In mid-2006, the Colorado legislature established a commission to study comprehensive state health care reform. This "208 Commission" met for about a year and presented its recommendations to the legislature in January 2008. The Commission's recommendations were to implement a state-wide medical plan for all Colorado citizens, requiring all legal residents to buy a health insurance plan approved by the state. In other words, the Commission recommended socialized health insurance in Colorado, which means having government controlled medicine.
Socialism is the political theory when government owns and controls the means of production. Several programs considered by the 208 Commission wanted medicine in the hands of the government—explicitly doing away with private insurance, hospitals and clinics—and having only public non-profit (i.e., state-owned or quasi-state) hospitals and clinics. This is the British model of medicine.
Other plans required that all residents be taxed for health care, and the state would then dole out the money to four or five or fifty insurance companies who would then pay for medical care. This is state-run health insurance—control of the insurance industry—providing certain proscribed benefits approved by the government. This is Medicare at the state level.
Economists refer to this as fascism—when the government controls an industry, but nominal ownership is left to the individual companies. It is nominal ownership, because true ownership allows the owners to make all decisions about what products or services to sell, pricing, choice of customers, etcetera. However, in the case of Medicare and national or state health insurance, the government limits the product and service choices, pricing, payments to doctors, among others.
Government controlled health insurance leads inexorably and completely to government controlled medicine. Many programs require doctors, hospitals and other providers to be paid the same price for the same services, regardless of quality, location or experience, or other factors. Some do not allow providers to opt out or to offer services that the program doesn't cover. Although currently Medicare allows doctors to opt out, a participating doctor can't offer unapproved services at any price (even for free) to a patient and can be charged with criminal fraud if he bills the patient more or less than Medicare allows for a particular service.
From an economic perspective, fascism differs from socialism based on ownership of the productive means. But, fundamentally, there is little, if any, difference. The fundamental nature of all of these programs is government control of medicine and health insurance. Canada, Britain, Germany, France, and Sweden are some of the most discussed medical programs. Under economic analysis, some may be fascist. But they are not referred to in that manner—they are called socialist or state-run medical programs. Each country has its own variation. Some have "private" insurance companies, some have only national health insurance or no insurance. Hospitals and clinics can be state-owned or private, quasi-state facilities. Doctors can be state employees or employees or partners in groups or clinics.
But, in all of these countries, there is no capitalist free market in medicine or health insurance. The government determines what services are provided, what is the appropriate and recommended treatment, when you can get that treatment, and what prices the doctors are paid. Fundamentally, that is Statism, and that is what is wrong with these plans. It is not simply that they are economically inefficient; that makes efficiency the standard of judgment.
What is crucially, fundamentally, wrong with these plans is that they are immoral. They are immoral because they treat doctors, hospitals and patients as widgets and diminish, if not eliminate, the ability, responsibility, and power that individuals have to manage their own health care. Under these plans, individuals have little power or choice over their provider, treatment or payment. Someone else, somewhere else, in the name of the government (or its quasi-agency), makes those decisions for every doctor, hospital, insurer, patient and consumer.
It might be more proper to call these fascist programs. Most Americans don't recognize the differences. What is important is to call them government control of medicine—statism—whether fascism or socialism.
We at FIRM oppose all forms of statist or government controlled medicine and health insurance. It is precisely because life and health are so important that these decisions should be made individually, without government being involved. It is morally right that these decisions should be made only by the individuals involved. Only individuals are able to have the knowledge, ability, values and the moral right to make the best decisions for their own health and the health of their families. For these reasons, we support capitalist, free market medicine and health insurance.
For information on the morality and practicality of freedom and individual rights in medicine, FIRM recommends:
Our blog contains news about and commentary on the fight for freedom and individual rights in medicine.
A current article from the Winter 2007-2008 issue of 'The Objective Standard', showing that years of government interference in medicine and health insurance have led to the present conditions, and that only the free market can save us from these crises.
Dr. Hsieh asks his fellow doctors to speak out against the plans to institute socialized medicine in Colorado.
A powerful essay on the immorality of socialized medicine, updated by Lin Zinser.
An informative report on the nature and ill effects of decades of intensive government regulations of medicine.
A provocative book on the immorality and impracticality of government interference in medicine. Some used copies are also available from Amazon.com
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