Healthcare Without Government
Joe Peacott
Economic Notes No. 98
ISSN 0267-7164
ISBN 1 85637 565 X
An occasional publication of the Libertarian Alliance,
Suite 35, 2 Lansdowne Row, Mayfair, London W1J 6HL.
© 2003: Libertarian Alliance; Joe Peacott.
Joe Peacott is an individualist anarchist and professional nurse
currently working in Alaska, USA. He is a leading figure in the BAD
Brigade whose website can be found at http://world.std.com/~bbrigade/.
The views expressed in this publication are those of its author,
and
not necessarily those of the Libertarian Alliance, its Committee,
Advisory Council or subscribers.
FOR LIFE, LIBERTY AND PROPERTY
The Therapeutic StateHealth care systems all over
the world are, to varying extents, dominated by government
intervention. Whether it is a largely 'private' system driven
by state funding and regulation, like that in the US, or a
'socialized' model like those of Canada and the UK, the state
manages to insinuate itself into the most intimate contacts between
individuals and their medical providers. Such intervention in the
health care market is advocated by its supporters for two primary
reasons. First, government is seen as the best protector of
consumers, through such methods as compulsory licensure and
accreditation of health care providers and institutions, as well as
regulation of what medicines can be prescribed and distributed, and
under what conditions. Second, in a world where health care can
quickly become prohibitively expensive and private insurance is not
always available or reasonably priced, government funding, either to
individual consumers or the health care system as a whole, can often
appear to be the only means by which people can afford to utilize
modern health care providers and technologies.Despite the arguments
of the defenders of government meddling, however, the state has shown
itself not to be a good steward of our health care. It denies us the
freedom to avail ourselves of the services of the practitioners of
our choice. It has produced an incredibly expensive health care
system which we are all forced to pay for, either out-of-pocket at
our doctor's office, with our insurance premiums, by taxation, or
through a combination of these. It lies about disease prevalence and
incidence in order to further bloat the budgets of public health
bureaucracies. It has kept life-saving drugs off the market, and made
some of those available so expensive as to be beyond the means of
many who could benefit from them. It requires people to wait months
for simple operations. It forces potentially dangerous vaccines on
children. It restricts access to pain-killers because of myths,
propagated by its own 'experts,' about addiction. It has
turned physicians into an economic and social elite who often treat
their customers with a complete lack of respect. And the individual
people seeking and receiving health care, the supposed beneficiaries
and focus of this system, are deprived of any real decision-making
power, while at the same time they are prevented from taking their
business elsewhere if they are dissatisfied.A Different
VisionAnarchists believe that people are capable of managing
their own affairs and providing for all their needs and wants without
the state and other authoritarian institutions. In a world without
government like that envisioned by anarchists, people would still get
sick and sustain injuries and require health care, surgery, and
medicines. But, because people have become so accustomed to
government involvement in health care provision at all levels, it may
be difficult for many to imagine how such needs would be taken care
of in a libertarian society.Anarchists differ among themselves about
how people's medical needs and wants would be met in the absence
of a government. Some believe that all health care should be provided
free of charge with costs absorbed by the community at large, while
people's good intentions and dedication to the interests of the
group would be sufficient to guarantee quality, ethical healing
services. Others, of a more individualist bent, believe that health
care, like all other products and services, could be provided on the
free market, with prices restrained by competition and quality and
safety insured by voluntary watchdog organizations and educated,
self-reliant consumers. Such a market-based system would not only be
capable of providing high quality, affordable healing services, but
would also maximize the range of choices in providers and therapies
available to people in need of medical or other therapeutic services
or information.The Current Model & Anarchist
AlternativesGovernment-run or -regulated health care systems
rely on mandatory licensure and accreditation to ensure the
competence and safety of providers and institutions. While this
method is somewhat effective in achieving its goals, it has
consequences that are detrimental to consumers. State control of who
can and cannot practice medicine or other healing arts severely
restricts the number of providers available to people in need of
health care. By allowing the professionals themselves, whether
doctors, nurses, therapists, or whatever, to accredit training
schools and set standards for entry into practice, it allows
established practitioners to limit the entry of new workers into the
various approved health care fields, and either severely restricts or
outlaws the practice of healing by those who advocate alternative
models of health care.The libertarian approach is to allow anyone to
offer their healing services on the market, and let customers sort
out for themselves who is worthy of their business, as they currently
do with so many other products and services. Consumer watchdog
groups, on the model of the Consumers Union or People's Medical
Society in the United States, could investigate and rate the various
health care providers, clinics, and hospitals and make their findings
available to those seeking health services, enabling them to make an
informed decision as to where to procure treatments and
consultations. Voluntary certification societies, which already exist
in the medical and nursing specialties, would also play a role in
ensuring competence by giving their 'seal of approval' to
providers who meet certain criteria. Meanwhile, those who reject
western scientific (allopathic) medicine, would be freely able to
seek out and purchase the services of practitioners of their choice,
who would no longer be barred from the health care market. Many more
physicians and other healers, of many different philosophies and
orientations, would be available to those seeking out advice and
treatment, introducing competition into the health care market that
would require providers to deliver better and more humane health care
in order to keep their customers.Medical education would still take
place without government oversight and control, as it once did in the
past. However, without state-imposed rules, it would likely take less
time and be much less expensive. Here, as well, competition, now
eliminated by government regulation, would bring changes, producing
more and cheaper training programs, as well as more varied curricula.
Potential health care professionals could choose from a variety of
learning models, whether academic, apprenticeship, or some mixture of
the two, and could learn at their own pace. Students would not be
forced to spend their time and money studying subjects in which they
have no interest, and could focus on and excel in the areas of their
choice. The hierarchical and often heartless methods now seen in
medical schools and post-graduate training programs would likely
disappear, as it is hard to imagine anyone voluntarily submitting to
such demeaning treatment if other options were available. Doctors who
are treated in a kindly and respectful manner by those who help them
learn their trade would then be more likely to relate to their
customers in a humane and courteous way, unlike so many of
today's physicians.As in the case of professional licensure,
government regulation of the production and distribution of medicines
through agencies like the Food and Drug Administration, as well as
the prescription system, by which people are prevented from
purchasing medicines without a doctor's note, purportedly exists
to protect consumers. However, although some harmful or ineffective
drugs are kept off the market by the FDA, and the need for
prescriptions sometimes prevents people from using medicines
inappropriately, these governmental methods come at an unacceptable
cost. Helpful medicines are often kept off the market, tied up in
regulatory channels for years, resulting in the death of people who
could have been treated, and prescriptions force people to consult
physicians or nurses whether or not they wish or need to, driving up
the costs of health care and further enhancing the status and power
of licensed health care providers. Government classification of some
drugs as having a potential for 'abuse', and the attendant
close monitoring of their prescription and distribution, cause many
physicians to limit their patients' access to narcotic
pain-killers, often the only palliative for people with cancer and
other serious illnesses.Just as there are non-governmental methods
that would enable customers to wisely and safely choose their healing
practitioners, there are alternatives to state control that could
provide those who take medicines with the means to protect themselves
from excessively dangerous or ineffective drugs. Consumer
organizations are capable of guiding people in their use of
medications or other treatments, and the studies published in medical
journals available to the public are a source of information critical
to choosing appropriate medications. Private health libraries could
even be set up to collect medical literature to facilitate individual
self-education. Knowledgeable buyers would then be able to make
informed decisions about what remedies to put into or onto their
bodies.Besides being able to provide health care and therapies that
are safe and effective, the free market can also assure that
treatment and professional advice are affordable. The competition
introduced among providers and institutions by the removal of
government restraints would drive down the cost of health services
and consultations dramatically. Unlike the situation today, there
would also be at least one less incentive for providers to try to
charge exorbitant fees, since the costs of their education would be
much lower in an unregulated system, leaving them free of the debt
many now face on entering independent practice. Drugs would be much
cheaper without the government regulatory system now in place that
drives up the costs for manufacturers, while abolition of
state-protected patents would allow increased competition among
producers, forcing the price of pharmaceuticals down even further.
And, when one does not have to consult a physician just to obtain a
prescription, more savings will be realized.Despite the overall lower
costs produced by a free health care market, there would still be
circumstances where someone will require financial assistance to be
able to afford a certain medical procedure or treatment. Even here,
however, there is no need for government to step in. Inexpensive
insurance of various kinds could be obtained on the free market,
including the sort provided by voluntary organizations like the
friendly societies of years past, which died out after the birth of
the modern welfare/corporate state. Additional sources of monetary
aid could also be found in the advocacy groups organized around
health care issues, like the American Lung Association or the AIDS
Action Committee. Such organizations now spend large amounts of the
money they obtain from private donors to influence government
agencies to direct ever more taxpayer-provided cash towards their
favored cause, often using padded statistics and half-truths to
influence policy and funding decisions. With no bureaucrats to
influence and no lobbyists to pay, these groups could instead
dedicate their resources to either helping people in need of services
directly, or funding the medical research that would still be needed
after the state is eliminated.Besides being able to provide for all
the health care needs of individuals, a society without government
would also produce a new, more egalitarian relationship between
health care practitioners and their customers. Instead of a
relatively small, privileged class of people who control the access
of others to medicine and treatment, physician, nurses, homeopaths,
and other health care workers would become service providers like any
other. People would be able to shop around for doctors, as they now
do for plumbers and car mechanics, and would not feel they needed to
defer to their health provider anymore than they do to their grocer
or bookseller. While health care is essential to our quality to life,
so is food, plumbing, and intellectual stimulation. Our doctors
deserve no more deference than do the other people who supply us with
the means to go on living our lives as we see fit. A respectful
relationship between equals is as appropriate in a doctor-patient
relationship as it is in any other.Freedom Requires Personal
ResponsibilityOf course, in order for government to be
eliminated and a free market in health care to be instituted,
individuals would have to change in important ways. A free market and
a free world require people willing to take chances and be
responsible for themselves and their voluntarily-chosen associates.
People at present have accepted a sacrifice of their freedom to
choose their health care providers, treatments, and medications, in
return for a promise of safe and effective treatment from the
medical-industrial-government complex. When they give up this real or
imagined protection from the vagaries of the market, they will have
to look out for their own interests when they seek out health care.
This will require that they educate themselves about health and
illness, current treatments, and available medicines and their
adverse side effects. They will need to investigate the health care
providers available to them and perhaps interview a few before
deciding with whom to contract for their care and advice. This can be
a time-consuming process and is not without risk. But nothing worth
doing is risk-free.This essay first appeared in the October 2002
issue of The Individual, the journal of the Society for
Individual Freedom (www.individualist.org.uk),
pp2-4.
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