Friday, December 6, 2013

Welcome to the Free Market in Medicine

(Updated, see below.)

This article at Talking Points Memo about a doctor in Arizona was in my inbox this morning:
More than half of AAPS members have stopped accepting Medicaid payments, [executive director of the American Association of Physicians and Surgeons Dr. Jane] Orient says, though she stresses that they'll still see patients if they either pay for themselves or come to a free charity clinic. A smaller number of her membership is also bucking the private insurance industry, asking for direct payments from customers and telling them to seek reimbursements from their insurers on their own.
They see themselves as the front lines in the fight against a "plan ... to destroy the current infrastructure," as Orient put it in a recent interview with TPM. Winning that fight starts with convincing their peers and patients to break away from the system set up under the health care reform law.
"Coercion, central planning, socialism if you will does not work. It kills the incentive to work. It misallocates all of the resources so that everybody is worse off than they would have been if they had just allowed free men and women to make their own decisions," she said. "The remedy is for patients and physicians is to decline to participate in the system, go for a true free-market alternative."
 Healthcare is very expensive. Dr. Jane Orient is willing, as a doctor, to take what the market will give her. Let the market set the price. The vast majority of Americans can't afford medical care her way, but she doesn't care, though some members of her association will donate time at free charity clinics. She despises -- fears -- socialism. Like fellow AAPS member, Senator Rand Paul, she regards Obamacare as a form of slavery.

These doctors reject Medicare and Medicaid patients and feel government-run healthcare systems are evil incarnate. They are a great, free-standing example of believers in the free market. An tenet of their philosophy is that there is no right to healthcare.

What does "no right to healthcare" mean in a free market context? It means if you don't have enough money to participate in a medical free market, you will be denied service. That's how this works. If it doesn't work this way, it isn't a free market.

No money, no healthcare, it's that simple. Poor people? Suffer and die, you're not welcome here. And don't think that "free charity clinics" and ERs take care of poor peoples' needs. That's just a fig leaf.

I'm not sure where the Hippocratic Oath comes in here, but all doctors take the Oath. I guess some think it applies only to people with money, plus the few unsavory people they come into contact with while they're being good and righteous once a month at a charity clinic.

There's a reason -- prior to Obamacare -- millions upon millions of Americans had no health insurance, while millions more had extremely weak "catastrophic" health insurance with extremely high co-pays and lifetime caps that means you have insurance until you don't, regardless of the consequences.

This is the free market libertarians revere. It's not a world I want to live in. Do you?

Queuing up at the free clinic. At least it's not socialism!

Let's be clear: These are doctors who won't participate -- or claim they won't -- in Obamacare. The part of Obamacare that gives most of the poor a shot at healthcare -- that's Medicaid -- these doctors won't participate in. I suppose for a doctor in a red state that refused the Medicaid expansion paid for by the federal government, that'll be an easy thing to do.

Update. I listened more carefully to Rand Paul's remarkable "if you think healthcare is a right, you believe in slavery" statement, in which he implies that healthcare-as-right would lead to people knocking down his doors and demanding service. Then I caught the rhetorical twist at the end, where he said that, in exchange for surgical privileges at his hospital back when he practiced medicine, he agreed to serve 100% of people who came into the ER. Speaking of the Hippocratic Oath, Paul said, "Since the beginning of modern medicine, we have always provided 100% access. I do it in exchange for privileges. I do it because I believe in the Hippocratic Oath....we've always provided 100% free access."

Which is it, Rand Paul, a right to healthcare is slavery, or "we've always provided 100% free access?" You can't have it both ways. Now, if the federal government offers hospitals money to help pay for that "100% free access," then how is that different from accepting Medicaid to help defray costs, as well? I wonder how much rhetorical trickery and hypocrisy are built into Dr. Jane Orient and her AASP's stance on no third-party money. Are their hospitals rejecting behind-the-scenes federal money? If we looked, I think I know the answer we'd find.

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