Many who advocate universal health care want the government to simply help pay the tab for people who need medicine or need to go to the doctor. What about a system where government co-pays for health costs instead of taking control of the hospitals? I don't like taxes anymore than anyone else, but many Americans can't pay health costs and many insurance companies are just as dubious as the government when it comes to health standards.

Forget that plan. It is government subsidy, mandates and regulation that raises the cost. If they'd just get out of it altogether, the price would come down to the point where voluntary charity could pay for those without coverage.

There used to be a time when a doctor would take a few eggs or some other item in trade for treatment. Most healthcare providers want to help people, but can't afford to deal with government regulations without charging enough for support staff.

Every style of providing healthcare involves choices. Face it: spending enough money to prevent Death is a very expensive proposition. (Can't be done, only delayed.)

The only question is who gets to make the choice for you? Will you like the corners voters, their elected representatives and government employees, cut for you?

In a room of 100 sick and injured, will a politician choose to treat the 99 people (voters) with a broken toe or sniffles? Or will he choose to treat your quadraplegia, given the limited budget?

There are 2 fundamental questions that libertarians must ask themselves when addressing this issue.

1. Is the profit motive irreconcilable with dispensing medical care? When can it be applied, and are their cases where it should not be applied?

2. Are there instances where economic theorems trump human life? I think a large portion of that answer must lie in one word
- "responsibility" A alcoholic who drinks themselves into a new liver has to be treated differently than those who take care of themselves, and those who fall ill through no fault of their own.

I personally have experienced what I regard as declining care standards during my cancer treatment going from non-profit to profit based institutions. As I regard a more humanistic and less doctrinaire libertarianism critical to growing the party, I'd like input into these questions.

We have abstractions of policy covered. Lets take it to the next level. What common assumptions of libertarianism might NOT be moral or correct in issues of life or death?

I'm interested in real discussion, not "my position is more libertarian than yours".

'the price would come down to the point where voluntary charity could pay for those without coverage.'

I dont think thats a given at all. Healthcare is not a computer or a widget where economies of scale, supply and demand, can play a part. The demand part of the supply and demand equation is not constant or predictable, either in cost or supply. Therefore, half of your free market solution is missing it's incentive.

There is an additional moral imperative to health care at the point of care that other concerns don't have to deal with. Human life will always and properly trump questions of economics. This isnt 1868, where doctors would take barter. We have 330 million people.

I'm tired of the pat LP charity argument. How we get from here we are now, which is a terrible system, to a better one, so our candidates in 08 can campaign on it and it doesnt sound nutty or heartless?

and Sandra, I can tell you from personal first hand experience that replacing "government employees" with "for profit private insurance carriers" that the results are about the same or even worse.

If you have a bean counter controlling medicine, it matters not if it is a government bean counter or a private insurance bean counter. The end result is the same. Things that should be done for the patient are not done or done half assed.

I believe in all cases, the doctors and care team closest to the patient must be restored to be the decision makers. In many for profit hospitals, they are no longer in that role. They should be.

Go back to questions 1 and 2 in my first post.

The LP does not question itself and it's basic assumptions nearly enough. If you dont do this, you cant ever grow. It's entirely possible that pure libertianism suffers from the same problems that pure socialism, or pure capitalism does. There are times when it simply does not work.

There is no one size fits all solution to the health care problem. The flaws in the system are many and require many solutions.

-The many government regulations add to the cost of doing business for insurance carriers, doctors offices, hospitals, and drug companies. They ALWAYS get passed on to the patient.

-There are more patients than medical staff and hospitals, partly because of the regulations placed on facilities, partly because we need smart people in these jobs and our public education system is failing, partly because we cannot self medicate or are sometimes required to go to one doctor just to see another. People should not be restricted from seeking out treatment of any kind on their own. Alternative medicines and treatments can go a long way to easing the burden on doctors and hospitals.

-People don't take care of themselves as well as they should AND when we want to care for ourselves we have restrictions placed on us that do not give us the freedom to choose our own form of treatment.

-Regulations prevent insurance carriers from providing differing levels of coverage; the cheaper coverage would only be for catastrophic or unforseen illnesses such as non-auto accidents, cancer, strokes, etc. Many insurers offer unnecessary perks such as gym memberships and massage therapy just to differentiate themselves from their competitors because regulations make them all pretty much the same when instead they should be able to offer levels of coverage relative to cost AND risk. A smoker should pay more than a non-smoker. Obese people should pay more than thin people. There is no incentive for people to make themselves healthy when they can hit up the insurance carrier for a gastric bypass.

-Tax burdens contribute to the inability of many folks to afford insurance (which would be cheaper if not for the above reasons) as well as doctors and hospitals being taxed so they raise fees.

-Private charity could not cover the 40 million uninsured now, but with steps taken to alleviate the above problems there would be far fewer uninsureds for charity to help.

-There is not enough competition between insurance carriers; many employers make a blanket choice for their employees rather than offering multiple choices which would lower costs through real competition.

-Prescription drugs are too expensive and that will only change with deregulation. Private consumer groups and doctors can evaluate drugs for effectiveness and safety far better than our inefficient government bureaucracies.

-Malpractice insurance is prohibitively expensive driving up costs or sending would be doctors into the legal profession because that's where the money is. If government does one thing to check rising health care costs it should be capping punitive damages - cap, not eliminate. $50 million is a tad much for screwing up a surgery. Sue to fix the surgery, cover lost wages, maybe even a little (say $250,000 max) for pain and suffering or inconvenience but these lawsuits are ridiculous and they overburden the courts as well as raise the costs for everyone else.

-Hospitals should be triaging appropriately - ear aches go across the street to urgent care, not the ER. If urgent care facilities are too few, municipalities can set up their own if they feel government must provide something, but the federal government and even states for that matter are far too large to effectively understand local needs and Hawaii shouldn't be paying for Maine's health care. Similarly, large cities obviosuly have a greater burden by shear numbers. They should not be subsidized by the rural and suburban areas that have lesser people and fewer overburdened facilities.

-If there is any kind of publicly funded benefit, it should not be provided to non-citizens. Hospitals can still treat real emergencies but send a bill. Collection agencies will have plenty of new employees when we cut out inefficient government bureaucrats. There are many charitable folks that would set up more free clinics or charity hospitals if they could afford to do so. Less taxation and regulation would help them do that.

More ideas are always welcome. Let's figure this out and make it an issue in 2008 to counter the socialized medicine plans that will break this country.

Tim, I feel you. But are you questioning "pure" libertarianism in general or specifically libertarianism as it applies to federal, state and local governments?

I think a federal government that is very libertarian is a must. Both theoretically and morally. As well as State. But as we progress down to county and city governments, I think competing forms of governments is a good thing, even if those forms are not libertarian.

If people living next to each other voluntarily give up their basic rights for some security, it is their right to do so. Especially if it allows for those that don't want a part of it to move away without much tribulation (such as learning a new language, new currency, etc).

A libertarian federal government allows for socialist communities, but socialist central governments won't allow for libertarian communities.

Part of the problem is government suppression of free markets in health care.

Look at cancer, for instance. There are literally scores, maybe hundreds, of effective cancer treatments, most of which could be quite inexpensive. But the medical establishment, using the coercive power of state and federal governments, suppresses the use of all but a very few of these in the US.

There is, in effect, a state religion of conventional "science", which mandates that very few treatments except cut, burn, and poison (surgery, radiation, and chemotherapy) can be legally used as a treatment for cancer. Numbers of people, included licensed medical doctors, have been persecuted and jailed for using other means.

What business is it of the state, or any other person, if a person wants to treat their cancer with laetrile, or Vitamin C, or hydrogen peroxide, or hydrazine sulfate, or Hoxsey formula, or Essiac, or electro-medicine, or ozonation of blood, or anything else?

Medical insiders have revealed that thousands of patients every year receive chemotherapy which is known to be ineffective in their conditions.
Why do the same people who needlessly and brutally poison thousands every year get to decide what I put in my body?

What if I could use absolutely any means I wanted if I had cancer? What if I could research with Consumer Reports or Underwriters Laboratories, talk to doctors and researchers, and decide for myself what treatment to pursue? What if all of the many treatments could be legally sold in the US? I believe that there would be an incredibly robust market in cancer treatments, medicines, and supplements. The cost of treating cancer with any means -- even surgery, radiation, or chemotherapy -- could fall dramatically in response to the competition.

There is no way to lower the cost of medical care without doing one of two things:
Shift the supply curve to the right
Shift the demand curve to the left.

If you've seen supply and demand diagrams, you know what I'm talking about.

State control of medicine shifts the supply curve to the left (wrong way) by discouraging people from entering into or staying in the medical profession.

State control of medicine shifts the demand curve to the right (wrong way) by shifting the cost from the receiver of the care to innocent third parties.

Lastly, and simply, it would probably be possible, were we to spend our entire GNP on it (12 trillion dollars) to add 10 years to the lives of thousands if not hundreds of thousands of lives. One problem. Lots and lots of people would starve. A working economy is needed for survival. Don't fall into the 'medical care is necessary, economic growth is not' trap. As long as people are starving in the world, economic growth IS an economic imperative. Slow economic growth, more people die. And that is just one of the awful results that would come from Medical Security.

'What business is it of the state, or any other person, if a person wants to treat their cancer with laetrile, or Vitamin C, or hydrogen peroxide, or hydrazine sulfate, or Hoxsey formula, or Essiac, or electro-medicine, or ozonation of blood, or anything else?'Look at cancer, for instance. There are literally scores, maybe hundreds, of effective cancer treatments,

I dont buy it. If they were as effective as you claim, the marketplace would quickly choose them instead of what has been chosen.

becuase it might be a bunch o quacks peddling garbage just like the 50% alcohol "patent" medicines of the turn of the century? Thats what happened the last time we had a "free market" in medicine. We also had a lot of people turned into
morphine addicts. The only saving grace is that the stuff was cheap. Most poeple didnt have to commit crime to buy the stuff. That alone is a great thing.

We should treat ALL drugs as prescribed through doctors and delivered through pharmacies, with the government supplying the dope. Drug crime would vanish. The vast criminal gangs would die. The addicts would be into he medical system without fear of arrest or jail and could be treated.

'Why do the same people who needlessly and brutally poison thousands every year get to decide what I put in my body?'

maybe becuase it works? I dunno about you, but in my case my 'poison' known as Temodar is the only thing thats kept me alive this far. Maybe because it works and it's state of the art in brain tumor treatment, proven again and again to add a year or 2 to the life of people like me with hi grade gliomas. I would be dead, today, right now, without my 'poison.' Yes, it may not work for all, but it worked for me to at least extend my life.

Please...dont recycle the same tired arguments. What can you advance as a stepping stone to get to where we are to where we want to go?

people are not receptive to a free market health care system. what can we advance as a party through our candidates that will move us in that direction without making us unelectable, which I believe the "charity" argument does without some intermediate steps? What are he best intermediate steps we could take?

by shifting the cost from the receiver of the care

so, where am I going to pull the close to a quarter of a million dollars it's cost to keep me alive his far? Who can pay for that? What my life worth in dollar bills and when do I get sentenced to death because I run over that figure? And who makes that decision?

no easy answers. But we should be asking the right questions at least. I'm just so sick of the pat "libertarian charity argument' regarding this issue. I want new thought and a middle ground between the extremes non-libertarians can see the wisdom of and vote for. It exists.

My greatest fear about government health care isn't the speculation of whether it will be better or worse that the present situation. My greatest fear is the proliferation of safety laws.

In most states you are required to wear a seat belt in a car. This is not because there was a great public outcry over the number of people being mamed and killed in auto accidents, it was so insurance companies would pay out fewer benefits.

If the government becomes our insurance company I envision all sorts of laws that no longer let us put ourselves at risk.

Smoking will soon be illegal. Kids will have to wear (dorky) helmets if they ride bikes. Forget bungee jumping, forget skydiving, forget playing hockey, etc.

We will be legislated into a perfectly safe society free from of danger and INTEREST.

I want the insurance companies deregulated so that I can get a personalized policy for me. I would join a group of like-minded people who take responsibility for their health, probably other libertarians.

If the voters, their elected representatives and government employees become the insurance company, they really will start telling me what to eat, do and wear. I already follow the Blood Type Diet for blood type B. B's are in the minority, so much of the dietary advice out there is already bad for me. What if it became mandatory? Majority rules?

It's a short step from that to prison sentences for smoking or selling Twizzlers to corn syrup addicts. (Assuming voters eventually stop the government propping up the use of corn, which they would do, if they had to pay for healthcare.)

We need choice. Consumers rule, and if insurance companies were free to change, we could make them do it.

I can fully support deregulation of the medical industry with the following proviso: That this de-regulation is coupled with an equal or greater increase in transparency. That is to say; that it become easier for the common individual to scrutinize medicine and thus make informed choices.

Without education -- without information -- there is no valid choice option. If there are no choices, there is no freedom. It's as simple as that.

Now, that being said; Tim -- I have a doctor that I visit specifically because he works with the GLBT 'crowd' (I live in an area that is highly bigotted [Phoenix, AZ], and while I'm not part of that 'crowd' I cannot abide by this.) He also works with the homeless and financially poor-off. He does this by, essentially, disobeying federal mandates and offering a sliding-scale payment schedule.

Many not-for-profit organizations do this. In the absence of regulation, it is just possible that many more doctors might choose to do this. I cannot, for myself, believe that someone who chose a profession of healing could sit idly by and watch someone suffer *for lack of money alone.*

In terms of more highly expensive treatments, such as your own, well -- I for one still support 'catastrophic' medical insurance. This would cover primarily those sorts of expenses as you yourself are experiencing.

I'm not entirely sure if it should be mandated or not (how is it libertarian to insist that others pay for your ills, just because you haven't the money to pay for them?) But the easiest way to avoid that question is to make it widely available and without third-party interception. That is, make it personally acquired at 'group rate'.

This, combined with the dismantling of the pharmaceutical companies' stranglehold on provision of medication, could radically reduce the cost of medicine for the common public. (Sure, Merck & Pfizer might complain that their costs are for research... but that research was done before them and it'll be done afterwards as well.)

This doesn't even begin to account for private charity organizations and the like.

Tim said, "I dont buy it. If they [alternative cancer treatments] were as effective as you claim, the marketplace would quickly choose them instead of what has been chosen."

Tim, my whole point is that the marketplace is not _allowed_ to choose most alternative cancer treatments, because they are illegal to use for cancer treatment in the US.

And I am not saying that any of those is necessarily effective in any given case. But shouldn't it be up to an individual, on her own or along with her doctor of choice, to decide what to try in her fight against cancer?

I am not trying to take away your chemotherapy. Of course it works for many people -- I was not disputing that. But cancer industry insiders, such as Ralph Moss, have revealed that it is grossly and negligently overused in many cases, causing needless suffering and early death. I'm glad it worked for you.

Tim said, "We should treat ALL drugs as prescribed through doctors and delivered through pharmacies, with the government supplying the dope. Drug crime would vanish. The vast criminal gangs would die. The addicts would be into he medical system without fear of arrest or jail and could be treated."

You must be joking, Tim. Giving the government a monopoly on _anything_ , except perhaps atomic weapons and such, is a mistake, and is the action which creates a black market. Without taking something away from the free market and making it illegal, a black market cannot exist.

The action which will eradicate most drug crime and drug gangs, etc. is legalization of all drugs.

If orthodox doctors today can tell me that my only legal chemical treatment is chemotherapy, that intravenous Vitamin C is illegal, what is to keep a later orthodoxy from telling you that chemotherapy is illegal?

The solution is to take the power to choose away from government and put it back in the hands of individuals -- in other words, a free market.

As for "people are not receptive to a free market health care system", I do not agree at all. As Harry Browne pointed out in his cogent dismantling of socialized medicine, as recently as the 1950s we had much more of a free market in health care, and those who could not afford to pay were cared for much more effectively than they are today.

I think much confusion in this area results from a complete ignorance of the field of praexology by most people. You cannot divorce human action from economics, nor can you divorce medical services from economics. It is impossible.

Pure capitalism has not existed in the United States, except for brief, localized periods in the 1800's. Mercantilism has prevailed in most of the U.S.'s history and more recently mercantilism/socialism. This deadly combination has shown its worst effects in the medical field. If we had been under a system of pure capitalism all along, we wouldn't even be discussing medical issues, there would be no problem.

The most obvious government interference is the blatent price supports. Medicare, Medicaid and regulated "insurance" plans, which are not insurance at all but buyers clubs. Other government interferences include patents, subsidies and corporate priviledges. And of course, the FDA, licensing, and prescription requirements further distort things.

It is going to get one hell of a lot worse, before it gets better. You will likely see the health care system totally nationalized by 2010. All health care workers, from surgeons down to lowly orderlies will become state employees as private practices are seized by the government. You think life sucks now. You ain't seen nothing yet. You wait six months and MAYBE you might get an appointment to see a doctor. You might or might not get the medicines you need as shortages will be common. And of course, the quacks that can't make it in private practice will be able to find spots in government healthcare, so if you need knee surgery, you better put a flourescent "do not operate" band on the other knee.

Timothy West said,

"'the price would come down to the point where voluntary charity could pay for those without coverage.'

"I dont think thats a given at all. Healthcare is not a computer or a widget where economies of scale, supply and demand, can play a part. The demand part of the supply and demand equation is not constant or predictable, either in cost or supply. Therefore, half of your free market solution is missing it's incentive."

And yet, we have seen tremendous cost reduction in elective surgeries and treatments, after some years of market discipline. Plastic surgery, for one, and Lasik eye surgery, for another. The cost reductions in the former benefit not only those who want to change their look, but also those who were disfigured by various diseases or accidents. Cost reductions in the latter have improved the lvies of millions. These are just two examples.

What does Mr. West have to say to the late Milton Friedman, and his essay, "How to Cure Healthcare"?

http://www.hoover.org/publications/digest/3459466.html

There are a lot of variables in healthcare, but market discipline can certainly lower the cost and improve the availability of drugs and medical technology. Healthcare may not BE a computer or a widget, but more and more, modern healthcare depends upon computers and widgets. Free market forces have shown themselves able to reduce the prices of computers and widgets by orders of magnitude.

The risk of legal liability and the cost of malpractice insurance are big forces that push up the cost of healthcare; so is the medicare requirement that indigent people must be admitted, regardless of ability to pay (or government willingness to reimburse).

Tim said, "I would be dead, today, right now, without my 'poison.' Yes, it may not work for all, but it worked for me to at least extend my life."

That's the point. It worked for YOU. Many others have died because of governmental controls on the types of care they COULD have received but didn't receive because doctors don't like to go to prison, or suffered needlessly because their elected officials have outlawed many kinds of pain medication, of the "alternative pharmaceuticals" variety. Every natural thing on this planet serves a purpose to some other natural thing on this planet, so why are some plants ALWAYS harmful. Because the government says so? Perhaps these plants are meant to cure certain ills, feed certain animals, etc. But I bet if the plant is found in Iran, Cuba, or North Korea our government would outlaw it even if it cured Cancer, HIV, or heart disease. In fact our government declined medical assistance from Cuba after Katrina because they didn't want Cuba's help. With any form of universal or socialized health care, they decide who gets treatment, where, from whom, and in what form.

Tim also said, "Please...dont recycle the same tired arguments. What can you advance as a stepping stone to get to where we are to where we want to go?"

It doesn't sound like we want to go to the same place, Tim, so that is why our arguments aren't working for you. It sounds as if you are looking for ways to get to an effective form of universal healthcare. We disagree because we don't think any form of universal healthcare will be effective. We are offering ways for free markets to solve the failures of the present healthcare system.

First, think of all the different ways people can get treatments and pay for them if the government did not regulate or enforce ANY healthcare providers (docs and hospitals), insurance carriers, medications, or procedures.

There are 40 million uninsured folks out of 300 million, or 13% of the population. Let's say for argument's sake legalization of all drugs and treatments (which would lower costs across the board for medication) cured or greatly helped 5 of the 13% and was affordable.

Let's add 2 of the 13% because more doctors and hospitals were available to treat people without fear of massive malpractice and entrepenuers built more facilities of differing kinds and treatment levels.

Add 5 of the 13% more insureds because they could now afford it through lower insurance costs because of less cost of doing business, different plan options including cheap catastrophic coverage, better competition and choice, and lower taxes for everyone.

That leaves only 1 of the 13% (or 4 million people) for charity to pay for. If 2 of those 4 million are children, state and local governments would probably provide insurance as NY and some other states already offer. So only 2 million people out of 300 million would have to rely on charity.

If Medicare for Seniors were eliminated that would add greatly to the pool of needy so to start we continue the current entitlement with new options for young people to reverse the effects in the future, much like the retirement plans libertarians have been screaming for that do not involve governemt social security.

It can be done. We just need to do it.

elective surgeries and treatments, after some years of market discipline. Plastic surgery, for one, and Lasik eye surgery, for another. The cost reductions in the former benefit not only those who want to change their look, but also those who were disfigured by various diseases or accidents. Cost reductions in the latter have improved the lvies of millions. These are just two examples.

ELECTIVE is the key word. it puts the demand back to the supply and demand equation. My opinion through my experiences in my treatment is that when the demand half is broken, market forces cant work properly. In many areas of medicine delivery,
I think it's a toss up as to if government is worse or better at actually delivering quality care than private for profit institutions. It sure has seems that way in my own experience. If anything, the government (NRC) rehab center I was assigned to by my care team seemed to work better.

We all sympathize with Tim and his on-going war with a serious disease. As such, he has insights into the American health care system that we have not(and hopefully will not) experience. I'd love to see him do a white paper treatment - say, for LIBERTY magazine - on what the libertarian position should be to deal with the realities of health care today. Face it, libertarian theory just cannot be imposed, it has to evolve from where we are today in incremental steps. And the LP has to get behind incrementalism or it is going nowhere.

Illnesses like Tim's would strain any system of charity. One answer is catastrophic insurance - the chance of needing a $100,000+ treatment is relatively small, so maybe $1,000 a year to guard against it could cover you. Don't forget that the other requirement for liberty is personal responsibility: if you could afford the insurance but went on Vegas junkets instead, or you chose an unhealthy lifestyle, then you would have to depend on charity and there being a sufficient number of sympathetic people to bail you out.

Tim West said, "ELECTIVE is the key word. it puts the demand back to the supply and demand equation. My opinion through my experiences in my treatment is that when the demand half is broken, market forces cant work properly. In many areas of medicine delivery,
I think it's a toss up as to if government is worse or better at actually delivering quality care than private for profit institutions. It sure has seems that way in my own experience. If anything, the government (NRC) rehab center I was assigned to by my care team seemed to work better."

But you didn't really address my point. Benefits of elective surgery have also lowered the cost of related non-elective surgeries. Cost reductions in ELECTIVE plastic surgery have made restorations in the case of accident and disease more successful and affordable. Advances in developing "designer" drugs have made it possible to develop less-expensive, more effective drugs for more common or more serious ailments. And so forth.

You may be right: market forces may be distorted or rendered inoperative by emergency situations. But that doesn't mean that medicine in general cannot take huge strides toward greater effectiveness and affordability, due to market forces operating in more normal, common circumstances. One thing that spikes prices is the idea that "no cost will be spared" to deal with certain emergency situations, that we will pay any price, and tap any and all wallets, to extend life even for a few minutes, a few days, or whatever. If the insurance companies or governments weren't there to provide deep pockets for costly, heroic treatment, might the ever-present reminder of LIMITED resources spur the general public to take more care of themselves on the one hand, and motivate healthcare professionals to find more affordable, effective treatments and procedures on the other?

I am not advocating that we leave people who are in dire straits to suffer or die. On the other hand, I just think we are naive, if we think that we will EVER solve some of the worst of our healthcare problems, as long as there is no need to explore cost-effective alternatives because a deep pocket can always be tapped to underwrite expensive "heroic measures." Worse, if we embrace a centralized, nationalized healthcare system because we seek to enhance the benefits of "deep pockets," we will almost certainly find that the central authority will end up rationing healthcare in a way we would not endorse. This has happened everywhere socialized medicine has been tried.

I would still like to hear your views on Friedman's analysis and prescriptions.

I just got back from celebrating my wife's birthday with a good meal, I'll look at it. Suffice it to say that I've pretty much agreed with everything he's ever said. But at the same time, I can see where

But I want more soul searching within this party. I want to challenge the pet ideas that have been floated and failed, and I want more ways that we can get to where we are now to where we want to be, which my not be the same for all of us, but always go in the direction of greater choice, lower cost,and better services. I want something we can sell in 08,'10, not some throwaway line that if you accept every part of OUR way, charity will fill in the gaps.

I think the LP has to do better. And I think it has to accept that purist philosophy's (pure capitalism, pure socialism, pure communism) have historically failed to meet every consequence of human need or desire.

There's no perfect system of anything. We do the best we can. One of the changes I would like to see is medical euthanasia. I never have been able to understand why we treat cats and dogs wih more compassion and humanity than we do our fellow humans when they are nothing but broken shells. The Terry Schiavo case really got under my skin.

Of course, the answer to that is religion, but that another issue. Suffice it to say Jack Kevorkian is a personal hero of mine. He may be getting out soon.

Thank you everyone for your comments. They were helpful.

might the ever-present reminder of LIMITED resources spur the general public to take more care of themselves on the one hand,

No, I dont think so. and even if it did, it does not address the primary question: is human life worth more than money? Unless you answer that, all else is indifferent. There's got to be a middle ground here. we can both be moral and yet offer answers that the big parties are afraid to touch, becuase they are LEADING POSITIONS that force the issue, but in a positive way.

I'm talked out for now. Hope I made some sense.

HOW ABOUT STOPPING THE ILLEGALS LIVING OFF OUR HEALTHCARE FOR STARTERS. WE ARE PAYING FOR THAT. THIS UNIVERSAL HEALTHCARE IS JUST A WAY TO SNEAK PAYING FOR THE ILLEGALS AT OUR EXPENSE.

Of course human life is worth more than money, but how will human life be saved when a universal system is taxed to the brink? The government can't even do right by the military men and woman at VA hospitals so what makes us think they will be better when all of a sudden they are managing 300 million patients?

The point is, there are many parts of the equation that free market economics, supply and demand can fix. Making catastrophic coverage available to all who have no coverage may be acceptable. Anything beyond that will break the system because there are not enough medical providers to handle the patients. The regulations mandate that every coverage be the same. the only difference in cost is essesntially the size of the group. Individual policyholders pay in excess of $1200 a month while large companies with thousands of employees get rates far lower because they bring lots of customers to the table. Regulations prevent individuals from forming groups outside of employer programs. That is bogus and a huge part of the problem. There are simple ways to fix SOME of the problems, but the regulations prevent the fixes. We need to push to break some of the regulations. It would be a good place to start.

Nick,

the VA system is so bad I wouldnt send my own father here for care. Let me b clear here - I am NOT for he advocation of universal health care across the board. That would screw things up even worse than having the insurance companies in the middle. I do think cost has no place in life or death ER situations- yo do what you have to do to save the life.

I AM for he opening of his topic to THINKING by libertarians about where we can advocate "freer" market reforms into the systems where he laws of supply and demand can be brought to bear.

IMO, *emergency* medicine cannot be totally controlled by market forces becuase the demand side is unknowable, the needs each patient has are too different, and the moral imperative to save human life trumps economics in such life or death cases.

But we can do a lot to bring it to bear in other areas of health care. Nick has several good statements. I would love to end the tax deductions/subsidies
that only businesses get and offer them to individual health groups made up of community groups. We could cluster them around each hospital
and have them teach and volunteer to earn discounts. There's all kinds of things, some better than others, but all worth discussing.

we can campaign on such things and not look like a heartless bunch of whackos. We also need to form a internal (to Congress) core of allies regardless of party that can introduce bills for us, since we cant do that. I think there are some D's and R's in office right now that would sponsor some of this stuff. We might get rid of some of the offending regulations that way. Some of the motivations would dovetail.

The point is, issue by issue, we have to brainstorm
with the talent we have and the outside thinktanks
and get a unified national message going for 08.

We have had national public policy based on fear an implemented by force of arms since 9/11. I think a case can be made and sold that we can no longer base our national policy on fear and he exploitation of that fear. It is time to move beyond 9/11 and the LP should be making that case as a body.

Think about it this way.

If the state governments can't even effectively run something as simple as their respective DMVs, then how can they be trusted to run something as complicated as healthcare.

Here in southcentral Pa, we have a very substantial Amish population. Because of their lack of SSN (or paying much taxes (if any), the Amish were not able to access medical care through MediCare. It used to be that these people traveled, by rail, to Mexico to recieve cheaper medical care.

Recently, the local Amish population got together and negotiated lower rates with the local hospital. These rates are exactly the same as the Medicare rates. It always suprises me when people talk about things the government "needs" to provide, meanwhile these simple people have been doing without for hundreds of years.

ERs already provide care in emergency situations to all patients. The problem is many times ERs are overburdened by non-emergency patients, patients that should get non-emergency care from other places but know that only in the ER can they be guaranteed treatment regardless of their ability to pay. Several of the solutions offered here are designed to free up ERs for emergency care. Making health insurance affordable to the uninsureds will go a long way to making ERs emergency rooms once again.

Tim, I am in agreement 100% that we need a push for this subject to Congress but more importantly to the public. This party has ideas that are good. The Reps and Dems can't say that with a straight face, that much is for sure. And no one would take them seriously exept their own sheep. It's too bad the LP can't come up with a good idea how to spread the message, get elected, and fix the problems...because we have the answers.

Tim West: "I'm tired of the pat LP charity argument."

And I'M tired of the ridiculous "healthcare defies the laws of supply and demand" argument. It doesn't, Tim. If you think it does, you're obviously ignorant of the abundance of economic research on this point.

How do we know that charity would cover basic healthcare (as opposed to nonessential procedures) for people who truly couldn't afford it? Because that's how it WAS before the federal government started interfering in the system.

Fifty years ago, there were tons of charity hospitals and free clinics for the poor, and cheap health insurance was available for everyone. That changed with Medicare, Medicaid, and the government mandates imposed since then. Consistent with economic theory, this has lead to a huge increase in demand for healthcare AND a huge decrease in supply, resulting in WAY higher prices.

If you don't think Libertarians should advocate removing the federal government from healthcare entirely because you think that's too radical for the public, then you can make that argument. But don't try to enlist the laws of economics to help you out.

Cant have it both ways. If you want costs to be back into the 1950's era, then junk all the modern technology an advances since made since then, and that will do 80% of the trick right there. Infant mortality was 18% in 1940. So this idea that you havent GOTTEN ANYTHING FOR YOUR MONEY is crap.

But your mortality rate will then be right back where it was then as well. Many of the costs havent been due to "government" per se ( some have ) but they've mostly been due to turning the legal system into a legal lottery and the race for ever more technology to stay competitive with other health care orgs. My Variac IMRT radiaion machine that nuked my tumor cost 1,200,000 dollars and from what they tell me, extended my life maybe 2 years.

I could have foregone the treatments, been dead by now, and your health care bill maybe would be reduced a few hundredth of a percent. But you would be rid of me.

If we had the same number of people in the LP who understand salesmanship and political involvement as we do who understand economics, we'd be way ahead. The only thing a voter cares about in economics is if their check cashes or not. Thats it.

'And I'M tired of the ridiculous "healthcare defies the laws of supply and demand" argument. It doesn't, Tim.'

In some areas it does. I've lived it - recently.

The legal lottery is a big problem, so caps on punitive damages can take care of that. There is every reason to sue for correction of a failed surgery to be paid by the liable party, but when that cost is $15,000 and the punitive damages awarded is $50 million that's a problem. The argument that huge awards keep doctors from making mistakes is bogus. Mistakes are made because of incompetence, miscommunication, or simply human error and it certainly doesn't help thinking you could bankrupt your malpractice insurer.

As for charity covering expenses for the indigent (I still maintain that several corrections in the system will make it affordable for most) it would certainly be more possible if taxes were cut across the board in most things. The price of everything would go down, so everyone would have more money in their pockets, they'd give more to charity or not need charity. Medical costs would drop because technological advances although great are not an enormous piece of the total cost. They wouldn't even be necessary in some instances because other life saving cures would not be restricted. The government has given benefits to some drug and technology companies over others which always raises costs.

They could end up keeping Medicaid because so few people would need it compared to the current numbers.

Several recent academic studies have placed much of the blame for the outsized costs of our healthcare system on three things:

1. Healthcare providers have not digitized in any significant way or numbers, and thus have not enjoyed many of the cost-savings other industries have experienced;

2. Both government and insurer regulation and bureaucracy, which combined adds an estimated 160 billion dollars in costs annually to the system. Reducing government regulation not directly related to patient safety, and freeing care-givers to make decisions without second-guessing by insurance clerks could reduce much of this bloat; and most of all

3. The lack of "ownership" for their healthcare on the part of everyone. Patients today do not get involved in their care, do not question either the efficacy or the economic efficency of their treatments. One answer to this is a "major medical" approach to healthcare where all patients assume a greater share of the burden for primary care, tests, etc while being relieved of much or all of the costs for catastrophic care.

There are certainly other issues to be addressed, but whether you look at the disaster that is the V.A. Health system, or the inefficencies, waiting times, and physician desertions of all the single-payer systems of the world, MORE government involvement is most definitly NOT the answer!

And yes...I was shouting!

Tim West: "If you want costs to be back into the 1950's era, then junk all the modern technology an advances since made since then, and that will do 80% of the trick right there."

That one statement proves you don't understand the issue, Tim. It's NOT new technology that's making healthcare far more expensive than it was 50 years ago. Look at the computer industry: computers today are far more advanced than they were even 10 years ago, yet they cost LESS than they did back then. Why? Because there's no US Department of Computing (yet) imposing reams of costly rules on computer companies and forcing some people to pay for other people's hardware/software purchases. If there were, we'd see the same skyrocketing costs in the computer industry as we do in the healthcare field today.

Tim West: "If we had the same number of people in the LP who understand salesmanship and political involvement as we do who understand economics, we'd be way ahead."

I'm not knocking salesmanship. I'm not opposed to considering the argument that separation of government and healthcare is too radical a position for most Americans. But I AM opposed to offering wrong economic arguments to back up one's alternative position.

Remove liability from the drug companies. Publish research data and let the patient and doctor consider the risks.

Abolish the FDA entirely since we won't need to "approve" one drug or another. Further, since no more LOBBYING will be needed for new drugs to be accepted by the FDA, the entire drug industry will operate more efficiently (cheaper).

Surgeons must be held STRICTLY liable for their procedures. If a surgery goes awry, the patient must have recourse.

For example, my wife elected to have her tubes clamped (reversible sterilization). The surgeon was unable to use the scopic technique we agreed to and DURING SURGERY asked me to decide if she could use an alternate method that did not appear on the release forms. She said it was usually there and didn't know why this time it wasn't. She conveniently left out the fact that a LARGE SCAR would be the result of this procedure. Then during surgery she nicked a lymph node which caused massive fluid loss. This wasn't discovered until a day later when we complained that the swelling was a real problem. Multiple doctor and nurse inspections failed to notice anything wrong. Because of this fluid LEAK, she was forced to let a 10" cut heal WITHOUT STITCHES (making the ugly scar). To top it all off, the surgeon missed with one of the clamps and a year later my wife got pregnant anyway! So what the heck IS being restricted by the clamp? Oh, since the operation she experiences pain during sex on the side with the errant clamp.

All this and no lawyer will take the case.

I think since the surgery was not successful, we shouldn't have to pay for it. Or at the very least, that surgeon should have to pay to have someone else fix all her errors.

I think if we had either FREE MARKET or UNIVERSAL health care, the problem would be fixed by now. I'll take anything over what we have now.

'It's NOT new technology that's making healthcare far more expensive than it was 50 years ago.'

that statement is so false I have no idea where to begin to start. It's not the entire reason but it's a goodly chunk. I have to go. doctors appt.

Health Care Reform would have to go hand in hand with Legal Abuse Reform. The two are intertwined. Many medical products cost a fortune because of legal costs. A wheelchair costs $1,000 while an 18 speed bicycle costs $139? Why is that?

JT: "It's NOT new technology that's making healthcare far more expensive than it was 50 years ago."

Tim: "That statement is so false I have no idea where to begin to start. It's not the entire reason but it's a goodly chunk. I have to go. doctors appt."

JT: If it's false, perhaps you can explain why costs in other industries in which technology is so far advanced compared to years ago (e.g., computers, electronics, etc) have gone WAY DOWN--after your doctors appt. of course.

i had a nice response and went off into another window and closed it down, and of course my history is set to purge.

there's no wy I'm typing hat all in again wih one hand. It will have o rest there.

The federal government caused the current problem with socialist regulations requiring employers to insure employees. These laws directly benefit insurance companys. Doctors and drug companys don't need to offer competitive prices to patients because the bill has no real meaning for them. What we get is the worst of communism and the worst of capitalism. Rapidly deteriorating quality of care and rapidly rising costs.

The answer is high deductible catastrophic coverage insurance combined with tax exempt medical savings accounts.

Im reading some of your posts and thinking maybe we've been infiltrated by "progressives"

Timothy West; In 1979 my oldest daughter required a heart transplant. Stanford University accepted her at no charge. Now admittedly they were getting grants from the Federal Government, but the point is, there are educational and research facilities all over the country that would love to provide you with the best and newest treatments for their research. These are excellent medical facilities such as Stanford, U of Michigan, and Rutgers, in fact almost every higher education institution in the country.

Having lived more decades than some of you have lived years (just kidding) I have been growing little tumors all over my body for the last three years. None have been found to be malignant, but why am I growing them? U of M loves me for allowing them to study these benign tumors and allowing them to try and figure out why I am growing them. So far, several thousand. Some get to be the size of Baseballs, but most are more like golf balls. I don't like it when they decide they want to take one out, but that's my price.

We have the greatest medical system on the planet, which is why people from Canada, Germany, England, France all come here for their medical treatment.

New technology does far more to reduce over all medical costs than it adds. I am sure you and I can offer tons of anecdotal evidence to the contrary, but it is just anecdotal evidence. In my never to be humble opinion, the two biggest forces on our medical costs are; our legal system, and our Federal Government.

I do not believe that my Doctor should have to treat me if she doesn't want to. If I can't pay her, her treatment of me should be her decision, not the governments. Medical care is not a right. If it is we are failing millions of people around the world.

Nick; When you sit down and explain a situation, nobody does it better!! Thank you for excellent posts on this issue.

Keep in mind:

HMOs were created by act of Congress

Much of the increasing costs over the past 50 years can be attributed, whether directly or indirectly, to government influences over the sector or related sectors

"My Variac IMRT radiaion machine that nuked my tumor cost 1,200,000 dollars and from what they tell me, extended my life maybe 2 years. "

There is an example of a problem with modern medicine. A $3,000,000 CNC machine will cost you maybe 5% per hour to have it make something for you VS what he probably paid to have a 1.2 million medical machine do. When it comes to machines it seems hospitals want to recoup their investments in 2 years, then keep charging the same rates anyway.

Anyway, maybe we should all just accept that life is a sexually transmitted, terminal disease and that people will die and quit trying to formulate a world where we all have to work 6 months out of every year just to save a few unlucky people.

Frankly the weak and unlucky die, that's life, that's natural selection, and we are a LOOOOONNNGGG way off technology wise from being able to effectively change those facts. We already spend a massive amount more then in the past for modest gains, mostly offset by people being fat and lazy.

Human life does have a price, your lives value ends when it makes the next five lives miserable and worthless tending to you.

Tim West: "i had a nice response and went off into another window and closed it down, and of course my history is set to purge. there's no wy I'm typing hat all in again wih one hand. It will have o rest there."

How convenient for you.

Suggestion: read a study on this issue from Cato or another research organization (there's many such papers freely available) before you spout off about it. The laws of supply and demand are real. There are NO exceptions.

"We have the greatest medical system on the planet, which is why people from Canada, Germany, England, France all come here for their medical treatment."

Um, golferhal you are entitled to your opinion. Mine differs.

Our current system is definitely a government-run system. They have very restrictive laws (VERY) on what I can say and offer to my patients. Efficacy and patient cost have NOTHING to do with these laws. Our government utilizes the "Mob rule" school of policy setting. No problem, except the "Mob" only knows what they're told.
Control the information flow, you control the "Mob".
There in lies the cause of our current situation.
The healthcare information flow is controlled by...follow the $$$$.
Lets ask a simple question.
If you are the average 55 yr old diagnosed TODAY with Diabetes, its estimated your net worth to the current 'system' via medication, tests, research for "cures", complications of peripheral neuropathies, blindness, etc. to be approximately 1.5 million dollars.(This is a conservative estimate)
How much are you worth to the 'system' if you are CURED?

T.West, you seem to be very passionate. However, I feel your information on alternative treatments is limited. Be open to things that treat the cause of your problems, not just the effects. You see, treating the effects and ignoring the cause, means you will remain a customer. Do both, and you heal. All the best.

MGordon, add in that many treatment options are decided by insurance companies. That is, this drug is covered, but that is not, or at the very least, drug A must be shown to be ineffective before drub B would be covered...etc. To me, THAT is the biggeest problem in the medical industry.

What's the solution there? The insurance companies want to guard against unnecessary claims, but statistical majority, by nature, is a total failure for at least some (the minority) of patients.

Is it just a matter of shoppers refusing policies and companies that use profit-based treatment coverage? I don't know that there are ANY insurance options that leave treatment up to the doctor and patient.

I would guess if medical insurance were to be nationalized, this would get worse, not better.

This problem should make sense and have a clear-cut answer, but I don't have it (yet).

Coach Jim,
You bring up good points, and the experience you and your wife are going through is horrible.

Health Insurance is definitely part of the problem.
As long as you participate in "their" plans, you would need to play by "their" rules.
Insurance companies are 'for profit'(typically) and pay for disease treatment, not "health-promoting" activities. (A topic worthy of an entire discussion)
The solution, most likely, lies in developing a competing system (MSA's, HSA's are examples) that relies on consumer choice, satisfaction(and transparency of consumer satisfaction), and reasonable legal recourse for mistakes and errors.
I am sure there are other options and nuances, but that is the gist of it.
Unfortunately, arguing about which procedures and medications are covered by your policy doesn't seem to produce anything. Money talks.
A national healthcare system or mandatory health insurance is a disaster waiting to happen.
My earlier post about "mob rule" and controlling the information flow is very pertinent, since the lobbyists/policy makers employed by the Insurance industry are well funded, and will look out for their own interests, period.

Look how they managed to require an insurance policy in order to open a MSA. Suggesting a catastrophic policy in addition to opening a Medical Savings Account, is one thing, but mandating it? That stinks.

Solutions? Libertarians in Washington.

MGordon

Coach, you are exactly right that a government run healthcare system would be worse when it comes to certain treatments being required before others may be tried, if the second treatment is allowed at all. Forms of treatment will be decided by lobbyists. You'd be lucky if your doctor even had two options. If Congress is going to be given gifts to decide what can and cannot be covered I hope you are all very wealthy people.

Having previosuly worked in health insurance I can tell you that HMOs kept costs down a great deal compared to other plans, HOWEVER there were many areas that costs could have been slashed even more if not for government regulations that were not beneficial to patients, such as the referral requirement. Our best HMOs were those that had a Direct to Specialist without Referral option. Non-HMOs usually offered only 70 or 80% coverage of total costs and no cost-reducing deals were made with doctors on those plans.

The point is, don't be afriad of HMOs. If your doctor is not in the network you may still go to him or her without penalty, but of course you will have to pay for the visit. If no participating HMO doctor is available, you usually have an option to go to an out-of-network doctor with prior approval (which is not hard to get when there are no in-network doctors are available.)

Another thing is that most people don't even skim over their policies when they get them, despite usually being typed quite clearly and often in laymans terms And anyone is free to call Customer Service for clarification ( make sure it is documented and get a name, CSRs are not paid as a talent based job so you know what that means). This is a huge reason people hate HMOs. They don't understand the guidelines of their coverage. They are paying to have the policy assuming it covers everything from heart attacks to massage therapy (it probably doesn't)and then they're paying extra because they went to an out-of-network doctor. Then they blame the insurance carrier. Take responsibility for your actions. Insurance helps many people get care and could help millions more if it were more affordable.

Government interference, plan restrictions, taxes, and legal costs add far more in your premium payment than the greed of insurance companies. And, trust me, I am no corporate shill. In fact, I tried very hard to make positive changes within the company. Some fell on deaf ears but mostly because they knew the state wouldn't budge on their rules.

Tim West: "i had a nice response and went off into another window and closed it down, and of course my history is set to purge. there's no wy I'm typing hat all in again wih one hand. It will have o rest there."

How convenient for you.

not really. each comment I make here or anywhere takes about 5X as long because I can only type with my right hand, one finger style. I used to type 60+ wpm before. Since my brain does not "see"
the typos I make without seeing them on screen more hn once, I then hve to go back over what I write and remover them all. I often dont get all of them.

his i a exmple of how Itpe when I do not do tese thing to make my coments more readble. As a result, it is an efort on mypar t to make s ure tHat my ommnts are reada ble. This is aa direct result of my sur gury and probab;y wo nt be re versred.

How inconvenient of you to think tHat I am ducking you in some manner without a reason.

I have to balance my effort expended with what I think will be done in doing so. In your case, not much. my response was 6 paragraphs with 4 links, and there's no way I'm going to go through that again, becuase we probably wouldnt have convinced each other of much, would we?

I choose to fight with my medical problems and continue to write because I believe I have had a impact on he LP through my past blogging efforts and I want to continue to do so best as I am able.

But ducking other commenters on the LP blog is not high on my priority list.

The simple truth about our current system is that the majority pays in far more than they use. Over the past four years my employer has payed $1,000.00 dollars a month for my single coverage policy. Thats $48,000.00 I've been to the er once in this time frame for six stiches.

Thats leaves a lot of money that should have been direct compensation for me going into the insurance industries coffers. This is just another form of socialist wealth redistribution and its unacceptable. It may sound heartless but someone elses misfortune is not my problem.

"Human life does have a price, your lives value ends when it makes the next five lives miserable and worthless tending to you."

make sure you remember that and stop all treatments on yourself and your family members in case of illness or accident. Keep your principles.

C Lang,

dont forget the your employer got to write that entire expense off on their taxes. Individuals should be able to do likewise. We also should be able to form insurance buying groups as individuals.
Transitional measures until a better system can be in place.

I hate for our corporate masters to have perks and bennies I cant get.

C Lang, actually insurance is not socialist wealth redistribution at all. It is a very capitalist venture. Companies choose to offer insurance and other benefits because that is what employees want. Most people, given the choice would rather work for a company that offers medical benefits versus one that does not. Consider it a perk, even if you pay a portion. Insurance is designed to be used when needed and it is understood that some people will benefit more than others because no one knows when you OR your co-worker will require medical care. Most companies do not require you to take the insurance they offer but they have no obligation to give you cash in place of it because their plans are designed to be group plans at lesser rates than individuals pay. It is a deal for them that doesn't translate equally to cash.

Many companies now offer high deductible plans that cost employees very little. But if you have an expensive medical problem of any kind you will get stuck with paying a large chunk before the insurance company starts to pay. Urge your company to have that as an option if that is how you prefer to receive a benefit. Insurance is a safety net against the unepected. The issue here is that the government is not supposed to be a safety net. Private companies can provide safety net services more efficiently.

As far as the tax breaks for employers go, most of the time employees see a deduction too,(usually at the time they get paid without realizing it) but what is unfair like Tim West says is that individuals should have no restriction placed on them preventing them from joining a group to get not only a better rate but the same tax deduction everyone else gets. Individual plans are extremely expensive because there is no company portion paid on their behalf.

Health insurance rates, like auto, life, and home should be based on risk level. Smokers and obese people should pay a higher premium than non-smoking thin people. The elderly should get higher rates but that can be offset if they have been insured for a long time and built up premium so to speak. It would be unfair for an elderly person all of a sudden to get the same rate as me (29 years old) when the risk they pose to the insurance carrier is far greater than mine. But, if I pay for 50 years I have contributed a large share and coudl get a discount in my later years. These are broad generalizations but you get the point. Unhealthy lifestyles contribute ufairly to the insurance costs of others. Other than a few instances such as those, an even pricing structure is good because most illnesses and injuries are unforeseen and accidental, basically. And unlike auto insurance your rate should not automatically go up just because you became ill. They should have a system where once you are in they do not penalize for future conditions.

MGordon; I didn't say our medical system was perfect, I said it was the best one on the planet and that I stand by.

If we could start reducing the government influence on the system, it would get better. If you increase government influence it will get worse. Look at Canada, they are now allowing doctors to opt out of the government system and use private insurance. Probably won't happen too much in the east, but in the western provinces it is taking hold.

golferhal, We are in complete agreement.

Cheers!

Mike Gordon

Good work on this Nick.

Private companies can provide safety net services more efficiently.

Not in my direct experience with my private insurance. I would put their level of employee incompetence and paperwork requirements up against any government agency, bar none.

Tim -- I respectfully will remind you of Benito Mussolini's definition of 'fascism'.

The American medical system is a fascist system, bar none. Fascism is antithetical to efficiency and productivity.

If the clinical process alone were utilized to determine the viability of medical procedures and the FDA removed wholesale, immediately prices on all future medications, machinery, and techniques would drop by roughly 10%, as a highly conservative minimum.

I am a former health-worker. I have also worked in medical insurance as a data entry worker entering claims into the system. I have SEEN how complex the insurance claim system is.

I also know the source of that complexity; while not wholly "to blame" it could be summed up with three letters: "FDA." This is not a conspiracist diatribe. Without the paperwork and bureaucracy existant under the current system, medical care costs would reduce by a minimum of another 10-25%.
I will be conservative and say, 25% total reduction in the immediate sense.

In engineering, physics, non-medical biotech, chemistry, there is no equivalent to the FDA nor to the levels of restrictions. In the days of snake-oil salesmen absolutely there were problems.

But I can *ABSOLUTELY* and *COMPREHENSIVELY* guarantee you, Tim, that people in your situation would be BETTER cared for in a system with even abysmal private charity but non-existent government-mandate organizations such as corporate-sponsored "Health Insurance" (as it is today) and the FDA.

Malpractice suits are also a problem, but not one I will address here.

I know as *FACT* that many medical practitioners continue to follow the old adage, "whatever the traffic will bear." (I.e.; take from your patients only what they can afford.) Making no other changes to society other than the elimination of ubiquitous "cover-everything" health 'insurance' and the FDA regulatory bodies, I can explicitly state that people in your position would find themselves still cared for -- if perhaps as charity cases by the doctors caring for you.

The key to ensuring that all of this happens actually rests, however, with the public-at-large, and NOT with the government. It will only work so long as people start becoming self-informed.

I do not use any medication that I have not examined what studies I can from my layman's perspective, and approach my doctors when seeking prescription medications already knowing the indications and counter-indications.

For those of you reading this; if you don't know what "indications" means... honestly, you're part of the problem.

We will never be free of the government until we start performing for ourselves the functions we have "entrusted" to it.

"Not in my direct experience with my private insurance. I would put their level of employee incompetence and paperwork requirements up against any government agency, bar none."

Be careful what you wish for.

I would say part of your insurance company's problems are government induced, but other than that, competition and choice would be better for everyone. If you have an employer chosen insurance carrier you and your co-workers should press for better insurance, not just on price but on service, coverage, etc. If you are paying for your own insurance you can choose a different carrier. I don't know about the laws of your state but most states require pre-existing conditions to be covered when you change carriers as long as you have had prior insurance for at least a year. It is also possible that you are an exception. You have a very difficult medical problem that likely requires numerous medical providers and each of them must submit claims, each of which must be reviewed against your policy to verify that you are covered.

Part of the problems with the services you may get or try to get that are not covered may be due to government interference, regulations, certain drugs have to have FDA approval, certain treatments are against the law because God forbid they might cure you and that doesn't do the drug company any good, etc. If the government were running your care AND everyone else's at the same time, how efficient would they be? They would have to hire the same customer service reps that the insurance company employed to take on every American's coverage and the government would have absolutely no incentive to do right by you because you can't go anywhere else. If you can't go anywhere else now I bet $100 it's because of some law restricting your choices in coverage.

And those paperwork requirements you mentioned are probably government required, or the insurance carrier does it to cover themselves against the legal machine when you or anyone else sues them for $50 million dollars whether they acted in good faith or not. I've seen customer service reps in my previous company upset so much they were crying because they couldn't help the customer who was sick or injured because of some law restricting us from paying a claim. If we felt bad, think how the patient feels. I'm sure you know personally how fruistrating it is. Don't think it doesn't happen because I've been in the middle of it. The peons in these companies are generally good people just like you and me. The laws do more harm than good when it comes to insurance companies. Years ago they were designed to protect the patient. Now they just prevent good coverage and competition.

The only laws that should exist regarding insurance carriers are:

- that they accept appeals that can go to the state insurance department if upheld (this is a useful role of government to protect against the taking of premium without the provision of coverage in accordance with your policy)

- the insurer must make claim decision within 30 days one way or the other

- basic catastrophic coverage (and its subsequently related care, ie physical therapy, medication, removal of cast, etc) exists on all plans, other plans build on that base

- rates for each person not be raised due to illness or injury while on the plan

Everything else would be vastly improved through competition. The government should not get involved in the fluctuation of rates, up or down. Options of several carriers, the more the better, will help bring prices down.

Ian hit the nail on the head:

We will never be free of the government until we start performing for ourselves the functions we have "entrusted" to it.

This doesn't just apply to health care, it applies to EVERYTHING.

I just argued a case in City Council to stop funding blight inspectors and their respective hearings court (we won). But the bottom line is that if "we the people" don't start fixing the issue ourselves, the inspectors and judges will be back.

Jim; by and large I believe it applies to "everything" as well.

I'm not at all sure about maintaining the peace nor about dispute arbitration; in fact I believe that arbitrary total force is necessary to make those two functions successful (maintaining the peace meaning the prevention/prosecution of violent crime, and ONLY the prevention/prosecution of violent crime). I recognize that, like anything other than the fact that I exist, I am not 100% certain of that statement.

But that's a conversation for another place & time.

Nick, I am aware that insurance companies are private for profit enterprises with no interest in helping others with my wealth. The problem is the government mandates that force certain employers to give these companies money (our money). This money is redistributed when healthy people don't use their share.

What I'm saying is why should my employer be in the business of offering perks regarding my health. Whats next maybe a group negotiated rate on groceries at the the supermarket to take the place of my next raise? Maybe a nice workers dormitory where me and my coworkers can live packed together like rats because subsidized housing has driven housing out of middle class price range.

Health care should be a free market. Insurance individualized to consumer demand.