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From: nrh@inmet.UUCP
Newsgroups: net.politics.theory
Subject: Re: (Orphan) Re: re: Why not now
Message-ID: <28200308@inmet.UUCP>
Date: Thu, 21-Nov-85 19:52:00 EST
Article-I.D.: inmet.28200308
Posted: Thu Nov 21 19:52:00 1985
Date-Received: Fri, 29-Nov-85 21:00:56 EST
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Nf-From: inmet!nrh    Nov 21 19:52:00 1985


>/* Written 10:51 am  Nov 19, 1985 by mrh@cybvax0 in inmet:net.politics.t */
>In article <28200286@inmet.UUCP> nrh@inmet.UUCP writes:
>> Doctors, licensed as they are, are not a bad example.  The thing I'd
>> do in a libertarian society is go with a large health center, and keep
>> an eye out for reports of malpractice -- JUST AS YOU DO NOW....
>
>Huh?  I doubt that many people on the net can name one doctor from a
>report on malpractice.  So how are we keeping an eye out for it?

I was specifically interested in an example of a large health center.
The idea was that you WOULDN'T go with one that Ralph Nader had just
done a number on.  You probably WOULD trust "Ace Community Health Plan", 
but not if you just found out that they'd been performing experiments
on their unwilling patients.

>Why isn't somebody making a profit right now with a malpractice suit
>database?  No slander involved: just a collection of public records of
>cases filed.

I wouldn't be at all surprised if you could get this off of "NEXUS".
Certainly the New York Times Index, or "Reader's Guide" could point
you in the right direction.  Again, no need to check out individual
doctors if you're confident of the judgement of the institution.
(Just like there's little need for you to investigate the clerks at
a bank if you're confident of the bank's insurer).

>> It would be dangerous to think that just because doctors can be sued
>> for their mistakes, and perhaps prevented from practice, that they
>> couldn't kill you by accident or incompetence.
>
>Of course it might be more dangerous still in Libertaria, where doctors,
>instruments, and drugs are unlicensed and possibly harmful or ineffective.

Possibly, but there's a difference again between "lack of license", and
"unendorsed".  I would bet that some doctors in Libertaria would obtain
certification from some agency which made its money on its reputation for
dependability (we don't have many of these now because the government
occupies their niche).  You'd have a choice: go to the certified doctor,
or go to Dr. Feelgood.  Or join the "Dr. of the Month Club".  

I suspect that most folks would go for the certified doctor, but I don't
demand it of people -- the ones going to chiropractors make this decision
without the endorsement (as I understand it) of the AMA, but I don't know
that a government has the right to tell these patients to stop.  

>
>> Of course, in Libertaria, Doctors wouldn't be so able to quash
>> competition by limiting medical-school enrollment, or prevent
>> people from putting up bonds to warrant their success as 
>> practitioners..... 
>
>Right.  Anyone can just say "I'm a doctor".  Medical schools can lower
>their standards and provide incomplete (but oh so economical) educations.
>Produce class after class of "doctors" that nobody would want to insure,
>post bond for, whatever.

Anybody can say "I'm a doctor", but not anybody can say "I'm 
a doctor recognized by the AMA".  Some medical schools would no doubt
have very low standards -- and a correspondingly low certification
rate.  The interesting part of such a system is that they'd be CHEAP.
If you want poor folks to have a way of (with a great deal of motivation)
becoming doctors, this is the sort of set-up you want.  Of course,
if you want to PREVENT the poor from becoming doctors, but at the
same time avoid charges of favoritism for the rich, all you need to
do is limit the number of slots in medical schools (this is done
quite nicely by the AMA now) and imperfectly compensate for the high
cost of an education in one of these (artificially supply-limited) 
slots by granting the odd scholarship.

>> To your question as to which is the more expensive method, I point out
>> that the current system permits an artificial limit on the number of
>> doctors, which in turn keeps prices up.   How much?  A tougher question,
>> but whatever the amount, it must surely be included in the cost of
>> the current system vs. a free one.
>
>Of course a "free" system has hidden costs which you haven't mentioned.
>Such as increased malpractice, decreased reliability, etc.

Increased malpractice?  I think you'll have a hard time finding the 
upper limit to malpractice costs in OUR society.  Or perhaps you're
talking about the increased overall costs of a system which doesn't
prohibit in advance poor medical practice, but rather punishes
it after the fact?  Gee -- I wonder if we could do the same thing
with newspapers and libel?

Decreased reliability?  I'd be willing to concede that the "average"
Doctor might be less reliable, just as I'd be willing to concede that
allowing anyone to dress hair might lower the average hairdresser's
quality (did you know that hairdressers were licensed in many states?)
On the other hand, if you WANT hoity-toity "certified by the AMA"
doctors, you could still get them.

>That same free system also opens the door to a host of other concealed
>costs.  Such as TB from contaminated meat that should have been condemned.
>Who's going to be able to pin down the multitudinous sources?  Such as
>ergot in grains.  Such as poorly pasteurized milk?

Excuse me, but these problems exist *NOW* with certified-by-the-US
materials.  Or don't you remember the Tylenol poisoning?
There's quite a bit of redress permitted for fraud in a libertarian society,
so if you advertise "health" food, and serve people unhealthy food, you're
liable to find your profits attached.  As for who pins things down:
you sue the vendor, the vendor sues (perhaps) his supplier, and so on.
Most of the time, almost all of the time, this doesn't happen, because
everyone's being very careful about what they buy from whom.  

A&P doesn't WANT to lose a million dollars  in legal fees and lost
revenue for selling you a bad apple, so they test the apples they buy.

>Rich people will be able to afford to buy from merchants who spend more
>money advertising their quality control than they spend on their quality
>control.  

And rich, STUPID people will do this.  SMART people, rich and poor,
will buy consumer reports, or subscribe to fact sheets about products,
or simply buy from stores who guarantee quality.

>The poor will have to buy elsewhere, and will be saddled with
>the risks of the "free" system becauser they cannot afford to buy the
>protections.

... but are not too proud to get food from charities that spend the
relatively small amount of money to do this.  Right now, as I understand it,
poor folks in New York can't buy milk at the price that obtains in New
Jersey because of the maze of "New York First" regulations designed to
keep New Jersey from selling milk in NY (note: it would be illegal to 
do this explicitly -- it's done by requiring that milk be sold within
the same county, or within a certain amount of time after it's produced).

In Libertaria, the poor get told: "Thompson's milk is OK" by the
Salvation Army (or some such group).  In the current scheme, they
are issued foodstamps that reduce the cost of their dairy purchase,
and perfectly good milk at low prices WITHOUT handouts is denied them.

>Likewise, the poor would be saddled with the risks and costs of the
>"free" Libertarian medical system, because they could not afford to buy
>the more expensive "high-quality" (what we consider standard) care.

What do YOU consider standard?  Should the poor get once-monthly checkups?
Massages?  Dietary counseling? Nautilus machines?  There's NO reason
to suppose that well-certified care would be MORE expensive in Libertaria --
indeed, it would be cheaper because it must compete with alternative 
practices (acupuncture, Dr. Feelgood, Chiropractic) without having the
State artificially limit new ways of providing health care.