System Dynamics
Atlanta, GA
January 31, 2023
We were at a gala last weekend where one of the speakers represented a major “healthcare” organization. His remarks reminded me how our conception of medical service has shifted dramatically since I was a kid.
This executive promoted “curated” care tailored to each individual, going so far as to etymologize the word “curate” from its Latin derivative curare: “to take care of”.
Makes sense. After all, no two people are alike. Each of us has unique genetics, values, health history, medical risks, and physiological needs, and so requires different priorities and approaches to preserve his health. I was pleased our presenter was on the right road.
But then he began to hit the skids. He swerved toward predictable platitudes, stressing the need for “all of us” to “work together” and “coordinate effectively” to build a better “healthcare system.” By not applying the brakes to such bromides, he drove his speech right into a ditch.
Collective action and centralized control are what created the healthcare pile-up we endure today. As in any arena of prospective exchange, medical care doesn’t require a “system”. It just needs an unhindered market.
Which means potential counterparties should be left alone to interact (or not) voluntarily…to give, take, hold, or fold…without external interference from insufferable busybodies they’ve never met. This is especially true for something so intimate and important as personal health.
When I was a child we were far from “rich.” But we obtained medical care like we purchased groceries or bought clothes. If we felt sick or wanted an exam, we went to the doctor. He worked in a small building with a couple rooms. We’d walk in, wait a few minutes, get checked, pay for the visit, and go home.
That was it. No enormous edifice, third-party payers, insurance oversight, impersonal administrators, sequential waiting rooms, series of nurses, or robotic doctors pushing piles of paper and a panoply of prescriptions.
And it was intimate, not industrial. We had a “family doctor”, not a “preferred provider.” We could see him whenever we wanted, without a six-month wait to get an appointment. House calls were still available to average Americans, and hospital visits didn’t impoverish or bankrupt them.
Physicians regularly made pro bono provisions…or were compensated by churches or charities…for patients who couldn’t pay. That was their calling, and they abided their oath.
The patient was a person and a customer, not a number or a “record”. He often paid for service from his own pocket. Care wasn’t always cheap, but it was rarely frivolous and seldom superficial. It sought sources of ailment rather than symptoms of pain, and relied more on nutrition and lifestyle than shots and pills.
Not that the current model doesn’t have customers. But the patient isn’t among them. Under the statist “system” we endure today, insurance companies, pharmaceutical corporations, and an army of bureaucrats call the shots (so to speak).
As in real estate, “education”, and financial services, third-party payers and lenders rose to prominence as the century proceeded. Dean Clancy, Senior Health Policy Fellow at Americans for Prosperity, pointed out that in 1920, 90% of US health spending was “out-of-pocket”. In 1960, half was. Now, almost none is.
For any product, the rates of out-of-pocket spending and price inflation are…as even an Ivy League economist could attest…inversely correlated. Ignited by a half-century of fake money and third-party payments, healthcare costs exploded.
Despite popular perception, our Rube Goldberg medical monstrosity is essentially a government concoction. In many ways…e.g., Medicare, Medicaid, compulsory coverage, medical mandates, etc….it unequivocally is. What the State doesn’t own or operate, it orders and orchestrates (or, in the case of its connected corporations, obsequiously obeys).
As in most major industries, even the remnants of healthcare that remain “private” are incorrigibly corrupted by regulatory capture and gratuitous graft. Like their counterparts in the “Defense”, “Education”, and Financial sectors, pharmaceutical companies subsidize, staff, and supervise the agencies by which they’re ostensibly overseen. And vice versa.
The FDA, CDC, and their partner corporations are the heart of the Medical-Industrial complex, with Academia and the press acting as propagandistic arteries to an anemic body politic. As with any centralized planning, under state-run medical care aggregate models, top-down targets, and corrupt money pervert incentives and distort guidance.
The covid fiasco manifested the farce. One-size-fits-all stupidity was superimposed on society by bureaucrats, politicians, and the corporate sponsors or lackeys of our pharmaceutical politburos.
Doctors who’d sworn to promote healing and avert harm became more concerned with dispensing decrees, following the rules, and toeing the line. Among the few who dared dissent, licenses were threatened, reputations tarnished, and careers ruined. It was reminiscent of Soviet-style “science”, under which political objectives drive medical decisions.
The idea that a single set of politically-prescribed preventative measures, therapeutic methods, or treatment protocols would be inflicted on millions of people by a cadre of cranks they’ve never met is clearly unethical and obviously insane. But during the covid fiasco, that’s exactly what happened. In many places it still does.
Yesterday, the Biden Administration announced it would remove covid “emergeny declarations” that never should have existed. But it won’t do so until May! We’ve seen this act before, only to have the performance extended and the “emergency” renewed.
But why? Except to incurable neurotics who’ve been terminally deranged, covid is clearly not a “national emergency”. And almost no one’s still dumb enough to act like it is.
But to certain vested interests, it’s a lever of power they’re loathe to release. In addition to enabling “public health” hacks to persist in trying to tell us plebs what to do, the declaration allows hospitals to receive vastly higher Medicare payments for treating a disease that’s clearly not a disproportionate threat.
Those who succeed in free markets must admit mistakes without throwing away the glimmers of truth they managed to acquire while making them. In state-sanctioned “systems”, incentives run the other way. If anything, “mistakes” are evidence that more money is needed and more power required.
The recent covid calamities and current “climate” disasters are what we’d expect from dictatorial eggheads unconcerned with billions of personal priorities in the real world. These are the sort of sanctimonious meddlers a European diplomat once described as “the types who’ve never had sex but read all the books about it”, so they feel perfectly qualified to tell the rest of us how to (shall we say) “fornicate ourselves.”
State meddling in medicine, as in everything else, has made provisions more expensive, scarce, and…as witness the last few years…deadly than they otherwise would be. After suffering such atrocious results, normal people who pursue profit would reassess the situation and revise their approach.
But abnormal people pursue profit too. Many of them gravitate to government and benefit by the boondoggle. And such people don’t give up; they double-down.
These world-improvers have long fiddled in every industry. But now they’re plucking those that matter most. Having screwed-up healthcare and destroyed “education”, they presume to make energy “sustainable” and our food “efficient.”
By doing so, they’ll control the weather…while billions starve and millions freeze. But the cream of the crop…the scum that coats the top of the pail…will remain rich as butter and deluxe as pule.
Perhaps it’s not a question whether a system “works.” Maybe it’s more a matter of who it’s meant to serve.
JD
