Jump to content






Photo

The profit motive and medicine


  • Please log in to reply
36 replies to this topic

#1 general semanticist

general semanticist

    $$$$$$

  • Members
  • 2,806 posts
  • Gender:Male
  • Location:NB Canada
  • Interests:Playing guitar, golf, renovating

Posted 10 October 2009 - 06:33 AM

Because of the current controversy going on in the US about healthcare I thought it would be timely to ask this question. United States has historically been the best example of individual capitalism in the world and this included medicine. My question is, if individual capitalism (as opposed to social capitalism) is so good, as the proponents of Objectivism claim, then why has the healthcare system got into such bad shape in the US? My position is that the profit motive cannot solve all of mankind's problems - there are some issues that are better dealt with by other means.
'Always' and 'Never' are two words you should always remember never to use. :-)

#2 Dennis Edwall

Dennis Edwall

    $$

  • Members
  • 91 posts
  • Gender:Male
  • Location:Thousand Oaks, CA
  • Interests:Science, mountaineering, reading, working, healthy eating and lifestyle, Colorado, Alaska, Objectivism, Rand, Brandens, investing

Posted 10 October 2009 - 06:58 AM

We are still learning, and some people are slow to learn. Progress would be faster and what works and doesn't work more definitive if there was more competition between ideas, but the government wants to impose uniform policy.

Why do you suppose that it took so long for a flush toilet to be invented that did not use much water but actually worked well? The need has to be strong enough. The need for greater efficiency in health care will become apparent (to some people at least) because the inefficiency can no longer be tolerated from an economic standpoint.

#3 BaalChatzaf

BaalChatzaf

    $$$$$$

  • Members
  • 10,729 posts
  • Gender:Male
  • Location:Currently residing in New Jersey, the Bad-a-Bing State.
  • Interests:mathematics, physics, alternative energy sources.

    I am also involved in preparing recorded books for blind and dyslexic folks.

Posted 10 October 2009 - 08:15 AM

Because of the current controversy going on in the US about healthcare I thought it would be timely to ask this question. United States has historically been the best example of individual capitalism in the world and this included medicine. My question is, if individual capitalism (as opposed to social capitalism) is so good, as the proponents of Objectivism claim, then why has the healthcare system got into such bad shape in the US? My position is that the profit motive cannot solve all of mankind's problems - there are some issues that are better dealt with by other means.


Our system is regulated by government (at several levels in several ways) and is ringed by circling flocks of vulture lawyers.

For starters, doctors, nurses and other medical-technical people are licensed by government. Medication must be obtained by perscription (this is enforced by law). Only legally designated schools can turn out doctors and other medical-technical types. And so on and so on.

You will notice that computers are inexpensive and medical treatment and drugs are expensive. Computers are relatively unregulated.

Ba'al Chatzaf
אויב מיין באָבע האט בייצים זי וואָלט זיין מיין זיידע

#4 general semanticist

general semanticist

    $$$$$$

  • Members
  • 2,806 posts
  • Gender:Male
  • Location:NB Canada
  • Interests:Playing guitar, golf, renovating

Posted 10 October 2009 - 08:47 AM

I believe governments get involved with things when they cannot be solved by private means. There is a problem when large numbers of citizens cannot afford healthcare and so governments get involved to try and deal with that. I believe this is a legitimate role for government to play - I am not saying I agree with their solutions but I believe it is their role to attempt to fix the problem. It seems to me that in Objectivism the feeling is that governments should stay out of everything but the military and everything else will fix itself via competition and profit motive. I find this hard to believe.
'Always' and 'Never' are two words you should always remember never to use. :-)

#5 BaalChatzaf

BaalChatzaf

    $$$$$$

  • Members
  • 10,729 posts
  • Gender:Male
  • Location:Currently residing in New Jersey, the Bad-a-Bing State.
  • Interests:mathematics, physics, alternative energy sources.

    I am also involved in preparing recorded books for blind and dyslexic folks.

Posted 10 October 2009 - 08:54 AM

I believe governments get involved with things when they cannot be solved by private means. There is a problem when large numbers of citizens cannot afford healthcare and so governments get involved to try and deal with that. I believe this is a legitimate role for government to play - I am not saying I agree with their solutions but I believe it is their role to attempt to fix the problem. It seems to me that in Objectivism the feeling is that governments should stay out of everything but the military and everything else will fix itself via competition and profit motive. I find this hard to believe.


Large numbers of people cannot afford yachts. Shall the government provide them? Should the government feed people who will not or cannot feed themselves? Should the government assume the dominant role in food production and distribution? God Forbid! If it did we should all soon be lining up for meager rations.

Government exists to keep order and protect property, not to coddle the incompetent.

Ba'al Chatzaf
אויב מיין באָבע האט בייצים זי וואָלט זיין מיין זיידע

#6 general semanticist

general semanticist

    $$$$$$

  • Members
  • 2,806 posts
  • Gender:Male
  • Location:NB Canada
  • Interests:Playing guitar, golf, renovating

Posted 10 October 2009 - 09:08 AM

Government exists to keep order and protect property, not to coddle the incompetent.
Ba'al Chatzaf

So what happens in a society when the percentage of the population which is poor (incompetent) gets too large? I propose that crime becomes more of a problem, including crimes against private property of the not-so-poor. So then what? Add more soldiers/police and increase protection? The concept of private property can only work in a society that is economically stable enough for people to have respect for each other property. The issue of equal opportunity is part and parcel of the concept of private property.
'Always' and 'Never' are two words you should always remember never to use. :-)

#7 Dennis Edwall

Dennis Edwall

    $$

  • Members
  • 91 posts
  • Gender:Male
  • Location:Thousand Oaks, CA
  • Interests:Science, mountaineering, reading, working, healthy eating and lifestyle, Colorado, Alaska, Objectivism, Rand, Brandens, investing

Posted 10 October 2009 - 10:00 AM

<<There is a problem when large numbers of citizens cannot afford healthcare

Two reasons:
1. Because they don't pay directly for their own care, someone else does, whether gov't or insurance. When that happens, the resource is not used efficiently.
2. If most everyone expects medical care in their final month or so of life that costs tens or even hundreds of thousands of dollars (just to delay the inevitable a bit longer as though somehow death might be cheated), then hey, guess what, those costs will ultimately need to be borne by each of us. That makes lifetime medical costs very expensive. There needs to be more realistic assessment of when and when not more medical care is justified, especially as long as there is a complete socialization of costs, whether by insurance or gov't.

You get these problems when there is no responsibility.

#8 Brant Gaede

Brant Gaede

    $$$$$$

  • Members
  • 14,265 posts
  • Gender:Male
  • Location:Tucson, AZ
  • Interests:All kinds of stuff

Posted 10 October 2009 - 10:49 AM

It kills me that people come to an Objectivist site and argue about things from a perspective that completely ignores free markets, free minds and free people.

Freedom in health care means government gets essentially kicked out of the equation. I'm talking about mandates, regulations, licensing, funding and insane tort.

--Brant

Rational Individualist, Rational self-interest, Individual Rights--Libertarian--objectivist Objectivist, not an Objectivist Objectivist


#9 Brant Gaede

Brant Gaede

    $$$$$$

  • Members
  • 14,265 posts
  • Gender:Male
  • Location:Tucson, AZ
  • Interests:All kinds of stuff

Posted 10 October 2009 - 10:59 AM

Freedom is a moral imperative. Governments doing for you what one should do for oneself means perpetual childhood and dependency--means tyranny much worse than being under the thumbs of one's parents.

--Brant
please buy me a car and a new pair of shoes, socks and underwear--I WANT MCDONALDS!!!! Wah, wah, wah!!!

Rational Individualist, Rational self-interest, Individual Rights--Libertarian--objectivist Objectivist, not an Objectivist Objectivist


#10 general semanticist

general semanticist

    $$$$$$

  • Members
  • 2,806 posts
  • Gender:Male
  • Location:NB Canada
  • Interests:Playing guitar, golf, renovating

Posted 10 October 2009 - 11:13 AM

One could argue that it is the profit motive that drives the costs of healthcare up for when there is money to be made then decisions get based on maximizing earnings and not providing the most sensible healthcare. Heart by-pass surgery is a good example. There is little evidence that it prolongs your life while there is much evidence that changing your diet and lifestyle does. There is even evidence that artheroslcerosis can be reversed with proper supplements but there is no money to be made in these treatments so the medical establishment ignores and tries to discredit them instead.
'Always' and 'Never' are two words you should always remember never to use. :-)

#11 Christopher

Christopher

    $$$$$$

  • Members
  • 962 posts
  • Gender:Male
  • Location:Sausalito, Ca
  • Interests:Studying Healthy Values. I love family, wine, and opera. I am also seeking deeper inner experiences through spiritual practice

Posted 10 October 2009 - 11:39 AM

There are certainly issues with the health care system in the U.S., some from over-regulation and some from lack of regulation to protect the rights of patients. Some of these have been listed elsewhere and include:

1. The monopoly on education and accreditation (there are many hoops necessary to become a doctor that lead to shortages). As M.Friedman pointed out, the education allows for only the training of good doctors, so there are no cheaper-doctor alternatives (like producing only luxury vehicles and banning the production of cheap vehicles... but luxury is not affordable to everyone).

2. Government promotes corporations providing health care, which in turn gives power to insurance companies. Government also protects insurance companies by having a set of regulations that prevents normal doctors from offering insurance-like packages (1-year subscription prices to lab tests, etc.)

3. Medical institutions charge lesser rates to insured clients than to non-insured clients, seemingly because insurance companies can negotiate rates. However, the power that allows insurance companies to negotiate such rates is partially derived from government supporting insurance companies through #2. If the medical insurance were like car insurance, we would see that when you crash with insurance, your damage is $500; when you identically crash without insurance, your damage is $2500. Therefore, it is not affordable not to have insurance, further increasing insurance monopoly powers.

4. As we've all read, insurance companies are dishonest and hesitant to provide the services necessary to sustain health when those services are expensive.

5. Health insurance companies cease allowing renewel of insurance to individuals who become sick; yet by the very nature of medical sickness, things take time to cure and insurance was purchased for the cure, not for the first month of support only.

6. People are driven by fear and absolute necessity to heal sickness. People will pay anything for a cure. Even with monopolistic policies and overpriced services, people will still pay. The system doesn't provide alternatives for a necessary product.

---
So it's a combination of lack of government regulation to protect human rights and over-regulation that infringes on human rights. In a free-market economy, we would have lots lots more options for different qualities of service: doctors of all skill-levels would be available at different prices; services would be identically priced for individuals with or without insurance (and if not at some institutions, there would be others that are identical); health insurance companies would insure people without deceptive loopholes and assume total responsibility for the sickness regardless of time (or at least, this would be explicitly and clearly stated if not); and because of successful protection of human rights and lowered monopolistic practices, even though people continue to be driven by fear, the market is not playing off of and taking advantage of that fear.

#12 BaalChatzaf

BaalChatzaf

    $$$$$$

  • Members
  • 10,729 posts
  • Gender:Male
  • Location:Currently residing in New Jersey, the Bad-a-Bing State.
  • Interests:mathematics, physics, alternative energy sources.

    I am also involved in preparing recorded books for blind and dyslexic folks.

Posted 10 October 2009 - 01:27 PM


Government exists to keep order and protect property, not to coddle the incompetent.
Ba'al Chatzaf

So what happens in a society when the percentage of the population which is poor (incompetent) gets too large? I propose that crime becomes more of a problem, including crimes against private property of the not-so-poor. So then what? Add more soldiers/police and increase protection? The concept of private property can only work in a society that is economically stable enough for people to have respect for each other property. The issue of equal opportunity is part and parcel of the concept of private property.


What is "too large"? I assume cops or the national guard armed with machine guns that shoot live ammo can take care of looters and rioters. Dead men don't riot and neither do they loot. If want and penury become extreme then the society will fall apart. The result is that thugs will rule and eat, and rest won't which is exactly the situation before crash. Some will eat and most will not. Obviously the "solution" is a productive society where most people are not in want and the few that are can be taken care of by voluntary charity. That is the way our society is, in fact. Very few people in the U.S.A. starve to death. There are kitchens and pantries for the poor and the poor eat.

The anti-capitalists love to paint a picture of a society where the vast majority live in misery, poverty, squalor and near starvation. This is not the way the U.S.A. and it never was. Even during the depression, the poorest got fed at bread lines and soup kitchens. The poorest were never given the impression they had a right to be fed. The were fed out of the goodness of someone's heart and had the decency to say "thank you".

Ba'al Chatzaf
אויב מיין באָבע האט בייצים זי וואָלט זיין מיין זיידע

#13 Brant Gaede

Brant Gaede

    $$$$$$

  • Members
  • 14,265 posts
  • Gender:Male
  • Location:Tucson, AZ
  • Interests:All kinds of stuff

Posted 10 October 2009 - 02:23 PM

One could argue that it is the profit motive that drives the costs of healthcare up for when there is money to be made then decisions get based on maximizing earnings and not providing the most sensible healthcare. Heart by-pass surgery is a good example. There is little evidence that it prolongs your life while there is much evidence that changing your diet and lifestyle does. There is even evidence that artheroslcerosis can be reversed with proper supplements but there is no money to be made in these treatments so the medical establishment ignores and tries to discredit them instead.

Then we certainly don't need a new health plan in the US to pay for all this worthless crap we're now wasting money on, do we?

Then Canadians can stop coming to the U.S. to get their MRIs and other medical surgical goodies--no?

--Brant
block 'em at the border

Rational Individualist, Rational self-interest, Individual Rights--Libertarian--objectivist Objectivist, not an Objectivist Objectivist


#14 Las Vegas

Las Vegas

    $$$$$$

  • Members
  • 906 posts
  • Gender:Male
  • Interests:Business, computer science, consumer electronics, lap swimming, weight training, photography, Rand & anyone else who makes sense.

    U.S. Army Veteran 1968-69

Posted 10 October 2009 - 02:51 PM

So long as people believe they are "entitled" to health care, or pots with chickens in them, there will always be a push by the despots in power to loot some for the benefit of another. They get their votes that way.
Live long & prosper

#15 Christopher

Christopher

    $$$$$$

  • Members
  • 962 posts
  • Gender:Male
  • Location:Sausalito, Ca
  • Interests:Studying Healthy Values. I love family, wine, and opera. I am also seeking deeper inner experiences through spiritual practice

Posted 10 October 2009 - 07:12 PM

GS does make a valid point on crime, etc.

As a society, we are willing to pay for safety through police enforcement. At the same time, we know that social programs geared toward education and anti-drug awareness/facilities actually reduces crime and saves money overall.

Therefore, if a logical argument can be made that shows providing some level of "free" health care significantly lowers cost in some other area (such as crime patrol), then health care could be seen as Objectively plausible.

But in terms of treatment costs and profit motive of medical industry, I think that has more to do with the state of a corrupted system that doesn't allow significant supply of qualitatively different levels of treatment (i.e. doctors work their asses off in school, so they might as well seek the highest-priced options... if there were lesser-trained doctors, there might be more support for cheaper treatments).

#16 Selene

Selene

    $$$$$$

  • Members
  • 14,791 posts
  • Gender:Male
  • Location:New Jersey
  • Interests:Chess, birding, football, baseball, minimalist backpacking, argumentation and debate, politics and philosophy, strategic board gaming, history, Rand, poetry, writing.

Posted 10 October 2009 - 08:22 PM

Improper assumptions of fact that create mistakes in logical conclusions:

Chris:

"At the same time, we know that social programs geared toward education and anti-drug awareness/facilities actually reduces crime and saves money overall."

This is not only inaccurate, but immoral even if it were accurate.

You then use that unsubstantiated statement to lynch pin to the following argument:

"Therefore, if a logical argument can be made that shows providing some level of "free" health care significantly lowers cost in some other area (such as crime patrol), then health care could be seen as Objectively plausible."

Capitalizing "Objectively" does not make it a false argument.

GS:

"...then why has the healthcare system got into such bad shape in the US?"

Answer: It is not in bad shape.

"There is a problem when large numbers of citizens cannot afford healthcare and so governments get involved to try and deal with that..."

No one in America cannot get health care. About 20% cannot or will not get health insurance. The "facts" are [and yes I have the sources] that the long term "uninsureable" class is somewhere between 9 million and 16 million. This is addressable with approximately 90 billion or less a year, I believe, by a form of assigned risk government supported/private partnership.

"So what happens in a society when the percentage of the population which is poor (incompetent) gets too large?"

The marxist statist government that always creates that state will either collapse, lose the wars of expansion or a revolution of freedom and liberty seekers with will overthrow the bastards, execute them and hang them by their heels from the nearest wind farm blades and charge a fee to watch them slowly elevate and decline in the wind.

"One could argue that it is the profit motive that drives the costs of healthcare up for when there is money to be made then decisions get based on maximizing earnings and not providing the most sensible healthcare."

One could argue that and one would lose the argument, but at least it could be advanced rationally. I think the connection you are struggling to assert in the blue highlight is going to be
difficult to establish.

Adam
"Extremism in the defense of liberty is no vice..and moderation in the pursuit of justice is no virtue."

#17 Christopher

Christopher

    $$$$$$

  • Members
  • 962 posts
  • Gender:Male
  • Location:Sausalito, Ca
  • Interests:Studying Healthy Values. I love family, wine, and opera. I am also seeking deeper inner experiences through spiritual practice

Posted 10 October 2009 - 08:47 PM

Improper assumptions of fact that create mistakes in logical conclusions:

Chris:

"At the same time, we know that social programs geared toward education and anti-drug awareness/facilities actually reduces crime and saves money overall."

This is not only inaccurate, but immoral even if it were accurate.


Fact: One million dollars spent on correctional education prevents about 600 crimes, while the same money invested in incarceration prevents prevents 350 crimes.

http://www.ceanation...ime-control.pdf

What is your basis for calling it immoral?

#18 Selene

Selene

    $$$$$$

  • Members
  • 14,791 posts
  • Gender:Male
  • Location:New Jersey
  • Interests:Chess, birding, football, baseball, minimalist backpacking, argumentation and debate, politics and philosophy, strategic board gaming, history, Rand, poetry, writing.

Posted 10 October 2009 - 09:10 PM

Excellent:

Define crime please. Is it growing marijuana in my backyard and selling it by the pound? A felony.

Is it finding a "citizen" dragging a neighborhood girl into the woods and putting a clean shot through his head?

Is it prostitution?

Is it manufacturing non fiat money?

Is it book making?

Is it running a poker game?

Let us start there. Fair enough.

Adam
"Extremism in the defense of liberty is no vice..and moderation in the pursuit of justice is no virtue."

#19 galtgulch

galtgulch

    $$$$$$

  • Members
  • 1,441 posts
  • Gender:Male

Posted 10 October 2009 - 09:20 PM

if individual capitalism (as opposed to social capitalism) is so good, as the proponents of Objectivism claim, then why has the healthcare system got into such bad shape in the US? My position is that the profit motive cannot solve all of mankind's problems - there are some issues that are better dealt with by other means.


GS,

It is hard for the vast majority of people to grasp just how far America now is from being a truly free society as envisioned by Ayn Rand and Objectivists. We have lived all our lives with so many manifestations of government interventions and I will only mention a very few: compulsory public schools, military draft until it was repealed, the income tax, sales taxes, capital gains taxes, inheritance taxes, occupational licensing, zoning regulations, business regulations, e.g. OSHA, EPA, Sarbanes-Oxley rules, property taxes, prohibition of substances, irredeemable paper currency and legal tender laws, central banking, and the list goes on...

The govt has limited entry into the marketplace by limiting the number of medical schools since the Flexner report and study. Medical licensing has established a monopoly in medicine. We are all aware of the consequences of the lack of tort reform regarding malpractice with resultant exorbitant premiums for insurance against claims of negligence or malpractice and awards granted even when the outcome was not the fault of the doctor at all.

One point here is that government interventions have had far worse outcomes than would have occurred without those interventions.

Of course when vast sums are expropriated from productive citizens who work for a living and used by govt for some purpose conceived by politicians under pressure from lobbyists there will be recipients who benefit. We will never know what would have been done if the money had been left in the hands of those who earned it.

I imagine you might wonder whether certain things would be done in a free society where no one would be forced to "contribute." Perhaps you might wish to know whether there is sufficient water on the moon and conceive of a program to send a rocket to the moon to crash and another rocket behind it to determine if any water existed in the plume kicked up by the first rocket, for the cost of $79 million dollars. You might think it worthwhile to make such a tiny expenditure because if there were water there it could be used to create hydrogen and oxygen to enable a base to be built on the moon to facilitate space exploration beyond the moon. I think as appealing as such exploration might be Objectivists, or at least this one, think such endeavors should be funded privately, not tax supported. If a military program were justified in space it also should not be supported by taxation or if so in accordance with the stipulation in Article 1 Section 9 after the Sixteenth Amendment were repealed as it should be.

We live in a mixed economy and there are a mixture of freedoms and interventions, rules, restriction, mandates, compulsory regulations and the like. So what you observe today is not a free market in medicine or anything else. It is unfair to place the blame for the shortcomings of our present system of medical practice upon the free market as it does not exist. A case can be made that those shortcomings would resolve if a truly free market in medical practice existed once again. There was a time when a doctor was free to contract with his or her patient without the interference of any third party. The patients were also free to choose their own doctors as well.

The issue is not the profit motive rather it is one of individual freedom. Government is coercion, produces nothing and should be limited as the Founders intended to protecting the rights of individuals. Unfortunately the sophistry and power lust of men has construed the Constitution to their own misguided purposes where the kind of evil intentions you attribute to those who seek profit actually are more appropriately attributed to those who have priorities above the freedom of the individuals whose rights are violated and who are enslaved by the laws politicians legislate.

Two men may each have a desire to acquire wealth and so may be considered to have a profit motive. One will acquire a marketable skill and earn his pay by dealing with others by mutual consent and create products or services others value and for which they are willing to pay.

Another may resort to force or fraud in his behavior thus violating the rights of others to satisfy his desire to acquire wealth. Or he or she may simply vote into office a politician who is willing to cast his votes for bills which in turn benefit some at the expense of others. As Spooner has pointed out the secret ballot enables a secret band of robbers and murderers to achieve their ends through the political process. Than only can happen when politicians fail to grasp the meaning of the oath they take and of the Constitution itself which forbids the evils you and i abhor.

www.campaignforliberty.com 218,938

#20 Selene

Selene

    $$$$$$

  • Members
  • 14,791 posts
  • Gender:Male
  • Location:New Jersey
  • Interests:Chess, birding, football, baseball, minimalist backpacking, argumentation and debate, politics and philosophy, strategic board gaming, history, Rand, poetry, writing.

Posted 10 October 2009 - 09:37 PM


Improper assumptions of fact that create mistakes in logical conclusions:

Chris:

"At the same time, we know that social programs geared toward education and anti-drug awareness/facilities actually reduces crime and saves money overall."

This is not only inaccurate, but immoral even if it were accurate.


Fact: One million dollars spent on correctional education prevents about 600 crimes, while the same money invested in incarceration prevents prevents 350 crimes.

http://www.ceanation...ime-control.pdf

What is your basis for calling it immoral?



Chris:

On page 30 to 32, the tables are from 1994. The "study" is restricted to, apparently, three states and riddled with leaps of bureaucratic bullshit. Ohio California and the Department of Education are the sources.

C'mon Chris. There is not even what I required of my freshman rhetoric/debate students which was what precise statistical analysis was used.

You cannot seriously base what you said on this. It proves nothing.

Adam
"Extremism in the defense of liberty is no vice..and moderation in the pursuit of justice is no virtue."




0 user(s) are reading this topic

0 members, 0 guests, 0 anonymous users




Nightingale-Conant