I speak with economist Bob Murphy about what needs to happen in order to heal the deep dysfunction that is healthcare in America. If you think we can "reform" our way out of this mess, you might need to listen to this interview. We unravel the complexities of regulation, the insurance industry, licensing, and what an alternative way might look like.
Bob's book on "surviving the sick-care sinkhole" is here.
The Bob Murphy show is here, and you can find Bob on Twitter here.
My recent episode on medical licensing can be found here, and my September 2021 episode with Keith Smith, of the Surgery Center of Oklahoma, is here.
I speak with economist Bob Murphy about what needs to happen in order to heal the deep dysfunction that is healthcare in America. If you think we can "reform" our way out of this mess, you might need to listen to this interview. We unravel the complexities of regulation, the insurance industry, licensing, and what an alternative way might look like.
Bob's book on "surviving the sick-care sinkhole" is here.
The Bob Murphy show is here, and you can find Bob on Twitter here.
My recent episode on medical licensing can be found here, and my September 2021 episode with Keith Smith, of the Surgery Center of Oklahoma, is here.
Welcome to the podcast that's all about solutions. If you're tired of complaining about tyranny and you want to take action to create a freer world, this is the place for you. Join us as we ask what then, must we do? All right, I'm here again with economist Bob Morphe, and we are here today to talk about healthcare. This is such a huge topic. There's so much going on and there's I mean, it was dysfunctional before COVID and you know, over the last four years I think that dysfunction has kind of come to the surface more, but it's also got you know, literally gotten worse. So it's a little hard to know where to start. I mean, there's just there's so much.
Speaker 2:Let me just ask you Well, can I just say something fast? Brett, you're just in response to what you're saying, because you're right, I co-wrote a book with an ER doctor several years ago. At this point you're talking about the Affordable Care Act, or what's known as Obamacare, and that I just thought if they don't get rid of this, it's going to totally drag down the whole system. So it's just funny that, yeah, I thought you know it was like put a fork in it even before COVID hit. So right.
Speaker 1:I mean, who would have guessed that it could have gotten you know this much worse and I will link to that. I'll link to that too. There are so many issues. There's medical licensing, there's insurance, there's the regulatory agencies, there's Obamacare. If you could sort of articulate what needs to happen, where do we need to be? Not necessarily how to get there, but where should we be aiming? If we wanted to fix healthcare, make it actually, you know, functional and so that it's serving people, what should that look like?
Speaker 2:Okay, sure, and again, like you say, this is such a huge topic and I know we don't have seven hours to go through this stuff, so it's a little bit difficult to know where to begin, how much detail to get into. But let me just make some observations just to kind of frame the issue. So you know, nobody says in the United States nowadays that you know, hey, there's a party we're all meeting at Joe's house on Friday. Do you want to swing by? No, I can't. Oh, why not? Because I'm in between jobs right now and so I don't have car insurance. You know, because my, you know, my car insurance is tied to my employer. So, right, no one talks like that. Right, like you can, I mean, unless it was a financial thing. But the point is, your car insurance isn't tied to your employer, but yet it is commonplace for people to say, oh yeah, I had this elective procedure I was going to have done, but you know what? I'm in between jobs, I'm changing jobs, and so I have to wait until I get my health insurance back. You know, people do talk like that, and especially it was true before the Affordable Care Act when you know it was, you couldn't, you didn't have the, the guaranteed option. So I'm just, I'm just trying to isolate that something's odd about that, and so it's when we talk about these things. So it's not just a matter of insurance, it's, it's something about health insurance, right? Because you don't the car insurance, you have the fire insurance on your house, things like you know, life insurance. None of those are tied to your employer. Those are separate things. And yet health insurance is like that.
Speaker 2:And then also, just to stress that there's something, I think part of what's going on right now and why the you know the prices are so crazy and it just it feels like it's a fake system, is it's not a business transaction, that you, as the patient, you're not the customer of the you know the doctor or the hospital or wherever you're dealing with you're this annoying thing, and the actual people paying the bills are combination of the government and private health insurers, so they're the actual customer from the point of view of the medical provider. And again, you are just, you know, it's like you're a six-year-old kid going to a private school. The parents are really the customers, the kids, just, you know, this person that has this plays some role in the system, but isn't really relevant, isn't a decision maker by any stretch, and that's kind of what's happening. And when you think of it that way, you realize why it's unfolding like this. And imagine, just as an analogy you know, if that was the way we paid for new cars, that your job typically had a program in place and that every time you needed a car you just went to the lot and picked one and then some third-party insurance company paid for it and ultimately, you know, money was taken out of your paycheck in order to fund the premiums for that, but you didn't directly, and the car dealer would sell you the car and you wouldn't even know how much it cost until after you bought it. I think in a system like that, the quality of the cars would be lower and the prices would be crazy if you had to buy a car and you didn't even know how much it would be until you already bought. And yet that's how our healthcare system works right now. And so, again, I'm just trying to ice this. So it's nothing intrinsic to medical care per se. It's this crazy system we have and that's what's producing these.
Speaker 2:And the way to realize it's not about medical care per se is if you you know there's like strictly cash practices like Keith Smith of the Oklahoma Surgery Center or other things that are real.
Speaker 2:You know, like certain types of cosmetic surgery that aren't typically covered by insurance and it's just a cash thing. You know, like the laser eye surgery things that you know and I can get at the mall or something as they get better, those types of things that that seems like a normal business. Like you go into a waiting room, it's very pleasant, you don't have to wait two hours to get in, you get in and get out, you know it's cash boom. And why is that? It's because, again, that's like a real business. You are the patient, you're the customer, you're the client, you know it's all rolled into one. And that's why it seems like a normal business, where it's the other system, where it's the payments, disconnected from you as the customer, that I think gives these perverse outcomes. So I just want to kind of frame it like that to get people to realize that it's not that there's a problem with healthcare per se because of its nature. It's the way the system is dealing with it that's producing these weird outcomes.
Speaker 1:Yeah, and it's also a little weird that we call it insurance, because it's not insurance in the traditional sense, is you pay some premium in order to protect yourself against some unforeseen outcome, and that's not really what you're doing with health insurance. So even that it's like, well, we call it insurance, but it's really this weird system we got. It's not quite socialized medicine, it's not quite government provided healthcare, it's not that, but it's also not insurance. So it's this whole, it's this weird sort of thing that we've got going. So okay, so that's one thing that maybe we should do away with that. But then we've got, like these regulatory agencies, and RFK Junior, for example, is running on this platform of reforming healthcare, medical freedom, bringing choice back to individuals, and he talks about how he's going to clean up the regulatory agencies. Is that something he can do?
Speaker 2:I mean, I don't know in terms of like what his exact proposals are, and if you mean like with the president, have the authority to do that or you know what he need congressional approval, that stuff I'm not as sure of. But in terms of like an incoming administration, if it had the cooperation of Congress, you know what sorts of things could they do. That, yeah, and a lot of this all ties together. So partly why just to go back to your earlier point, you're right, it's. It's not like you go in every time you get an oil change and tires rotated, that your car insurance pays for that. And if it did, then your car insurance premiums would be a lot higher. Right, and that's so you. So you're right that it we are getting this, and partly why that happens is because normal medical care now is so expensive that a lot of people like you know, jeez, I can't do both. I can't pay these huge premiums and, you know, pay out of pocket, except for catastrophic things. That's why you get in this like sort of worst of both worlds, where you're paying really high premiums, plus there's still a big deductible, but then you know so, if, if we could bring down the cost of the actual, you know, medical services, then that would make it more affordable and so people wouldn't, you know, need insurance to cover so much. So a lot of this of all kind of you know plays together that if you had an improvement one area, that would help improve the other side to. But yeah, answer your question. I mean, for example, the FDA, and I know, brittany, that I think probably we would say a lot of the treatments being brought to market by pharmaceutical companies are actually not good for people, but in the, to the extent that some of them may be, the amount that's paid like to bring a new drug to market now it's over a billion dollars research and it's not because you know they're doing so much testing and it's because of the hurdles and everything and they have to like it's, you know. Analogy is people are saying to like if an oil company is drilling for oil, like they drill a bunch of test wells because they don't know exactly where the deposits are and then once one hits, then they really develop that one. So it's like wise, the drug companies have lots of different things in play and then only some of them are going to hit and finally make it over the hurdle, that which can take several years to then be able to bring it to market. And so again it's a vicious cycle where that's partly why they have to charge so much for the ones that do make it, and it also means they're only going to develop products that you know have a wide market, that someone's got some kind of you know rare disease. There's no money to be made. But again, that's not just a, that's capitalism for you, that's no, that's hyper regulated capitalism, you know. So that's that's part of it too.
Speaker 2:And, by the way, to also the FDA makes mistakes coming and going, that not only do they put up a lot of barriers for things that you know could potentially be helpful, but they also approve things that they shouldn't have approved. So, like viacs is the classic example and I'm just saying that because a lot of times, like a lot of free market economists, I think, fall into the trap of just complaining about look at all the roadblocks the FDA is putting. But again it's the opposite error to where the public thinks something safe because the FDA said so and it gets approved, and then the institutional incentives are in place. If the FDA approved something they don't want to then later backtrack because it looks like they made a mistake and then any deaths that occurred were their fault. You know, as it were, so this perverse thing where they give their blessing to something and then are very reluctant to admit when they were clearly wrong and they shouldn't have done that.
Speaker 2:So it's really like I say, the problem on both ends of the spectrum for that and so things like that. You know, medical licensing, not a lot of that. Yes, it's like at the state level how that works, but I mean people can see it with something goofy, like like African hair braiding. There's cases where the local regulators you know the other hairstylist won't let someone open up a shop and do that. You can't get a license. And clearly that's not because they're protecting the public from incorrect hair braiding. It's they're protecting their own turf and they're raising, you know, their own revenues.
Speaker 1:When medical licensing was first proposed, when the AMA came in and started really pushing for it, they were explicit that that was their goal. They were explicit in saying that. You know, our doctors aren't making enough money. They're not, you know, being treated as the you know, the Paragonist society that they should be. They don't have their proper place in economic life. We've got to put a stop to this. We've got to cut down the number. You know there are way too many doctors for the population. That was their goal. It wasn't about safety. It wasn't about all the stuff that you know is now used to justify licensing. It's they were. They were really upfront about that.
Speaker 2:Right, just like like during the Great Depression. You know a lot of the official rationale some of the New Deal policies was expressed like railing against cutthroat competition, you know. Oh, and how can legitimate business people, you know, earn a living when you've got these other people coming in and dumping in the market? So you're right, they're the same. Like they were literally saying you know, we want to restrict competition, to raise prices that the public has to pay for these goods and services.
Speaker 2:And yet, you know, they were trying to frame it like they were the heroes. So yeah, and that's some of the stuff I cover. You know, in the book that I mentioned was like the Flexional Report came out and really got the public up into a tizzy and tried to justify hey, we need to have higher state and in the abstract, you know, that sounds great to have high standards. A good analogy that I think Milton Friedman came up with. That I think is pretty good in this context I don't know if he was talking about healthcare per se or he was talking about something else, but I adapted it for this that you know, if supposed to government passed a law saying any new car has to be a Mercedes or better, or, you know, cadillac or better, whatever good, nice car you want to pick, so yeah, there's a sense in which, oh well, that's good, so that everyone who's driving is in this really nice vehicle and that's pretty good, right. But then of course, the downside is that means the cars are going to be more expensive, and so now there's plenty of people who could have afforded, you know, a less fancy car. Now they got to take the bus or something because they just don't have a car period and so likewise yes, other things equal if there's a rule saying for anyone to practice medicine they have to meet these minimum standards, and if you make the standards more stringent than assuming they made sense, like we're kind of giving the benefit of the doubt, then yet on average anybody seeing a doctor, you'd be more certain that that doctor's service, you know, would be qualified and it would be good, but it would be more expensive because you're restricting the supply. And so it's not obvious, even if you did it right, that you're helping people on that Because, again, anyone who wanted to really you know people could voluntarily do it.
Speaker 2:Someone who said, no, I'm willing to pay more to go to a doctor who went to a legit school and I know you have the freedom to do that if the government isn't enforcing it, right. But what they are doing is they're taking away the option of people of paying a lower amount for a doctor that maybe doesn't come from the school. But what's funny is I almost don't want to follow the trap of saying that, because that makes it sound like they're legit in great medical care now because the government has those standards in place. But that's obviously not the case, why would we expect a bunch of politicians to know how to pick doctors better than people left to their own devices? So again, like I say with the FDA, with the Viac scandal just showing the problem's not merely that, oh, they're making medical care too good and too expensive. No, they're making it expensive, that's for sure. But it's not obvious that the quality of care is better now than in a system where we had more, like you know, private watchdogs.
Speaker 1:Yeah Well, and you mentioned the Flexnew report. I mean, it's pretty clear in hindsight, you know when you look at how that was implemented. You know when the report came out, basically it was damning against everyone who was competing against the pharma-centric school of thought, and so they shut down what's now considered sort of alternative medicine. They also shut down schools that were teaching African Americans and women. Those, you know, happened to be the ones that didn't meet the standards. So just historically, you know, I don't, I don't it's hard to make the argument that it was, that it was about improving standards or that regulation actually improved standards. But I think your point's really important. Even if it, even if that is what it was doing, even if it was raising this bar and saying, well, if you're going to be in the market, you've got to meet this high standard, you're then cutting a bunch of people out. You're cutting out a bunch of customers, the example that comes to mind.
Speaker 1:So when I lived in Hong Kong, there was the walled city, was this place where it was like a no-man's line. It wasn't ruled by China or Great Britain, it was just this free place. On the bottom level there were all these unlicensed dentists who would come in from China and set up shop, totally not licensed, and if you had a problem with them, I don't know how they would even deal with that, because Hong Kong didn't have jurisdiction over them. Nobody had jurisdiction over these dentists. Yet they were doing a thriving business because there were enough people who wanted to pay bargain basement prices to come and get their teeth fixed. Apparently they did a good enough job that they were still in business, but completely unregulated, unlicensed.
Speaker 1:Why shouldn't there be that option? Why shouldn't people be able to go and yell all go to Joe's GP practice care, who just read it about on the internet and put together his own practice and he's going to charge a dollar an hour. Why shouldn't people have that option, as crazy as it sounds? Because, as you say, there's still the other option you can still pay and get better quality care this idea that people shouldn't have the option to choose shoddy service should they want to. But I also am wary of saying too much about that argument because it presumes that what regulation does is up the quality. I don't think there's any evidence for that.
Speaker 2:Great points. Let me just respond to a few things you said. On the point about in the wake of the Flexin report, they were shutting down, I guess like what we say homeopathic.
Speaker 1:Homeopathy and Native American.
Speaker 2:And that some of the people caught up in that tended disproportionately to be the not as powerful people at the time, and that makes sense. So there's a similar thing. In 1931, they passed the was the Davis Bacon Act, and if you just read the text of it it says oh, you know, for government projects they have to pay the prevailing local wages, you know? In other words, you know so the government wants to go build a bridge or something somewhere and they're taking up bids from the local contractors. And the idea was, if a contractor comes in with a low bid but you look and see he's not paying the prevailing wages of that region, you can't take that bid, you know. So it's not just the lowest bid. And so, oh yeah, that's that's good for helps the workers. And what that was doing, it was making sure just white union workers got the contracts right, because that, you know, the union like determine what the prevailing wage was. And so if you were, you know, a black crew that wasn't unionized, how would you compete? Well, you know, your men probably didn't have the experience and the training that the white guys did in 1931. You know, it's no fault of their own. And so how would you compete with them, you'd have to do it for a lower price and yet the government was making that illegal right and so and this isn't just pure cynicism, like you can go see at the time, at least some of the I'm not saying everyone who voted for it was racist, but some of the people in supporting it you could like on the house floor or whatever we're clearly saying you know this will ensure that government, you know taxpayer money goes to. That are the exact language, but they weren't beating around the bush, they were explicitly saying you know so anyway, just that's one example of this kind of thing that you see this pattern a lot. And also to like with the with the hair braiding example, we said a minute ago that you know that policy obviously is having disproportionate effects in terms of, you know, racial pay among hairdressers in that region. So, yeah, you're right.
Speaker 2:I got just to make sure people aren't missing the point that if the government comes in and sets a threshold, like it restricts the supply in the in the name of unaccording to the rationale of improving quality, even if what they were doing actually didn't prove the quality, it's not obvious. That's, you know, helping anybody Because, again, it's, you know, the only people you would be helping are like those who really have no frame of reference. They have no ability or willingness to judge quality on their own. And you know, so that kind of thing, that maybe you could make an argument that if there's this bare minimum, but like you're saying, like if they just said, hey, you know what we're going to just randomly say half of the current brain surgeons need to drop out, you know that would also restrict the supply, but there's no reason to suppose the half that remained would be a higher quality than the half they kicked out. And so I'm saying, like, just the mere fact that you're restricting supply doesn't prove an, especially for people who now, you know, doing more research and whatever, and it looks like a lot of these alternative medical treatments might make more sense, or at least for certain people, than what the you know standard scientific, and this is what you do and what you got a problem will go get a pill for you.
Speaker 2:You know that, that's right. You know, oh, changing your diet, that's. You know that's hippie-dippy stuff, that like right, it seems more and more people are real. But at the point is, it doesn't matter, we don't, whether you think it's not. It's like the. Wouldn't the system be more robust if it were open ended? And you just said let the evidence go where it may. And then, yeah, if it does turn out that some of these therapies are you know, or whatever, ok, well then people probably will stop going to him over time. But you don't want to give the government the power to just pick and choose. No, this is the right way. And you know anyone else is wrong, like once. You do that if they happen to choose wrong. And again, why would we expect politicians to pick the right ones, even if they wanted to? They're no more trained than right, even if it's not corrupt.
Speaker 2:And. But yeah, like you say, then behind the scenes too, they're getting, you know, campaign contributions, the very least from certain groups. So why would we expect that to be an unbiased choice?
Speaker 1:Yeah, and what's interesting to me about that history is, you know, at that time, prior to the Flexin report, the, there was this war between, like the, what we now call the alipaths and the homeopaths, and the alipaths being the ones who were starting to use. You know, back then it was called patent medicine. It's medicine that you could actually you could patent and then sell. What's interesting to me about that is that the economics of selling patent medicine is very different from the economics of, like, herbal medicine or homeopathy or, like you know, traditional Chinese medicine or so, because you can't patent those things and so you can't make the big profits.
Speaker 1:And what it looks to me like what happened is these folks who were making medicines that could be patented pharmaceuticals. They were able to make a lot more money, and what they did was they went to the politicians and said, hey, can we? You know, let's have this partnership and we'll pay you essentially, which is still going on today. It seems to me that patents are sort of a central part of that. Like, if they didn't have the power to patent their products, they wouldn't have these enormous profits which they could then use. You know, they have the advantage, you know, in the market of buying politicians. They have the advantage over, you know, the vitamin sellers or the herbal remedies. What are your thoughts about that?
Speaker 2:Yeah, it's a great point. I don't know that. I've thought of it from that angle. But yeah, I think you're right to understand that history. And how do they have the ability to do that? I mean, it's funny.
Speaker 2:There's a thing in economics called Baptists and Bootleggers, and for people who don't know that term, it's an economist that has studied, like trying to show historically who were the groups supporting alcohol prohibition. You know when that was in force, and he summarized by saying Baptists and Bootleg. So Baptists mean of course there was the religious, you know the T-totalers, who really didn't want alcohol to be allowed. They thought it was bad for society and you know against God and whatnot. But then the people who were in the Bootleg industry were making a bunch of money by selling moonshine and so they also, behind the scenes, were actually you know. So somebody might have originally thought, oh, the people who'd be most in favor of drug legalization would be the drug dealers. No, they're the last people, because they know they would go out of business. You know, if you're a heroin dealer right now, then you're not going to be the CEO of a reputable company 10 years into it if it's legalized. It's going to be somebody else who's got a different skill set than you do. So so, yes, in a similar vein, then you just you know that same thing, that it's right the people supporting and of course it's not that they need to send lobbyists who say, hey, we have these drugs that we just spent a bunch of money developing and so we want you to make it illegal for people to compete with us, even though our drug is no better than vitamins. That's not what they're saying. They're going to give, you know, research and whatnot to try to make reasoned arguments in defense of the public.
Speaker 2:But it's sort of like you know, I think, with a lot of stuff, bretney, that the rise of Uber, you know, and Lyft and whatnot, and Airbnb really helps the public to see that our arguments make sense, because we can see in the case, you know, when, like the taxi cab drivers are saying, oh no, uber shouldn't be allowed because you know the public, you might get into it, the guy might be an ex murderer, and people just realize, well, no, that's not happened. You know they have a system in place that you know there's ratings and stuff. So if the guy really is a terrible driver or whatever, the car's awful, you know he's going to be quickly weeded out of the system and it's just so much cheaper and convenient. Anyway, we don't believe you. The reason you guys are lobbying against Uber is so you can charge more for cab ride. That's not because you care about the public.
Speaker 1:And before over existed. You know they would make very well reasoned arguments about why there had to be this medallion system and why, you know, we've got to limit the number of taxis. And I remember writing about this, you know, years and years ago. And it's like, you know, when you really look at it it actually doesn't make sense. But I think until people can see with their own eyes the alternative, it's like oh yeah, medallion, that makes a lot of sense. You know you got to keep the streets, you know, clear of all these cars, can't have too many taxis. All the sudden it's like but once you see, you know the, once the reality changes and you see, oh, it's working just fine without that. It seems ridiculous.
Speaker 2:Yeah, and so, again, like I understand people I'm guessing the listeners of your audience, breton, you are pretty open minded about this stuff, but like the average person, I get it. If they heard our discussion from 10 minutes ago, I would think so you, anybody can just, like you know, put sign on their window saying brain surgeon $10 a pop and the public's going to go. And so, first of all, probably you know somebody who would willing to go to just some random person on the street and get a brain surgery done. You know that's the hey. They probably got a brain tumor, but beyond that, that you know, like you're. So, where you're going to go, you're going to go to a hospital, they're going to have brain, so the hospital is not going to hire Joe Schmoe, you know, who failed out of high school to be given brain surgeries. You know in their ER, because in the hospital, even if there's not medical liability, they just they're going to go out of business, right, if we're talking about a more, you know, business oriented system, and so I guess. So some of these crazy cases, and, like you said, you know, for something that's less risky, like just having somebody check, you know, oh, wow, my tooth is killing me. I need someone. You know, like you're talking about Hong Kong, well then, there maybe you would take the chance of doing something. And if you have a bad thing, well, the person's not going to die. And then they're going to tell all their friends and then we're going to minimize the damage. And again, you can always come up with scenarios where something bad is going to happen. But bad things happen with the current system. Right An example people might realize that there's been a proliferation at least where I've been living in the last several years of urgent care centers, and you need those had to spring into existence because now, even if you have a pediatrician and your kids sick, you can call them up and they're like, yeah, we can see in three weeks.
Speaker 2:And there's like, well, the kids sick right now, it's all. You take them to urgent care, you know. So I'm just saying, and the standards, I think, for that are lower than other thing people might be worried about. Oh, but you know what? If your kids sick, you need someone to see them and it's. You know you can turn to Google, but you know some. And also, too, I should mention last thing I know I've been going here, but part of why everyone has to go to see somebody is because you can't just get prescriptions filled without having a doctor prescribe them.
Speaker 2:So that's part of what keeps everyone locked into this crazy system too is that, if you know if you had more for it. It's not just like my wife had a certain thing she needed for a nebulizer for she's the lung issues, and when we were traveling in Europe she ran low and I was like, oh no, what are we going to do? And we just went down to the pharmacy and they gave it to us. I mean, we paid for it, but we didn't need a doctor to give us a, whereas in the US you would have needed a prescription to get that refilled. So I'm just saying things like that, and people might have been surprised by that, thinking oh yeah, socialized. Well, in at least the country we were in at the time, it was easier to get stuff there than in the good old United States with its wild Western healthcare.
Speaker 1:Right, and let's just talk a little bit about the whole the whole prescription thing. I mean, it's something that people, I think, don't really question, but I think it's insane that I have to go to another adult to get permission to get medications for my child or for myself. I think that's insane. And yet here we are and, as you say, what happens if you need something urgently? We actually had a thing come up recently where we got sent the wrong medication and then it took several days. We had to give our daughter the wrong medication for a few days and it caused problems and it's. I mean, I'm just sitting here thinking I should be able to just go to the store and buy this and get as much of it as I want and have it on in stock so I don't have to wait until my permission clears. And I mean, it's just when you think about it, it's pretty nuts. And yet people have come to accept it. Why does that even exist?
Speaker 2:Yeah, and just to get one specific illustration of just the absurdity and the horror, I think for certain people chronic pain patients they really have had a roller coaster the last several years because the opioid crisis and doctors over-prescribing.
Speaker 2:They would say, you know, and I get that, but then there was the crackdown on that and so then you know, doctors were very reluctant to prescribe pain killers even to people who just went through like a bad surgery or just again, someone who has a condition where they're really constantly in pain and just to function and not want to jump off a bridge you need. And a lot of them got you know cut way down just because the doctor was afraid. And no, no, no, if it looks on paper like I'm just passing out opioids, I could lose my license, right, so anyway. So I'm just saying there's lots of things like that where for people who are in generally good health, they might not realize just how crazy some of these outcomes in the system are. And again, this is in the United States. It has this reputation of being laissez-faire healthcare. No, it's not.
Speaker 1:Nothing close to it. Yeah, nothing close to it. Yeah, it's. Yeah, if you're in good health, I think you don't realize how much control they have and how, when you really need something, you're at their mercy. You're really, you are, and you know. You mentioned licensing again too.
Speaker 1:I think we've seen over the last few years how licensing is really used as a tool of control, how it's really, you know, as with you know, the FDA or anything else. I don't think it has anything to do with quality. It has to do with this is a way that we can make sure that doctors toe the line. You know, specifically in the last few years with regard to, like, unapproved treatments for COVID, ivermectin, that kind of thing. I don't know if you've been following the case of Meryl Nass in in, but she lost, she had her license stripped because she was giving ivermectin to patients, because she was basically trying to save their lives. Other doctors have had their licenses threatened because they talk about the risks of the COVID vaccine, or you know things that are clearly politically motivated, that are like you know, you're not towing our line and so we're going to take away your permission. You know again, why does anyone have that power?
Speaker 2:And it was on the going the other way too. Bretany, maybe this is on your radar too, but in the beginning, you know, when COVID first started becoming a thing, there were some researchers off the top of my head, I don't remember the details in the United States so that they had what they thought were, you know, rough and ready COVID tests. You know so the all the people saying, oh right, when, when an outbreak begins, if you could just isolate it and contain the people, you would save so many lives. And Donald Trump just sat and refused to do it. And no, what happened early on was there were some people who had, you know, crewed tests ready to start testing people in the FDA. Well, I think it was the FDA told them no, you're not allowed to use those tests, you have to use the ones that we approve.
Speaker 2:And so the people you know again, this is narrative has just arisen from the left about the US did nothing and, you know, put their head in the sand. And no, some people were trying to do early reaction and the government literally told them you are not allowed to test people and and you know it wasn't like they were going to be quarantined. There was no, there was no coercive power, it was just a matter of hey, there's this new thing and it would probably help if some people we could tell them you tested positive, maybe you want to stay home, you know, not that we're going to force you to, but just so you know you test the positive for this thing that we think came over and could be a deal. And no, the government said no, no, you're not allowed to do that. Yeah, the tests that we developed.
Speaker 1:Yeah, yeah, I remember that there were several labs that had developed and there were, they could use them internally. They just couldn't ship them out, they couldn't let anybody else. It was yeah, yeah. So you know, assuming those tests were a good thing to have, not so sure now, but you know like I said yeah, I realized you know there was a whole big thing, but I'm.
Speaker 2:But again, even the people who are trying to say oh, yeah, it was the inaction, and Donald Trump dragging his feet, and then say, no, there are several things where, even in your own worldview, the government prevented people from doing what you would have thought was the right thing.
Speaker 1:So yeah, it's the regulatory state doing what it does. What do we do? What do you think ideally, what would have been Sorry?
Speaker 2:can I say one last quick thing? I knew a guy he's a doctor, I forget he puts stints in people's like that, so he's a heart doctor. And when COVID was first hitting, he went because he had contacts with people in China and he was going to get what is a K-95s and masks, which are not the same thing as a 95. And so it was right. You remember when there was a shortage and people were going into hospitals and putting towels around their face and certain hospitals, and so he was like, for free, he was going to give for free. He was contact like and he had to. On Facebook, he had to use code to tell other people, hey, if you have a hospital, that's willing, I have crates full of K-95s sealed from the manufacturer that I will just give to you.
Speaker 2:And Facebook was shutting it, making it so he couldn't easily communicate that in all the local hospital, like I even reached out, like I knew some people, like through my wife who worked, and nobody took them up on it, like, no, we're not so because, no, we need N-95s for the healthcare workers. And so it ended up that they were like, like you said, reusing masks and we're just putting plastic instead of a K-95 because no, that's not allowed and it was just insane. Again, I know there's people like to say with the studies about the masks. But I'm just saying even in their own mind they thought masks were essential, but no, the rule says it's got to be an N-95 for the healthcare workers. So we can't take these. It was just insane.
Speaker 1:Yeah, yeah, let me just go up on one little tangent. It may not be that little, so one of the things that happened during COVID, it's probably still happening. There are all these cases. I don't know if you've seen all the accounts of people who were kind of coerced into taking remdesivir, coerced into being put on ventilators, not given care. What it looks like and I don't want to get too accusatory, but what it looks like is the hospitals had financial incentives to have people die from COVID and they were getting money from the government and there was specific bits of that money were earmarked for died of COVID.
Speaker 1:And so there are these accounts coming out now of people who were flat out denied care, left in rooms with starved, no water. I don't know another word for it than murder. It looks like people were killed in hospitals. In my mind, a healthcare system doesn't really get much worse than that. That's kind of the worst thing that can happen, and it looks like that was happening and baby still is. I don't know how do you fix that? How do we get from this point of oh my God, look at this horrific thing that's happening in this system. How do you stop that? How do you fix that?
Speaker 2:Well, I think, taking the coercion out of all of it. So, all these things we're talking about, what ultimately upholds each leg of the system is the coercion behind it all. And so, yeah, if the government for the medical licensing, if the government just wanted to publish a list and say these are the people we approve of, you can go to this website. You want to go to Cease Someone? Hey, before you go, make that initial appointment, why don't you double check with this list that we maintain at wwwblahblahblahgov? But if you want to see someone who's not on their list, you have the freedom to do it. I'd be okay with that. I mean, I might spend some. You know that might take taxpayer money or whatever, but it wouldn't be a big deal. The issue is, no, you're not allowed to go against what they say.
Speaker 1:To be clear, there are already private credentialing agencies. You can get credentials. You know even you can. You know you meet your licensing standard. But then you know in whatever specialty you are you can get private credentialing in that already. So there's no reason to think you know if there wasn't licensing that there would be these credentialing agencies.
Speaker 2:Oh right, totally. I'm just saying that, like if the government feels like, oh no, the public's too stupid, you're saying that notice the reason that their licensing has teeth. It's not because they're just making a recommendation, it's because they're saying if we catch you trying to go to a doctor that we don't approve of, he's in trouble and you're in trouble possibly. You know, so that's that's the just like in other countries, that where they like in Canada or whatever, you can't on the side, even for an approved doctor, if you're just on the side want to say, you know, here's some money, can you treat me, that's they've committed a crime in certain cuts. You know some. It's like a hybrid where they have a single payer or a government healthcare system but you can, on the side, opt out if you want, but in some of them you can't. So I'm just saying that, like that's here the US has that too, in the sense of if you're not an approved medical practitioner, so that's something.
Speaker 2:And again, you know, with that's partly how the government had such a stranglehold over the acceptable treatments, like you said, that the case earlier, the doctor using ivermectin, you know, losing her license. So that's the way they can ultimately control, and then that's why you know, geez, if someone's in the hospital and you go to visit them, for one thing you know you might not be allowed to visit them with those procedures. So even there you said well, gee, how come someone didn't open up a different hospital that will? Because you need to show a certificate of need in order to you know, it's not like just opening up a pizza shop, you know.
Speaker 2:So, again, this, every element of this whole thing, is tightly controlled. It's not a free market. And so then, given that, when the government has such tight control over it, don't be surprised if then, if you find yourself not with public opinion on something in public opinion, of course, is heavily molded by a smaller group then you could be in trouble. And that's when you see crazy things like hey, if you're not vaccinated, you should be denied medical care, and that you know, whereas you know that's coming from the open-minded, tolerant leftists, yeah, so yeah, do you think?
Speaker 1:you know? I think if we talked about some of these ideas like five years ago you know, not having licensing and you know not having government approval of drugs and that kind of thing it would have been dismissed by, you know, people who are not already on our side. I feel like most people would just think, oh, there are a bunch of lunatics. Do you think that's changed? Do you think there's an opening to have these ideas heard now?
Speaker 2:Oh, definitely, yeah, people saw how the health care, you know, the interventions in the medical sector, could be weaponized against unpopular groups, and I think that you know they've learned that lesson and they're going to. I mean, arguably. It's almost the other way that, like now, people are like, hey, I don't trust anything. You know viruses exist, and so it's like, yeah, so in terms of trying to get people to just do whatever the government wants and toe the line, it had the opposite effect. So to answer your question, right, I think, just like we said earlier, that 20 years ago if you said, oh, you know what, the taxicab medallion, that's an unwarranted government intervention and it makes cab rides more expensive and don't worry, there could be a free market and there'd be methods of private monitoring of the quality and the driver, and that would sound science fictiony, like who care what's the big deal. But once you see the alternative, and so then you heard somebody who might have thought, oh, the system basically works, bob, give me a break. And then, when you see what happened, then a lot of people are taking it more seriously, like, oh, yeah, maybe we shouldn't put this kind. You know, it's kind of funny that you wouldn't want the government to be just like to have total control over the food supply or something. You know that's kind of an essential thing. And yet you know they do have this very strong grip on healthcare, which is also pretty important for people. It's it's sort of like Brian Kaplan one time. He's a libertarian of cops and he had this offhand remark on a blog post about. You know that. You know, if you took some of the libertarian arguments seriously, you would think that, like drinking water wouldn't be something the state could provide. But you know it's basically a pretty good.
Speaker 2:And then the Flint Michigan thing came out, and so I, you know I said, oh, actually, no, it's not the case. The government can. You don't want them in charge of your local drinking water? Yeah, so like you could. As absurd as you could come up with, that's what the government's going to do and you don't want them in charge of it. You don't want them in charge of your money. Look what happened. You don't want them charged the schools. Look what happened. You don't want them charged of healthcare. Look what happened. You don't want them charged your drinking water.
Speaker 1:If we waved a magic wand, got government completely out of healthcare tomorrow, are there any problems you can foresee? Is there anything that would happen? Or even you know let's say it happened over, because there's also the issue of you know anything that happens instantaneously. There's going to be adjustment issue. But leaving that aside, if government wasn't involved in healthcare at all, can you think of any problems, any legitimate problems that that would create?
Speaker 2:Well, well, certainly, if by saying getting out, getting it out altogether, you included current government expenditures for healthcare item. If you turn that off next Thursday, that could lead to a lot of issues, like people who, right, or you know right now, like, like older people who have, you know, their whole lives in terms of budgeting and how much are we putting aside for our retirement, whatever, assuming? Oh, well then I'm going to be on Medicare at that point, like for them, it would be tricky if all of a sudden, that got turned off. Yeah, like I said, though, a lot of this stuff, though I think one of the I don't want to call it silver bullet, but if you got rid of the mandatory licensing and again the reason I'm saying the mandatory, I was saying before about the you know putting the thing that if the public thinks, oh no, we need, we need some sort of central authority to tell us who's a good doctor, I'm saying, okay, well then they can publish the list. They can just say if we, you know, according, these are the people that meet our criteria. So anybody who wants likes that system, you can still go to just those doctors. It's just, don't force other people who disagree with you or who disagree on the tradeoff between the price versus the quality. Yeah, don't force them into that same system. Give them the freedom to opt out. That's all it would mean. Just like with the FDA, like there could be. The FDA could still give its approval to certain drugs and then, you know the CVS or whatever could have two different sections. They could even have it, you know, the unregistered or unlicensed ones behind the counter right and glass or something, and maybe only sell those to people who are 21 or older or something. But again, it's just the idea. So you can still have a bifurcated system and all the stuff that you think the government's giving right now. A lot of that you could get without the coercion involved. So that would bring down prices.
Speaker 2:That's where I was going with. All this is to say. So that would ease a lot of this. That hardly reason right now it seems like, oh, we need to have massive health insurance coverage and government subsidies is because it's just so expensive. But no, the reason it's so expensive is because we've got this crazy system where again, the customer is not the one making the decisions, like when people who decide to go get some tests or whatever.
Speaker 2:If you had to pay for out of pocket all the different MRIs and whatever, there'd be a lot fewer those ordered. And I know some of that too is like because of the male practice issues that a lot of times doctors order a bunch of tests just to have themselves covered and for there's more reasonable legal system, maybe that would be lower too. So anyway, just opening that up a lot, a lot of the prices would come down, which would make a lot of the other fixes less painful. That, oh yeah, you could end government subsidies a lot more easily if the prices dropped 90%. And by the way, those numbers I mentioned Keith Smith of the Oklahoma Surgery Center. Yeah, that's some of that, because for people who don't know it's like a cash practice and on some you know a lot of procedures. He says the cost savings are 90, 95% in some cases.
Speaker 1:Yeah, they've documented that and it's. It's a huge, huge difference. I mean such a difference. People frequently fly in from other parts of the country just because it's still way, way cheaper, even with your travel.
Speaker 2:Yeah, and even like taking a week at the hotel down the street to recover from the surgery and then fly back, even all all in people saving thousands of dollars and going and doing that. And so that kind of mileage of shows that, at least for a lot of the more routine procedures, a lot you know the. So these, these humongous prices, the people, when you go, you go to the hospital and you come out you look at the actual itemized bill and you're just shocked Wow, it's a good thing I have insurance. Well, it's partly because you have insurance the bill is so high. If they had to actually get, you know, give that to paying customers, the prices would have to come down because nobody would be paying those figures.
Speaker 1:Yeah, really quick. I know we've got to wrap up pretty soon Because we're talking about insurance. I think there's probably a perception, among some people at least, that well, that's just the free market, that's, that's something the market came up with. Why are why? How did we end up in this weird, with this weird insurance insurance model? How did that happen?
Speaker 2:Sure. So it's great question. I'll try to give a quick answer Again. A lot of it. This is a great illustration of little Venmese's head, this idea of like the logic of interventionism and how one intervention causes problems that then justify the next round, and then you just keep rationing up, you know, moving towards outright socialism.
Speaker 2:So in health insurance, the United States, so one of the things that happened is, during World War Two there were wage and price controls, right. So the government's fighting the war, the Federal Reserve's creating boatloads of money to pay for it. They're going through. You know, the government issues bonds, the Fed monetized it and whatever, and so that was pushing up prices. The government didn't want that. So they had wage and price controls. But they had an exception If a company like offered to cover someone's health insurance as part of the compensation package, that wasn't included with the cap, so that you know companies bidding for workers in that period couldn't just say, oh, we'll give you 10% more money, because that would be in violation of law, but they could say, hey, we'll give you this amount of money in salary and we'll pay for your family's health insurance.
Speaker 2:So that's partly what, how that came to be a thing. And then you know there's right now at the tax code has certain provisions that also make it advantageous that if an employer you know gives you $80,000 in cash and $20,000 payment for your health insurance, that's you as the employee are only taxed on the 80%, whereas if they just gave you 100 grand in cash, it's by your own health insurance and you spent 20,000, you'd be getting taxed on that 20,000. And so that's another reason like keeping it locked in that, especially like higher compensation. Employees would rather their compensation be, you know, allocate. They want the insurance to be provided by their employer rather than them getting paid and then they shop around and they buy it themselves over the counter. So things like that just give them two quick examples to help show that it's not market forces, it's government rules that have sort of shepherd us into this system, and that's that's part of the explanation for why it's like that. And then there's lots of you know there's rules against interstate competition and things like that that you know help make insurance more expensive than it needs to be, and a lot of stuff to like the portability.
Speaker 2:Like you, in principle, you should be able to buy a real low frills health insurance plan that just follows you around. But in practice that's not how you know. Kind of renews every year where it's like you buy a life insurance policy when you're 25. And you keep paying the premiums, even if you develop a brain tomb or five years later. As long as you keep making those premiums, that policy is still enforced. But with a health insurance it's not like that. You know it's going to renew soon enough. So a lot of those. And I think again. I think it's because there's government rules about what type of policy you need to have, and certainly with Obamacare now Right, certainly after the CAA.
Speaker 2:So partly you know if they could do things like like, for example, my first son. When he was born he had a heart murmur and I was self employed at the time. This was right before Obamacare came in.
Speaker 1:And.
Speaker 2:I had the hardest time just getting basic health coverage for, like he's, we got in a car X or something. Because I was always at a health murmur, our heart murmur, and I was saying, well, can't we like have a writer and the policy saying if it's heart related it's not covered, but just basic catastrophic? And they wouldn't do it. And I think partly it was because they thought if something were to happen this guy would go before a jury and say my poor little boy had a heart problem and a big bad insurance company didn't cover it and so like they wouldn't be. So I'm just saying some of that stuff. I think too. Just the legal system the way it is, and you know everyone's afraid of being sued for absolutely anything.
Speaker 2:Yeah. So I think that's partly why you can't just get real bare bones, catastrophic coverage and now it's literally illegal.
Speaker 1:Right, even before Even before.
Speaker 2:Yeah, because of things like that. So that's so. I'm just giving you some examples to try to explain. You know, why is it that we're in this weird you know situation now where health insurance seems to be so distorted, relative even to other forms of insurance?
Speaker 1:Yeah, yeah, just quickly to wrap up. Final question we have a vision of what needs to happen. We need to get government coercion, get government out of healthcare. Can that happen through the political system? Can a politician do that?
Speaker 2:I mean in terms of like, is it theoretically possible? Yes, like Andrew Jackson famously got rid of the second bank of the United States, you know, which was like the Fed of his day. So, certainly, you know, airlines used to be heavily regulated in the 1970s, and then there was deregulation. So, even though, as libertarians, we like to joke and say, hey, there's no such, you know, there's nothing that lives longer than a temporary government program, stuff like that that you know, yes, there are just historical president, it is possible to roll back the state in certain areas. I do think, though, it's really difficult because, again, even if any single politician really does have the right vision or whatever, typically the way the system works, they're gonna have to work with others, and it's hard to, you know, really get that to go through. So I think what I try to do, at least, is to sketch a vision and to show you know, this is what a good system would look like, a free society. This is how it would work, and so keep in mind, yes, these government interventions over the years are what's causing the problem. So people know what the heck happened, but in terms of, you know where I personally would put my efforts in trying to fix things, is developing alternatives where people can kind of opt out of the current system. So, like you know, in monetary arena, rather than trying to abolish the Fed even though that would be a good thing it's more, you know, telling people about Bitcoin and other things and other you know, financial vehicles you can use, blah, blah, blah, blah, that sort of thing. And instead of attacking the taxing account, you know monopoly directly by getting rid of the medallion system, just having Uber and Lyft come through, and then, you know, the public will just gradually go away. And you know the post office still has a monopoly on first class letter delivery, but you've got FedEx and UPS and you know. So that's kind of what I think.
Speaker 2:So, just on the margins of me, if they could just more liberalize. So I think what's gonna happen maybe this way to wrap up for me is, rather than just the government totally shutting down the existing, you know, systems that are totally dependent on the government's existence, instead just on the margins, freeing up and liberalizing, so that allowing people to, you know, do these things on the side, to give an opt out option for people. To me that's what's gonna give the most freedom, in the short run at least, and also to then to provide an example so the public can see wait a minute these, you know, that's why I like the Keith Smith example so much. They he's showing this, isn't? You? Gotta go read Rothbard and we can imagine a tropical island where there's free healthcare. You know, free market healthcare, not the.
Speaker 1:Right, but no, it's fear and it's.
Speaker 2:So, yeah, I think that's what it'd be. So, politicians, maybe you know to be able to, I think what's realistic is they could liberalize certain things and allow competition. Like I said, instead of abolishing the FDA, just maybe saying, oh, within certain classes of things, you know, if your doctor approved, you can get a prescription that's not FDA approved. You know what I mean. That's not total laissez-faire anarchy, but it's better than you know the current system kind of thing. And then, once that's in place, people could check that out after five years and become. The rate of death in that population is no higher than the general population. So maybe this isn't such a crazy. You know that kind of thing.
Speaker 1:Yeah, yeah, yeah, okay, thank you so much. This has been great. Yeah, thank you.
Speaker 2:All right, thank you. Keep up the good work of getting all this message out to people.
Speaker 1:Yeah, you've been listening to. What, then, must we Do? The podcast. For those who understand the state is the problem and are seeking solutions For more episodes, go to bretanysubstackcom, that's B-R-E-T-I-G-N-E. Dot substack dot com and subscribe.