn’t utilize the laundry service. A car dealership has cleaning staff, but you don’t get nearly as much variance from car dealership to car dealership in the price of a vehicle.
“Also, it’s possible for there to have been a heart attack, and the ekg after to show normal…hence the enzyme studies.”
I had no symptoms of a heart attack. The pain was on the right side of my chest and it only hurt when I inhaled. Anything is possible. That doesn’t mean it’s reasonable to test for everything. They didn’t test me for TB. That would have been more likely than a heart attack.
There is also that matter that hospitals have to cover those who don’t pay, especially in the ER, which the poor frequently use as primary care adding a very large number of unpaid visits, by splitting those costs among those who do.
Don’t make me go through the whole deal about how heart attacks don’t always have classic symptoms, and they couldn’t know you didn’t have a heart attack without testing you. What I would have tested you for was a PE, though.
I’m not going to say for certain there wasn’t something shady going on, I just want to point out that it’s not as simple to price hospital care as it is a carton of milk.
“Don’t make me go through the whole deal about how heart attacks don’t always have classic symptoms…”
Most do. Silent heart attacks are not very common, especially in people in their early forties with no risk factors. A pulmonary embolism? These usually involve cardiac symptoms. I had a fever. The diagnosis of bacterial infection was fairly obvious.
“There is also that matter that hospitals have to cover those who don’t pay, especially in the ER, which the poor frequently use as primary care adding a very large number of unpaid visits, by splitting those costs among those who do.”
This is why we need public health care. Hospitals should not be forced to tax everybody who walks in the door because some people can’t pay anything. Every other civilized nation in the world has it.
I agree completely. And we need tort reform, so that medical professionals can practice for the patient, instead of for the lawyers — which is what I think was going on in your case.
(And a PE doesn’t always have cardiac symptoms, my daughter’s got misdiagnosed as a respiratory infection twice before someone finally got it.)
If the government would stop mandating that a doctor review every case the cost would probably drop quite a bit as well. From the sound of it, a nurse practitioner could have taken care of you just fine… Instead, you were charged for a doctor, along with the fees, taxes and other costs incurred by hiring the doctor (malpractice, 8 years of medical school, etc) when someone with quite a bit less expertise would’ve done an adequate job.
There’s no reason to drive a nail with a sledgehammer and there’s no reason that anyone with some basic medical knowledge and internet access couldn’t have come to the same conclusion as the doctor did.
In my experience (my wife worked at a hospital for a few years checking people in and out of urgent care) hospitals have a standard protocol of overtreating patients. Partly to avoid malpractice but mostly because everything that was done for you that day would’ve been paid for by insurance, no questions asked. It’s like taking a car to a mechanic and telling them repairs will be covered by your collision insurance no matter what they need to do to fix it. You’ll get a lot of unnecessary services. The problem is that hospitals are not allowed by law to follow different procedures for patients without insurance; so they end up overtreating and overbilling everyone…
Government interference is at the root of the problem. Over half of all US medical costs are born by the government in the US and people with medical coverage don’t bother shopping around for cheaper cost of care. At the same time insurance companies are required to pay for any costs incurred during a hospital stay. This leads to massive overtreatment and huge bills for simple services. The same people who run the government agencies responsible for health care either currently, at some time in the past or at some time in the future are part of the “private” health care industry. Even while in office they receive quite a bit of under the table stuff from the industry they’re supposed to be regulating.
In other words they have every incentive to raise the cost of care and no incentive to please the taxpayers by lowering costs since taxes are taken by force rather than voluntarily paid to the government. And “consumers” of this “free” (read: paid for by someone else) health care have no incentive to reduce their spending on health care since it doesn’t cost them anything personally.
@Josh Acquard
While the American system is poorly designed if you meant to assert that government interference itself is bad your conclusion does not follow from your evidence. The UK system which is less than half the price (per citizen) of the American one and gives better outcomes than the American one. This does not mean that it is good, just that the less regulated American system is worse. The fact that the American regulatory framework is stupid does not mean that regulation is bad on principal.
The most obvious example of where subsidy is good is that you DO want to pay for everyone else’s vaccinations, as they are not 100% but having others protected reduces infection and reduces spread and therefore protects you.
Note also that for-profit unregulated hospitals have a huge incentive to over treat for profit. So saying that over treatment would be solved by reducing regulation is at least an unfounded assertion, unless you have some comparable system to use as evidence. Also how often do heart attack victims get to shop around?
Just because having everyone vaccinated is better than having only some people vaccinated doesn’t mean that you have the right to use force to pay for it. What gives you the right to pay someone to point a gun at me to pay for anyone’s medical costs?
I may want to pay for vaccines for other people. You don’t know if I do or not. My point is that just because one or more parties are willing does not change the fact that some are not. Rape does not equal making love and theft does not equal charitable contributions. Regardless of what the money is for, taxation is theft and forcing people to pay for services they don’t want to pay for is wrong. As is telling people what they can charge for a service and who they can accept payment from.
For profit hospitals only have an incentive to overtreat because insurance companies pay for services that are not needed. In many cases they have to pay for these services by law. As I mentioned, hospitals are not allowed to change the level of care in order to save patients money and so they overtreat the patients that can’t afford it in order to get the maximum payout from the ones who are covered.
Emergency care patients could shop around ahead of time. All they need to do is have a medic alert bracelet (similar to an allergy bracelet) with their preferred hospital listed on it. I’m not saying that it is the normal practice for people to have one. What I am saying is that it is possible, especially if you’re conscious to tell EMTs where to take you. Unless local regulations require that you be taken to the closest facility. In that case you are again being forced to use a service that you do not want.
@Josh Acquard
I will start with your emotive read herrings
Do you actually know the law in England at all? Cops do not normally carry guns and are not allowed to use lethal force unless you threaten someone else’s life. Equating tax to rape and theft is also a good touch, nice debating strategy there.
On to your real arguments
1. that the government does not have the right to infringe on your property.
All rights are relative. The American constitution and the British system of laws do both protect from UNREASONABLE government imposition but I put that word in capitals for a reason. There is no protection from reasonable imposition. If society thinks that taxes are reasonable then you either need to change society or move before you have any right to complain.
2. that “profit hospitals only have an incentive to overtreat because insurance companies pay for services that are not needed.”
Sorry but no. If you can afford a treatment and it can be made to sound necessary then there is a profit incentive to do so even if it comes with a hinger risk of death. If there is a less effective treatment that gives a higher total profit, then there is a incentive to use it. Without several years of training you have no idea when they are exaggerating or overstating their case.
Insurance increases the amount of treatment you can afford both for good and for ill, but does not cause the problem. Removing it won’t solve anything, cutting the total amount of good treatment along with the bad. (America’s bad regulation is *still* not an argument against others more regulated better designed systems)
3. “Emergency care patients could shop around ahead of time”
I used heart attack victims for a reason, for several types of urgent care getting to the hospital fast has a huge affect on survival rate. You can shop around but you are much more likely to die if you do, how is this any real choice?
I’ll answer your points in the order you’ve given them. “Cops do not normally carry guns and are not allowed to use lethal force unless you threaten someone else’s life.” So if they came to take you to jail for non-payment of taxes and you fought them with lethal force, as you might any kidnapper, they wouldn’t use lethal force against you?
1) “If society thinks that taxes are reasonable then you either need to change society or move before you have any right to complain.” So If society felt it was right to execute me for having blue eyes (or enslave me based on the color of my skin) you would expect me to move out of the country? Just because “society”, which is really just a group of people, says that something is right does not make it so and how could I change society without speaking out against the injustices that I see? (what you’ve called complaining)
2) You have a point that both good and bad treatment will drop (temporarily) if insurance is not forced upon people. The benefit that I believe would come out of it is that the cost of treatment overall would drop and people would be able to afford more treatment on their own. For the record I am also for having less barriers to entry to allow more competition. Competition almost always leads to innovation, greater access to a product and lower prices.
3) “You can shop around but you are much more likely to die if you do, how is this any real choice?” There is an option, therefore it is by definition a choice. Just because you don’t like the options doesn’t mean there is not a choice available.
From Wikipedia: Choice consists of the mental process of judging the merits of multiple options and selecting one of them.
Here are a few points that you didn’t bring up.
1)If I have something that you think you need and you convince the rest of the town that we live in that you need it. Is it right for you to demand that thing of me? If I try to stop you from taking that thing, am I then a criminal?
2)You assume that taxation is NOT theft. How so? Explain to me how a person taking something from me without my permission is not theft. Also from Wikipedia: In common usage, theft is the taking of another person’s property without that person’s permission or consent with the intent to deprive the rightful owner of it.