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From: mrh@cybvax0.UUCP (Mike Huybensz)
Newsgroups: net.politics.theory
Subject: Re: Medicalert
Message-ID: <778@cybvax0.UUCP>
Date: Mon, 30-Sep-85 17:15:45 EDT
Article-I.D.: cybvax0.778
Posted: Mon Sep 30 17:15:45 1985
Date-Received: Wed, 2-Oct-85 20:35:48 EDT
References: <776@x.UUCP>
Reply-To: mrh@cybvax0.UUCP (Mike Huybensz)
Distribution: net
Organization: Cybermation, Inc., Cambridge, MA
Lines: 127
Summary: 

In article <776@x.UUCP> wjr@X .UUCP (STella Calvert) writes:
> >If you are rich enough to afford that sort of medical service, you can buy it
> >right now.  The only thing that might make it slightly more expensive is
> >that you still need real doctors.
> 
> The big thing that will make it cheaper is that I will be using my former
> tax dollars to pay the premiums.  Think about it.  Now I pay for coverage in 
> aftertax dollars.  When I get all the value my customers are willing to pay, 
> I can afford to pay for more of the good they produce.

That's assuming (without any estimates or justification) that you will be
able to substitute or do without current government services for less.  I'm
not saying that you can't make such an accounting, just that the money you
pay in taxes isn't simply thrown away: you receive benefits in return that
you will probably desire in libertaria.  And they aren't free.

> >People who can't afford high medical premiums (many plans cost about $2000 a
> >year) will still have difficulty.
> 
> Please read the next sentence twice.
> 
> Medical care is expensive because it is a limited resource;  it is a limited
> resource because the present government requires that you have a union card 
> from the AMA to apply the science that should be common property.

Medical care is expensive for a number of reasons.  It is intensive in its
use of high-cost facilities (such as hospitals, offices, equipment,
esoteric drugs) that must have high quality and reliability.  And it is
intensive in its use of the time of highly trained personnel.

Medical care is also expensive because despite the expense it can be cost
effective, from the standpoint of an investment by society, a family, or
an individual.  Essentially, any of the above can profit from a purchase
of medical services by increases in the potential life earnings of the
patient.  Standards of quality (such as "union cards") help ensure the
safety of the investment.

> >Assuming a real libertaria, then your flavor of medicine is quite likely
> >to be Dr. Smith's Astrological Aura Manipulation.
> 
> Ad feminam arguments? Or just that you don't see where libertaria is 
> different.  I was fairly careful not to specify the medical model I would
> support (take that discussion to net.med and "n" past it).  I don't think 
> I've noticed you posting to net.adhominem, though.

This wasn't meant as derisive, but rather as an example of something possible
and likely once standards of judgement are relaxed.

> > Once you remove medicine and medical practice from regulation, you end
> > up with the full spectrum of snake oil and other fraud, only now with
> > better advertising.  Look at all the people who use fraudulent (unregulated
> > and sometimes lethal) diet plans.  Advertising dollars generate much better
> > profits than research or training dollars, and advertising reaches a much
> > larger audience than product comparisons.  If you were brought up within a
> > libertaria, bombarded with propaganda and counterpropaganda, with no
> > statistics you could trust,
> 
> Where do you get THAT?  In a libertaria, if you attempt to defraud me, I post
> bond and file an account of your wrongdoing on as many information nets as I 
> can afford to post bond on.

Oh?  And how are you or anyone else going to decide that?  "XXXX penicillan
is no good, I nearly died!"  How will someone determine the truth of this?
How will anyone decide between 1) tampering 2) a bad batch 3) you are
allergic 4) you had a resistant strain of bug 5) you are lying 6) you took
the wrong dose 7) something unrelated almost killed you 8) ineffective drug?
Assuming, of course, that you have the resources to post bond, as a public
spirited thing to do?  How would you profit?

> If you dare, if you want to risk _your_ bond, 
> you sue me for libel.  Adjudicators on the various nets investigate, the bonds
> we posted would be returned or applied to the cost of running the
> services as the facts require, and only people silly enough to listen to 
> only one expert would be in any danger of being misled.  And because it is 
> in my interest to monitor the treatment less wealthy people receive (I may 
> join that class with my next bad business decision.) I contribute to 
> something rather like legal aid, which guarantees the bond for folks that 
> can't cover their own.

We already have fine, working systems of monitoring for danger and
effectiveness of products and medical treatments.  They have recently found
quite obscure problems, such as AIDS (early on, well before it was obvious),
toxic shock syndrome, contaminated watermelons, etc.  And for this you want
to substitute an uncoordinated, undirected system with built-in noise?

> >you would probably pick a popular, well advertised quackery.  After all,
> >it would probably be cheaper than the best medicine.  Kidney machines too
> >expensive?  Oh, then they're bad for the aura.  Pills cheap?  They brighten
> >the aura.  And let's not forget the addictive "health" prescriptions,
> >whose ingredients need not be divulged.  But wait, you need psychic
> >surgery for your muffler bearing (oops, that was the "doctor"'s previous
> >employment.)
> 
> You assume, it seems, that people make decisions only on the basis of cost.
> Do you ride a bike rather than owning a car?  Do you eat soybean extract or
> beef?  If you smoke tobacco, do you handroll Top?  I know I consider other
> factors and I hope you do.

Providers of medical services will look for ways to increase their profit
margins, unless there is a standard.  You see it in business all the time:
the best product doesn't make the best profit.  And yes, I do ride a bike
because it is cheaper.  I got rid of my car last year.

> >> I will also be paying, in my premiums, for the right to call my plan if I
> >> encounter a John Doe who does not appear to have medical coverage.
> >
> >Very generous of you.  I'm sure that your provider will provide enough
> >disincentives to reign your generosity in, and thus prevent your
> >distribution of medical services to everyone in libertaria.
> 
> Disincentives?  What disincentives?  It's all in the rate structures.  If you
> want to be a selfish s0n of a b|tch and have one-person coverage, you'll pay
> the single-person rate.  If I want John Doe coverage, I'll PAY for it.  And 
> I'll shop for a plan that sets rates for it.  My self-interest demands that 
> I avoid the kind of devil-take-the-hindmost libertarianism you describe,
> because I may someday be hindmost.  (In fact, since I value many things more
> than cradle-to-grave financial security, I'm planning for it.) And
> since I am paying for that coverage, I will determine (not you and not
> the insurance company) how much Samerit I can acquire.

I greatly admire your stated values, which are quite different from those
I've heard espoused by other libertarians (who mostly sound like Calvanists.)
But the simple fact of an increased rate for "Samarit" is exactly the kind
of disincentive I'm talking about.  And many people wouldn't want that expense.
-- 

Mike Huybensz		...decvax!genrad!mit-eddie!cybvax0!mrh