Government Medical 'Insurance'

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by the Ludwig von Mises Institute. This article is excerpted from Making Economic Sense (1995; 2007), chapter 20, "Government Medical 'Insurance.'"

One of Ludwig von Mises's keenest insights was on the cumulative tendency of government intervention. The government, in its wisdom, perceives a problem (and Lord knows, there are always problems!). The government then intervenes to "solve" that problem. But lo and behold! instead of solving the initial problem, the intervention creates two or three further problems, which the government feels it must intervene to heal, and so on toward socialism.

No industry provides a more dramatic illustration of this malignant process than medical care. We stand at the seemingly inexorable brink of fully socialized medicine, or what is euphemistically called "national health insurance." Physician and hospital prices are high and are always rising rapidly, far beyond general inflation. As a result, the medically uninsured can scarcely pay at all, so that those who are not certifiable claimants for charity or Medicaid are bereft. Hence, the call for national health insurance.

But why are rates high and increasing rapidly? The answer is the very existence of healthcare insurance, which was established or subsidized or promoted by the government to help ease the previous burden of medical care. Medicare, Blue Cross, etc., are also very peculiar forms of "insurance."


If your house burns down and you have fire insurance, you receive (if you can pry the money loose from your friendly insurance company) a compensating fixed money benefit. For this privilege, you pay in advance a fixed annual premium. Only in our system of medical insurance does the government or Blue Cross pay, not a fixed sum, but whatever the doctor or hospital chooses to charge.

In economic terms, this means that the demand curve for physicians and hospitals can rise without limit. In short, in a form grotesquely different from Say's Law, the suppliers can literally create their own demand through unlimited third-party payments to pick up the tab. If demand curves rise virtually without limit, so too do the prices of the service.

In order to stanch the flow of taxes or subsidies, in recent years the government and other third-party insurers have felt obliged to restrict somewhat the flow of goodies: by increasing deductibles, or by putting caps on Medicare payments. All this has been met by howls of anguish from medical customers who have come to think of unlimited third-party payments as some sort of divine right, and from physicians and hospitals who charge the government with "socialistic price controls" – for trying to stem its own largesse to the healthcare industry!

In addition to artificial raising of the demand curve, there is another deep flaw in the medical-insurance concept. Theft is theft, and fire is fire, so that fire or theft insurance is fairly clear-cut – the only problem being the "moral hazard" of insurees succumbing to the temptation of burning down their own unprofitable store or apartment house, or staging a fake theft, in order to collect the insurance.


"Medical care," however, is a vague and slippery concept. There is no way by which it can be measured or gauged or even defined. A "visit to a physician" can range all the way from a careful and lengthy investigation and discussion, and thoughtful advice, to a two-minute run-through with the doctor doing not much else than advising two aspirin and having the nurse write out the bill.

Moreover, there is no way to prevent a galloping moral hazard, as customers – their medical bills reduced to near-zero – decide to go to the doctor every week to have their blood pressure checked or their temperature taken. Hence, it is impossible, under third-party insurance, to prevent a gross decline in the quality of medical care, along with a severe shortage of the supply of such care in relation to the swelling demand.

Everyone old enough to remember the good old days of family physicians making house calls, spending a great deal of time with and getting to know the patient, and charging low fees to boot, is deeply and properly resentful of the current assembly-line care. But all too few understand the role of the much-beloved medical insurance itself in bringing about this sorry decline in quality, as well as the astronomical rise in prices.

But the roots of the current medical crisis go back much further than the 1950s and medical insurance. Government intervention into medicine began much earlier, with a watershed in 1910 when the much-celebrated Flexner Report changed the face of American medicine.


Abraham Flexner, an unemployed former owner of a prep school in Kentucky, and sporting neither a medical degree nor any other advanced degree, was commissioned by the Carnegie Foundation to write a study of American medical education. Flexner's only qualification for this job was to be the brother of the powerful Dr. Simon Flexner, indeed a physician and head of the Rockefeller Institute for Medical Research. Flexner's report was virtually written in advance by high officials of the American Medical Association, and its advice was quickly taken by every state in the Union.

The result: every medical school and hospital was subjected to licensing by the state, which would turn the power to appoint licensing boards over to the state AMA. The state was supposed to, and did, put out of business all medical schools that were proprietary and profit-making, that admitted blacks and women, and that did not specialize in orthodox, "allopathic" medicine: particularly homeopaths, who were then a substantial part of the medical profession, and a respectable alternative to orthodox allopathy.

Thus through the Flexner Report, the AMA was able to use government to cartelize the medical profession: to push the supply curve drastically to the left (literally half the medical schools in the country were put out of business by post-Flexner state governments), and thereby to raise medical and hospital prices and doctors' incomes.

In all cases of cartels, the producers are able to replace consumers in their seats of power, and accordingly the medical establishment was now able to put competing therapies (e.g., homeopathy) out of business; to remove disliked competing groups from the supply of physicians (blacks, women, Jews); and to replace proprietary medical schools financed by student fees with university-based schools run by the faculty, and subsidized by foundations and wealthy donors.


When managers such as trustees take over from owners financed by customers (students of patients), the managers become governed by the perks they can achieve rather than by service of consumers. Hence: a skewing of the entire medical profession away from patient care to toward high-tech, high-capital investment in rare and glamorous diseases, which rebound far more to the prestige of the hospital and its medical staff than it is actually useful for the patient-consumers.

And so, our very real medical crisis has been the product of massive government intervention, state and federal, throughout the century; in particular, an artificial boosting of demand coupled with an artificial restriction of supply. The result has been accelerating high prices and deterioration of patient care. And next, socialized medicine could easily bring us to the vaunted medical status of the Soviet Union: everyone has the right to free medical care, but there is, in effect, no medicine and no care.

Murray N. Rothbard (1926–1995) was dean of the Austrian School, founder of modern libertarianism, and chief academic officer of the Mises Institute. He was also editor – with Lew Rockwell – of The Rothbard-Rockwell Report, and appointed Lew as his literary executor. See his books.

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Recent Comments

18

Well said! Health Insurance companies are here just to get your money and now with the government trying to push healthcare reform it's even worse. At least in my opinion! I have health insurance as a so-called benefit from my workplace...I end up paying almost 500 bucks a month for me and my family, not to mention co-pays for almost everything else. What a scam! This used to be free to those of us who worked full time there. It gradually increased to $24 a month and so on. Then a couple years ago, it jumped to around $138 a month. Last year almost $400 and now $500? What on earth happened? Now I can barely afford the $30 co-pay for a doctor visit to even bother going to see the doctor. Especially since it takes longer in the waiting room than it does for the doctor to examine you. If he or she even does that much! Sorry to rant and rave here, but I definitely agree with you! :)

When it comes down to it, I believe this health insurance has much to do with money but also part of an agenda to find a way to control the world's population

I'm surprised at how well you can write. You won't have any problems doing this. You are coming across to me as very gifted. It's a great life enhancement.

Yes i think i mind that, maybe if you don't buy a car that is electric you get taxed or maybe if the car doesn't get a certain miles per gallon you get taxed

I thought the appropriate path to make something a tax is to have Congress vote that as of x date in the future, $y will be levied for reason abc.

Yes, it would have been more honest if this had been called a tax from day one. I always called it that.

You mind that they were asked to find whether it's constitutional under one the Commerce clause and they switched it to the powers Congress has to levy taxes?

Do you mind because it's a tax for not doing something (as opposed for doing something)?

DABK i hope your not saying the sin tax on cigs are the same as this. Even the sin tax on cigs went through the appropriate path to make it a tax, this healthcare thing did not. It was not vote on as a tax. It was not a tax when voted on, understand? But ok, i know you are a smart person and i do make the assumption you are a good person, I have been here from abot 1.25 years read a lot of you in the forum. And I know your not a person who I completely disagree with

I agree with almost all of what you have said. but this is not the proper way to pass a tax I don't now what precedent you are speaking of where the federal gov't taxes you for not following their orders? As for a Ponzi scheme, you seem to doubt what I say or maybe you don't think I know what I am saying or I'am confused? A Ponzi scheme is when you pay into or invest in a security, or social security or health care. And the initiator of the scheme needs to rob the next person of their money in order to pay you to provide you with the services you paid for. Sooner or later it collapses. It collapses because on the side the initiator of the scheme is taking money out to do with it as they please. You don't believe this goes on in the gov't? Is it any coincidence that this single largest tax increase ever in the USA occurs when we are in trillions of dollars of debt?

As regards Ponzi schemes and such, I agree.
It's a tax aimed at a behavior. There were others like that (my wife is about to quit smoking, because taxes have made it too expensive).
It occurs in the government... but you don't have a better way than a government. You improve the situation by improving how government works not by eliminating government.
Coincidence? Largest? Don't know about them... What makes it the largest? How do you compare? Coincidence? No. A lot of things did happen to make it possible.

@stadium
They did not set the precedent; it's already existed.

There will be Ponzi schemes with government run programs? Someone's always trying to move ahead faster than they deserve (based on the value they add).

What I'm saying, there's a place for the government, the government is not efficient. I want an efficient government that's working towards improving the lives of all...

I am annoyed by people who say they want the government out of their lives but want their Medicare untouched or the government to be the decider of who sleeps with who, who has kids, etc.

I am annoyed that we no longer do you have people of the caliber of Jefferson running for higher office.

I am annoyed with people who vote without understanding or knowing what they're voting for... Who don't check anything... It was on TV.

I think too many people with money are allowed to switch the focus of low information voters to hide things.

I'm annoyed when people don't suffer the consequences of their actions, like what happened with the mortgage industry, for instance.

I'm annoyed when the board of directors of a big company is run by the CEO of the same company...

And so on and on and on...

For now, I'd be happy if more people, including more people in the government, found some common sense.

@stadium

Insurer greed. It's been known to happen that some companies got together and manipulated parties, hid information, etc., in order to make more money than their product warranted... or to eliminate competitors...

I don't disagree with you there, I believe there were at least 10 insurance company CEOs who made over $100 million last year. But the gov't were the one's who enabled this take go on for decades. The gov't created the health insurance industry. You really believe there will not be a ponzi scheme in gov't ran health insurance? I respect your opinions DABK and I'm not saying you are wrong. And another thing I don't like about this, the supreme court ruling has basically set a precedent allowing the gov't to tax you for not doing what they say. Funny, Obama said it wasn't a tax from the beginning, at times he vehemently defended this as not being a tax. It was passed under the commerce clause. But as soon as it was taken to the supreme court he ran to the supreme court saying "it's a tax, it's a tax" he knew if it was judged under the commerce clause it would have been found unconstitutional. He didn't think it would go to the supreme court until the dems lost the house in the past midterm elections. And then he had to call it a tax but it would have never passed if it was called a tax at the onset.

I'm definitely on your side, Stadium. Our government has gotten much too much control into our lives. And, unemployment will now remain High because of this. Way to Go Mr. President.

he is only a pawn in the big picture.

Yes only a pawn. The party is more important. They are willing to take a major risk on his re-election to get this healthcare through something they have been trying for at least 50 years.

Many statements about facts that I never verified. However, the conclusion: for profit insurance and medial problems do not mix, is a true one.

Because, like as mentioned, the disparity between premiums people can afford and the care they may need. Insurers don't insure: they gamble that you don't get sick before they get enough money but before you get sick.

Because of patient greed.

The one not mentioned: insurer greed.

Besides, Blue Cross and such are businesses bent on making a profit.

If I pay $6,000 a year for 50 years and I'm guaranteed to get majorly sick, what's the insurance component.

With accidents and home insurance, you're really talking insurance. Some, but not all people will be involved in some kind of accident. Some, but not all homes will be broken into.

Given the above, I, as an insurer, can pay your car off because x car owners have not made a claim yet AND y number never will.

As regards the "government" part... I disagree.
Government doesn't always get things right, true. But it does get some. The unintended consequences are sometimes baneful, sometimes positive, sometimes indifferent.

And I'm not talking about people's opinions of such but at facts.

So, the thing is to determine where is it the Government's business to intervene and improve on how it does it...

And to take the for profit element out of medical insurance... Actually, since it's really not insurance, to not even call it that. Medicare for all works better.

Yes, I know, a lot of people disagree.

But that leads you to: what kind of country do you want to live in and, unfortunately, of fortunately, depending on your philosophical bend, there's more than one vision available.

The U.S. Constitution states specifically and delegates 17 unique discreet powers to the federal government. The rest is left up to the state and local governments. But the Federal Gov't is not playing by the rules but constantly expanding their powers. That's not a good.

Insurer greed? So the gov't should step in and push the controls? Yes, the gov't, politicians have never been known to be greedy... And they will NEVER lie to you. Very much like angels these people are. And, OH SO efficient, the public sector is oh so much more efficient compared to the private sector. Right? I bet you could find a 200 page instruction manual on how to bake a cake somewhere in Washington D.C.

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