Healthcare: A Libertarian perspective
Posted in Sound Off Soapbox by R Lee Wrights on February 9th, 2013 by Michael H. Wilson
Health care in the U.S. has been a hot topic of concern since the Truman Administration and it is certainly too big an issue to be dealt with in a short piece. With that in mind I would like to offer a few issues that the LP can promote as our own in place of Affordable Care Act or as it is better known Obama Care.
The government has been involved in health care since shortly after 1847 when the AMA was founded. Some have argued that it began when Connecticut passed the first anti-abortion law in 1821, which was done to deprive midwives in that state of a source of income.
The Libertarian Party supports a free and open market in health care and believes that you should have the right to choose the type of care you want whether it is traditional Asian, Western medical care or another variation.
Repeal the Occupational Licensing Laws. These laws do not protect patients but are there to protect the profession from competition. Occupational Licensing Laws and other regulations have deprived midwives, denturists, optometrists and others of an opportunity to practice and they deprive patients of a choice. Historically occupational licensing laws can be traced back to the Hammurabi Code of 1700 B.C. In the U.S. occupational licensing laws were used to keep newly freed slaves from competing against whites after the Civil War. Today these laws violate our freedom to engage in commerce with one another.
A couple of good examples where occupational licensing laws cost society and do little to help can be seen with Advance Nurse Practitioners and Midwives.
Sixteen states allow for Advance Nurse Practitioners to set up their own practices independent of doctors. In the others they are required to be supervised by an MD. Expanding the role that Advance Nurse Practitioners are allowed play will save tax dollars. Let’s repeal the laws in the states that restrict Advance Nurse Practitioners and give the public a few more choices. [1]
Nurse midwives are recognized in all states but direct entry midwives, which are those who did not study nursing, are prohibited from practicing in many states. Direct entry midwives may have learned this craft through an apprenticeship or by attending a college that trains people for this occupation. Approximately twenty-six states have some form of laws permitting direct entry midwives. In the other states direct entry midwives are outlawed thus depriving mothers of a choice. [2] Midwives deliver about eight percent of births in the nation. [3] Studies have shown midwives to be as safe as doctors and offer mothers and infants care that is as good and sometimes better. [4] Child birth in the U.S. costs about $8000 [5] for an MD to deliver but $2500 for a Midwife and often lower. With forty percent of births nationally being paid for by Medicaid expanding the opportunities for midwives would save significant tax dollars and result in healthier children at birth.
Abolish the state medical boards. In the fifty states the state medical boards are controlled by the professions and are a classic example of what is known as regulatory capture where the board is run for the benefit of the profession and not the patients. If the idea of equality before the law means anything then no profession should be treated any different than the general population. [6]
Repeal the Certificate of Need Laws. On the books in many states these are laws were originally intended to reduce alternatives to established services, but do little more than increase the costs and deprive patients of another choice. With this law those who want to open a new hospital or another facility need to prove that there is a need. [7]
Repeal the Corporate Practice of Medicine of Laws, regulations and court decisions. These laws and related court decisions were used by the medical profession to fight the growth of prepaid medical groups in the late 1800’s and later years. Today the laws may be preventing the growth of retail health clinics in some states. Retail health clinics offer a viable low cost alternative to people needing immediate care instead of running to an expensive emergency room. Retail health clinics have grown significantly since 2006 when there were about 200 nationwide, today there are about 1300 nationwide. [8]
Abolish the FDA. There is no reason that the functions performed by the FDFA could not be done by a private organization such as Consumer Union or Underwriters Laboratory quicker and with better results for consumers and do away with the need for a prescription. If nothing else we should let pharmacists prescribe medicine as they did prior to 1938. [9]
Adopt No Fault medical malpractice Insurance. I am not sure how no fault medical malpractice insurance fits into the libertarian mold because people should never be denied an opportunity to take the case to a jury. However with $250 billion spent on medical malpractice business and about 200,000 deaths annually [10] from medical errors and infections most of which are never compensated. We need to find a way to fix this system and a no fault system may be a practical approach.
[1] http://www.aanp.org/images/documents/state-leg-reg/stateregulatorymap.pdf
[2] http://mana.org/statechart.html
[3] http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5504a7.htm
[4] http://jech.bmj.com/content/52/5/310.abstract
[5] http://transform.childbirthconnection.org/resources/datacenter/chargeschart/
[6] http://www.justice.org/resources/Medical_Negligence_Primer.pdf
[7] http://www.ncsl.org/issues-research/health/con-certificate-of-need-state-laws.aspx
[8] http://www.manhattan-institute.org/html/mpr_12.htm
[9] http://econlog.econlib.org/archives/2012/02/how_to_increase_1.html
[10] http://www.nytimes.com/2012/08/01/opinion/more-treatment-more-mistakes.html?_r=0 & http://www.scientificamerican.com/blog/post.cfm?id=deaths-from-avoidable-medical-error-2009-08-10 & a very good article from the WSJ http://online.wsj.com/article/SB10000872396390444620104578008263334441352.html
Michael Wilson has been with the LP since 1980 and in that time has been a candidate three times and held numerous positions in the local and state organizations. Presently he is the editor of the Washington State party’s newsletter. Contact Mr. Wilson by emailing michaelhwilson@q.com.
