Mass Stupidity

One of the stranger things about the modern age, is watching people in the media discuss topics, as if they are experts, despite the fact they know very little about the subject. The recent “hacking” stories are a great example. Day after day, people who struggle to remember their ATM PIN, went on at length about the details of computer trespass. Of course, these nitwits know nothing about technology, but they were sure super villains from the FSB were secretly gaining access to the computers of the Democrats.

The people “reporting” on this story are not just ignorant about the topic. They think they know lots of things that are hilariously wrong because they get all of their information from television. They keep using the word “hacking”, for example, because they see it used on TV crime shows, along with the scruffy looking slackers, sitting in front of multiple monitors as they gain access to top secret computers. It is the Dunning-Kruger effect or perhaps the Charles Bukowski effect, if that’s your inclination.

The pseudo-intellectual poser has become a feature of our mass media culture. David Brooks, at the New York Times, is a good example of the type. According to his biography he has no math or science, not even a familiarity with economics, but he writes stuff like this anyway.

Believe it or not, we’re not really going to have to spend the next four years wading through wonky drudgery of Russian spy dossiers and hotel sex cameras. At some point we’re going to have a thrilling debate over the most scintillating question in health care policy.

The Republicans are going to try to replace Obamacare. They’re probably going to agree to cover everybody Obama covered, thus essentially granting the Democratic point that health care is a right. But they are going to try to do it using more market-friendly mechanisms.

As you know, the American health care system is not like a normal market. When you make most health care decisions you don’t get much information on comparative cost and quality; the personal bill you get is only vaguely related to the services; the expense is often determined by how many procedures are done, not whether the problem is fixed.

You wouldn’t buy a phone this way.

The Republicans are going to try to introduce more normal market incentives into the process. They are probably going to rely on refundable tax credits and health savings accounts so everybody can afford to shop for their own insurance and care.

As soon as the phrase “market incentives” comes up, you know that there is no existing market. This is phrase cooked up by managerial class types so they can engage in central planning, but pretend they have respect for free markets. Incentives are synthetic creations to get people to do things they otherwise would not do. If you want a market, you don’t want central planners dreaming up incentives to warp the market. What would be the point? You want the buyers and sellers to sort things out among themselves.

Pseudo-intellectual posers like Brooks don’t understand this because he does not have the slightest idea how any of it works, but he is willing to expound on just about everything as if he is an expert. That’s a problem we have in the mass media age. The alleged experts that citizens rely on for opinions, spend all their time filling the air with laughable nonsense. In health care, for example, most Americans not only think it is a right, they think it is a product that should never be rationed. This is compete lunacy, but you can’t blame people for thinking it. All the “smart” people say it on television.

All goods and services are rationed. The question with health care is how is it to be rationed. Will it be by price or by a monopoly of supply? Progressives want the latter so that their coreligionists on the health care boards can murder enemies of the faith by denying them health care. The alternative should be arguments in favor of free markets, but instead we get magical thinking from guys passed off to us a conservatives by the mass media. The result is an increasingly misinformed public.

The assumption at the dawn of the communication age was that the free flow of information, and the explosion of new media, would make for better informed citizens. The result seems to be the opposite. Middle-brow intellectuals, who used to serve the middle-class, are now just pseudo-intellectual dufuses. Their game is not to inform, but to strike the appropriate pose so their readers can have their beliefs validated. One sure way to get rich in this age is to be a media guy who is wrong all the time.

Idiotizing the general public is not necessarily a society killing act, but the people who rule over us appear to be getting drunk off the fumes. Paul Ryan is allegedly the smartest policy wonk in Washington. Yet, he is running around with his own ten thousand page bill he says will make health care free for everyone. We have our spy agencies pretending to investigate Russian hacking because President Camacho is demanding it. There is a limit to how much nonsense a society can believe. We seem to be bumping against that limit.

72 thoughts on “Mass Stupidity

  1. “Healthcare is not and cannot ever be a right7. We talk about “healthcare” like Mom’s legendary mac’n’chees! Best quality, free, available to aliens (in their language) and without limit.

    It has to be delivered by highly-trained people! No one has a right to anything. The 14th amendment says as much.

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  3. Once, just once, I want to see a conservative politician or talking head stand up to the leftists and tell them buck up, get a *$&#( job, and pay for their own damn health insurance. Wishful thinking, I know.

    Barring this, with some luck Republicans will replace Obamacare medicaid expansion with block grants to the states that match the 50% reimbursement for the cost of medicaid coverage per patient. This would push the costs of medicaid expansion back onto the blue (and traitorous red) states that adopted the Obamacare medicaid expansion. They adopted it; their taxpayers should cover it.

    Colorado adopted the Obamacare medicaid expansion in late 2013. Since then the entire *net* increase in health insurance coverage in Colorado has been due to medicaid expansion, proving that people like free shit. Colorado (population approximately 5.5MM) expanded our medicaid roles from approximately 800,000 participants to approximately 1.4MM. Stated otherwise, approximately 25% of our population is on medicaid, which has now “rebranded” as Health First Colorado. Those without citizenship documents can self-certify that they are eligible.

    FedGov picked up 100% of the cost for Medicaid expansion through 2016, and the FedGov contribution is scheduled to drop to 90% by 2020. Dropping the FedGov contribution to 50% would force the blue states to either roll back Medicaid expansion, raise taxes massively, or go bankrupt.

  4. One apparent bad assumption seems to be there should be A market in medical services. In point of fact there are layers/tiers everywhere. Here in the US there is a much lamented unregulated bottom tier found in health food stores, naturopathic web sites, faith healers, etc., a relatively lightly regulated slightly higher tier such as acupuncture and yoga studios, etc., then a yet-more regulated tier above this, namely chiropractors, etc., THEN we come to the national most basic regulated medical tier (ER,s – the modern charity ward, with added entitlement attitude). Then above this is what we narrowly think of as the medical services sector (once a market). Finally, there is the optional, premier, cash payment, elite tier (Mayo Clinic, concierge medicine, etc.).

    The premier tier may be overseas, which is actually how the vaunted Canadian Health System operates. The US main system is (or was) the lower upper tier and the US premier tier is where the Canadian elite go if they can’t or don’t care to pull strings to jump the queue in Canada. IOW, there will always be an premier tier for the national elite, either at home or somewhere else, that operates on market principles. This fact ought to be recognized: Might as well keep the money here at home after all.

    So, we ought to be discussing which tier, if any, should be ‘socialized’. In the bad old days it was done through the charity ward, which was, obviously if unsystematically, being subsidized by the paying patients with some NGO help. Because it was unsystematized and provided few slots for government workers, it was the obvious target when Medicaid/Medicare was first set up in the ’60’s. IIRC (and yes, I actually recall those days) the medical professions were ecstatic to be able to dump their culturally-expected charity caseload on the taxpayers. So, did their regular paying customers now get a price cut_? No, because human nature is as it is and the new governmental compliance overhead costs ate up most of the newly free-up cashflow anyway.

  5. I was kind of between things in the mid-2000’s and found that you could find some pretty cheap health insurance with decent deductibles at Costco. The Urgent Care storefront medicine joints were also affordable without insurance.

    The more conspiratorial part of my brain sometimes wonders that if left to develop according to market forces, whether those things and things like them would have undermined Medicine, Inc and whether Obamacare was really the last ditch effort of Medicine, Inc to forestall something that was as affordable as veterinary care from coming to America.

    Because let’s face it, once a new market entrant undermines your cost basis, you’re toast. You’re only only alternative to folding is to get the state to block new entrants. With so many other industries crashing and burning as the webz enable new entrants with much lower cost bases, why isn’t Medicine, Inc? Let’s face it, the only thing that the managerial class is good at is exactly these sorts of shenanigans.

    • We no longer have free clinics in the ghetto because because Rx Inc. found them a threat. No where is corporate welfare and rent seeking more common than in medicine.

    • My husband need to see a psychiatrist. Anybody who took our insurance was booked into the next century and not a native English speaker, which seemed problematic for mental health. Private pay in the city was $400 a session and only available during his working hours, which meant he couldn’t go.

      We ended up going with Doctor on Demand, where you can see a psychiatrist via webcam for $200 for the initial consult and $95 for subsequent appointments, charged to your credit card on file. Given that the first drug tried worked, he only needs quarterly medication checks. It’s costing us less on an annual basis to treat him than it would for a single psychiatry appointment in person. The doctor (I googled her) works on staff at a large hospital a few hours drive away. She sees patients for this service on evenings and weekends from her home study as a supplemental income. I’ve also used them for urgent care type appointments for myself. It’s $5 more than the clinic, but I don’t have to leave my house. Totally worth it.

    • Where pray tell do you find … affordable as veterinary care… . $100 bux to feel up my dog, pronounce her fit, and Sell flea killer for a lot more is not affordable.

    • Baboso, one thing I found out was that Costco has No requirement for membership for the public to use their Pharmacy. Anyone can walk in off the street and buy at reduced prices.

      Also, to your point of Crony Capitalism, that is the true crime here … blocking new competition and eliminating existing competition via government regulation. This is where recent info from the Trump camp looks so promising. Being a businessman, Trump knows the best way to fix any market is to introduce competition. Which is what he is doing in the MIC, Big Pharma, Medical Insurance, etc. Man, I don’t know about whatshisface from MSNBC, but I have tingles going up and down all over my body! I think someone just lit up a Tesla Coil.

  6. This entire ClusterFuck of ObamaCare could have been avoided by two simple things:

    a) Tort reform, and

    b) allowing insurance to have been sold across state lines.

    But then, I’m not a lawayer or a politician.

    • You should bless your lucky stars for that my friend. Both bottom dwellers especially the breed in D.C.

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  8. Did I miss the part about killing all of the lawyers? Because that’s gotta be in any new healthcare plan if it stands a snowball’s chance in Hell of working.

    Okay, call it “tort reform”. But we all know what we REALLY need to do.

    • Another crucial factor is the entire EEO, Affirmative Action charade which has ensconced itself at every step of the entire Healthcare structure, from hiring the janitors, to keeping the medical records, staffing the labs, and professional staff, and of course the entire administrative superstructure.

  9. Ha ha ha ha! I think this is your funniest post yet Zman!

    Quite honestly, I don’t know who the f**k David Brooks is because I don’t read the Slimes. Note: I do read certain NYT authors like Malcolm Gladwell.

    You are quite right that the people who “work” out of the offices in the ivory towers of the media always preach the truth, regardless of whether it is correct or not. “They” are the purveyors of “The Way.” They are infallible. Take for example, my favorite economist-not, Paul Krugman. He is like Al Gore “Seas will rise in ten years and coastlines will be flooded” with his so-called economic (Nobel Prize mind you) prognostications that are so much hooey. And yet, even when proven wrong, he simply crawls under a rock for awhile only to reappear and renew himself with a new prediction or other pontification about the world while ignoring what only recently happened.

    They are charlatans. But alas, your last sentence is wrong. There is no limit to the shit-for-brains that fill so many people out there. To wit, Albert Einstein quote:

    “Two things are infinite: the universe and human stupidity; and I’m not sure about the universe.” That is one truth I wholeheartedly agree with.

    • Wasn’t David Brooks the “exotic” columnist who spent the 2008 election studying Barky Obama’s trouser leg and decided he would be a great president?

  10. So the problem with healthcare is that you can spend essentially endless money chasing the most minor of improvements. Particularly without physical STUFF piling up, like when you’re shopping for consumer goods, there’s no obvious visual signal that you are just buying too much.

    My toddler has failed to develop an essential physical skill. And this needs fixed or she’s going to have serious limitations down the road. But there’s nothing wrong with her that really requires surgery or similar. What we’re finding is that with a really motivated parent who is willing to stick to a very rigid and tedious graduated therapy schedule, we can realize a lot of improvement with no cost beyond my own time. In addition, it’s less stressful and I think she’s progressing faster because she’s willing to work hard for me in a way she won’t for a stranger and we do the treatment at home where things are very low key and familiar.

    But the medical model has me private paying (or somehow forcing my insurance or Early Intervention to pay) for multiple therapy sessions a week, which would be thousands a MONTH out of pocket. I’m having a very hard time finding what I want: a therapist who will design a program I can implement, and reasess every 2-4 weeks to adjust it as needed. I don’t have the knowledge to design a therapy program, but I can certainly do the grunt work of implementing it. And their business model is just not set up for what I’m looking for. It’s as though the whole system is designed to force me into the most expensive possible way to deliver the care I’m looking for.

  11. “So it’s resolved. It would be in EVERYBODY’S best interest if the cat had a bell around it’s neck.”

  12. The media isn’t about freedom of everyones speech, it is about it’s singular supremacy to revise history. In fact Brooks job is not so much to revise “history”, his job is as gatekeeper, to revise possible future history in order to pre-empt any truth that critically threatens an ideology before it happens through a strategy to continuously setting narrative offensive. A cascade of lies designed to inundate the truth before it outs, clouding it with confusion and doubt.

        • And doesn’t blivet belong here? (and I meant blivet, not billet, you stupid autocomplete). This type of container is used to transfer fuel to various sites. Naturally, they wanted to cram as much oil as possible on board, perhaps more than the ship was designed to hold. Hence the ready appropriation for 20 lb. of sh!t in a 10 lb. bag. It is now called a “fuel bladder” to escape from the earlier connotation.

          • My favorite remains F’ed Up Like a Soup Sandwich. I always picture the Intellectual yet Idiot class ladling Cambells Chicken Noodle onto Wonderbread, then congratuling themselves as they try to pick up the mess and get it in their mouths.

  13. We are all of still very primitive people able to be persuaded to folly by well spoken, clever tribal chiefs, witches and witch doctors who convince us they can save us from our fears, even foolish fears like climate change, if only we give them authority and money.

    What else could politicians, journalists, priests, ministers, mullahs and public scientists be?

    Our vanity is that we are modern technocrats when we are fearful, ignorant villagers and will be for a long time, maybe forever.

  14. One of the most interesting issues uncovered by Wikileaks was the utter technological incompetence of the Clintonistas. Almost every aspect of their cyber operation was inattentive to security and common sense. All of that because not one of these cronies ever considered technology to be anything other than a method of control by them of the rubes.

    We see that a lot on the left. The “Smart Grid” would open your house to cyber intrusion. The grid could be fooled into thinking a heavy, industrial-type peak load, was coming from a residential neighborhood, taking the local distribution system with it. It was only by kicking and screaming that the Smart Grid proponents were dragged into some semblance of reality to look at network security. Visions of “enabling greater use of wind and solar in the grid” always took precedence over such mundane matters as reliability, continuity, and grid quality – you know, the kind of electricity supply needed to power a modern economy.

    Health care is another case. Does anyone really want to empower every bureaucrat to browse their health care files and test results? Confidentiality provisions apply mostly to the patient, not to bureaucrats within the system. The idea that a patient will have to “know someone” to get approval for surgery or advanced diagnostics is inherent in all the lefty plans. All of this done without any real consideration of medical technology or patient care itself.

    Then there is renewable energy; from the days of lefty-imagined perpetual motion machines in the 1970s and 1980s, to the pure ignorance of the useful idiots supporting the crony money grabs of Solyndra, et al, renewable energy technologies have proved a reliable way to separate the rubes from their cash and send it to campaign contributors.

    As always, the issue is never the issue, the issue is the power.

  15. Z man, what do you think of having nurses take on apprentices rather than relying on nursing schools to supply the country with nurses? There is a supply problem we need to address there.

    • Actually, apprenticing is still the way in which we train people for important tasks like nursing. If you look at how a nurse is trained and then enters the work force, the apprenticeship model has simply been grafted onto a the higher ed model, with higher ed operating like a highway bandit, robbing people as they enter the trade. At best, college is an IQ test, sorting those who have the aptitude from those who don’t have it. When you hire someone with an accounting degree, all you know is they have a willingness to do the work and the IQ to learn it. They will need to be trained on the rest.

      As far as health care in general, my view is we should look to veterinary medicine. Our pets get better care that 98% of the world’s humans. Our pets get world class medical care for a song. There’s no insurance and very little in the way of government oversight. Within a short drive of my home, I can see a dozen veterinarians, but just one doctor. Veterinary medicine operates like every other market. You buy what you need when you need it. There are even charities to help poor people gte Fido his life saving treatments.

      Health care in the West is the last bit of feudalism we have left.

      • Here’s where you analysis falls apart: when treatment gets too costly or when Muttley is too old, you can put him down. You can’t put Grandma down.

        I look at the rest of the world. The only places in the world that have a free market for health care are the kinds of places where you wouldn’t want to be treated. Every other place in the world that has a high standard of healthcare has some sort of government involvement. I think the problem in this country is that our so-called experts are in love with Rube Goldberg-type systems and make things overly complicated and that that over complication is what results in high cost.

        • This is a familiar claim and I have rebutted it many times. We do, in fact, put granny down. The doctors inform the family that there is nothing more to be done and the best course is to make granny comfortable. It has only be recent that doctors come in and say, “Since your insurance [your neighbors] has to cover it, we will conduct a range of experiments on granny, while pretending to help her.”

          As to the rest of of your post, it’s cargo cult thinking. Because X is always present when Y is present, X must cause Y.

          All goods and services are rationed. Fear of facing up to this reality has resulted in the jabberwocky of “universal health care” and all its variants. You want government bureaucrats to decide the time and manner of your demise. That’s fine, but be honest about it.

          • Zman, after being a guinea pig for someone’s pie-in-the-sky theories the last six years, do you want to submit yourself (and your checkbook) as a guinea pig to right-wing pie-in-the-sky theories for another six years? If we keep doing things that way, it’ll be 50 years before they figure it all out, if ever. You guys also forget that medicine is inherently expensive given the quality of people who go into it as a career and the science involved.

            I used to be on your side until a friend of mine convinced me that the reason we have the system we have now is because people had problems paying for treatment … and that it was a problem. I’ve come to the conclusion that the best thing to do is to just take the systems that work best elsewhere and apply it on a state-by-state basis. Doing it at the state level makes it a lot less likely to screw up health care for 12 million people than for 320 million. State officeholders are also far more accountable to voters, whereas the federal government doesn’t seem to be accountable to anybody anymore.

          • There are no “systems that work best elsewhere.” That’s another ridiculous myth pushed by the Left. All of them are a version of terrible.

            But, you’re free top put your life in the hands of the nearest postal clerk. I’ll pass.

          • I’ll have you know that I have the world’s BEST postman, but that’s not what I mean. I mean if you take Germany, the Netherlands or Switzerland or even the United Kingdom. They have similar high-quality healthcare to what we have and they do it for less. And regardless of what the right-wing propagandists say, they like their systems. Sure, if they have some rare disease they might come to the United States, but for 95% of the people out there their system is great.

            The right wing has burned me one too many times to follow the pied pipers into their pie in the sky theories and schemes anymore. Example: $4 gasoline when it was never in short supply (it was a function of overheated futures markets). Prove it works somewhere else before using me as a guinea pig.

      • Z Man;

        Right you are. Apprenticeshp with academic training to inculcate a base of knowledge to be built upon plus behavioral prior screening is EXACTLY how it’s done in the military

  16. Hotel sex cameras? What for? Doesn’t everyone record their entire life on their cell phone these days? As for ” We seem to be bumping against that limit. ” , oh my, no. Too many people of my acquaintance, people I know to be reasonably intelligent deplorables, will not take the time to sort basic sense from feels good on taxes and health care. We can still go a long way, zman. But that is only because the United States has a depth to draw from.

  17. “That’s a problem we have in the mass media age. The alleged experts that citizens rely on for opinions, spend all their time filling the air with laughable nonsense….”

    Yes, the British have a saying for this: “Often wrong, but never uncertain.” Or as one British officer put it, in his evaluation of a junior officer: “His men would follow him anywhere, but only out of curiosity.”

    Health Care is not a Right, by the way, since (unlike freedom and slavery) our Maker grants us both health and sickness in roughly equal measures, with death as a reward for both.

    • Like Zerohedge, Denninger has been writing “The End is Near” articles on MarketTicker for about a decade now. Anyone who followed his advice has lost their shirt and is probably living in a bunker in the woods somewhere.

      Japan’s national debt is about 230% of GDP and they are still issuing government bonds at near-zero interest rates. US national debt is about 100% of GDP. If Japan is any guide the US still has a long way to go before we hit some sort of currency collapse scenario. Until then we’ll just keep issuing debt. The day of reckoning will come, but Japan’s experience suggests we’re nowhere close.

      Some of his reforms (i.e., clear, concise billing) are sensible, but most of them would gut the healthcare system and crush any continuing healthcare innovation. Developing drugs and medical products is an expensive, time-consuming process that requires the expertise of lots of highly-skilled, and therefore highly-paid, people. The FDA approval process is a bitch and could certainly be streamlined, but Denninger’s reforms would effectively gut the FDA and destroy the industry.

      We live in an era of medical miracles and medical miracles cost money–lots of it. Pharmaceutical and medical product companies have to meet margins on their products, just like any other company. The reality is that they react to pricing pressure from foreign governments by jacking up prices in the US, so the outrageous prices paid by US consumers have subsidized pharmaceutical and medical device innovation for the rest of the world for decades. This has to stop.

      It’s time for the US to make pharmaceutical and medical device price fixing by foreign governments a global trade issue. Countries who use the coercive power of their national governments to negotiate rock-bottom prices should get whacked with penalties. In theory, the penalties could be used to offset the cost of coverage in the US.

      • I stopped reading Denninger mostly because it felt like he was losing his marbles. Those long, stream of consciousness rants with the excessive use of bold and italics for emphasis have a Unibomber vibe to them.

        Your point about debt is an interesting one. Not long ago, everyone knew that debt in excess of 100% GDP was impossible. Yet, here we are.

      • @ Guest:
        1) re: “US national debt is about 100% of GDP”

        No, the 20 trillion currently mentioned is one tenth of the accrued Debt of the USA which is circa 200 TRILLION. I don’t think that debt load will be politically or in reality solved by a soft landing.

        2) re: “We live in an era of medical miracles and medical miracles cost money–lots of it.”

        True. The cost of finding new drugs is hampered by two signal problems: First, FDA regulation (clinical trials) is insane as there is no cost benefit rationality to it, and Second, the patent law totally is screwed up so that many avenues to discover drugs are out of bounds for research because they can not be patented.

        Dan Kurt

        • With all respect, your 200 Trillion figure references unfunded liabilities, which are not debts in the legal sense of the term. You have no legal recourse if Congress alters or cancels your Social Security benefits. It doesn’t diminish your point–the unfunded liabilities won’t be paid.

  18. >> There is a limit to how much nonsense a society can believe. We seem to be bumping against that limit.

    Judging from the articles and associated comments in the NY Times and the WaPo we’re nowhere close to that limit. Lefties believe fervently that Obama saved the world, Putin stole the election for Trump, and that we can open our borders to unlimited immigration and provide them with free food, clothing, shelter, and health care.

    • >>Judging from the articles and associated comments in the NY Times and the WaPo we’re nowhere close to that limit.

      Unlike the fake media like Zman’s blog, NYT’s and WaPo has employs psychophants whose job is to delete comments that contradict and defy the narrative. Never mind The Media is solely controlled by a few actors of the Deep state as their public echo chambers, never mind the revelations of the CIA’s involvement in setting the tone and direction of the approved narrative.

  19. No one should discuss this issue without reading Capter Nine of Capitalism and Freedom by Milton Friedman. It is his chapter on occupational licensing and in it he takes on the monopoly generated by licensing and accreditation in medicine. There will be no actual market in medicine unless licensing and accreditation are abolished. Health care existed before government began interfering in it and doctors, nurses and hospitals are not going to go “poof” if they don’t have a piece of paper from the government.

    • Speaking as someone who doesn’t want to end up getting dead by mistakenly entrusting my life to a quack, I like the concept of certification that Friedman mentions in chapter 9. The certifying body need not be the government, but I want some assurance that I can pick from practitioners who have demonstrated competence to a trustworthy professional group.

      • If there were no government interference or input in health care (admittedly a state that does not exist even in a pipe dream) you ought to be certain that numerous private organizations would spring into being that the public would have reason to trust–some more than others, and all more than the government. Competent to excellent doctors and hospitals have an equal interest in seeing to that. This is an arrangement that has never been so easy due to the digital age. And customer reviews are as or more powerful an incentive to do well as lawsuits. I already shop them this way. Customers who abuse doctors would also not be immune from exposure.

      • That shouldn’t be much of a problem with the communications we have available today. When making an appointment you could verify the credentials of your doctor online. In the absence of a licensing regime that actually encourages obscurity, there would arise apps that would facilitate such investigations by potential patients, and physicians recently out of residency would likely join up with more experienced hands and gain cred like they did in the days of apprenticeships. This is already going on now to a certain extent.
        The fear that people have of an unlicensed medical world is unfounded. We don’t have licensing because people were rioting in front of the county courthouse because their doctors didn’t have a piece of paper from the government; we have licensing because the medical societies in England and the US decided that they didn’t like competition from alternative providers and they wanted a monopoly.
        I have to admit that when I read Friedman I was impressed by the rest of the book but does into a rage when I read that ninth chapter, because I felt he was insulting my profession. It took several readings and about six months for me to accept that everything he said was correct.

        • Thanks for adding to my understanding of how these licensing agencies work and the problems they cause. While I think the idea of a “clearing house” sounds good, I think it is best to just let doctors work as small businesses, or partnerships, etc. in competition with each other. The problem as I see it is one of accountability. These licensing groups don’t seem to protect “the public” in my estimation. Groups like the AMA provide a lobbying front and a legal foundation to “protect” their members. But to what extent do they really “police” their ranks and get rid of the bad apples? And then what should be the “patient’s” fallback of legal action, is daunting when fighting deep pockets and the “reputation” of MD’s. The legal field is problematic in this regard also. Just as bad, if not worse.

          The bottom line is the government is involved in too many things of commerce.

        • You have illustrated how it is that we evolved to embrace our bad habits, to assume that certain things are essential when they are in fact those things which are leading us down the rabbit hole. Then at each turn, to improve the poor quality of that thing we add more of what caused it to fail in the first place. This is government health care. Stating that there should be no licencing bar and no official credentialism of health care professionals is heard as a shockingly irrespondible statement to nine of ten people. In other words, we don’t have the answers because we can’t even imagine the question. End the FDA also. The fact that we have credentialism, the FDA, and the tort industry at the same time is proof of our failure, not a guardian against it.

        • Doc;
          With all respect to St Milton, I think he is wrong in this instance. The customer side obviously needs to be functioning largely on economic factors such as price, availability and quality for there to be an ‘efficient market’ (the Libertarians’ holy grail) in medical services. But from the individual customer point of view, medical service transactions are few*, hard to judge for quality, hard to compare to others’ experiences and the transaction risks are (or appear to be) very high. This is the opposite situation from hairdressing, the go-to example of service markets that ought not need licensing.

          It’s pretty easy to tell if you or a buddy got a bad haircut. And, worst case, it’ll grow out in a month or two with no long term harm done. But it’s pretty hard for a layman to tell if one person’s appendicetomy (a pretty straight-forward procedure these days, thank God) was better or worse done than another persons**. And information sharing about medical treatment is usually frowned upon in polite company.

          *There needs to be a reasonable volume of transactions in order preclude low sample size statistical anomalies (IOW, so that the ‘law of [reasonably] large numbers’ can kick in).

          **And if you’re tempted to say that I’m off base here, particularly if you’re right, that just goes to prove my point.

    • I just witnessed that monopoly in isolation in action. My wife was “diagnosed” with intestinal cancer. What transpired from our request for strict diagnosis of why my wife had certain physical problems, and only diagnoses was immediately a shell game and medical sleight of hand. From the start I contended knowing my wife so intimately as only a loving husband can, I was adamant from the start my wife did not have cancer. My wife was brutally specific. She stated upfront, she only wanted to know if she had cancer or other life ending ailment, that she was not going through years and unaffordable medical care, she was going to die in her own grace and dignity peacefully at home. Never mind the barely concealed hostility we received for such contention on our part, the battery of tests and specialists we had to submit to was like a an extortion racket dressed up as a con game to extract as much money as possible. It wasn’t healthcare, it was sick care profiteering. How the grift works is they find no definitive signs, only “possible trace indications” that a specialist needs to diagnose. It’s subjective “analysis” stretched to extremes in order to keep the shell game going. My wife checked out perfectly healthy but for deep back muscle spasms, probably due to a combination of stress and a prior injury.

    • The thing that has really surprises me about the Health Care / Insurance industry over the past few years has been the durability of its opaqueness to the end user, the Consumer, and how the Consumer is kept at absolute disadvantage every stage of the way. Impermeable bureaucracy. It is very, very difficult to navigate the system to one’s advantage, unlike almost any other service industry sector that interacts with the Consumer.

      It has become quite a simple matter in the age of the internet to become an Effective Shopper. But not with Health Care or Insurance. It’s still the Sacred Temple of Life and one still must consult the High Priest of Medicine or worse, of Coverage. Anyone who has ever had to wrangle the hospital bill of a loved one will know what I’m talking about, especially if it involved haggling.

      With respect to Friedman, is anyone else surprised that a niche industry has not evolved offering expert services to the Consumer for a fee? Like: who has the best coverage – or comparing coverage – or advising you where the cheapest prescriptions are available from, or who offers free prescriptions for certain drugs, etc. If you’re not a Health Professional, you’d be surprised how much really helpful stuff is not commonly known. We didn’t know until last week that certain prescription drugs are available for free at Sam’s Club. I would gladly pay a fee to optimize my Health Care, which right now is over $15K per year for 2 people with no major issues, for a suck-egg mule HMO.

      • It isn’t run on the law of supply and demand, it is run on a price fixing scheme, i.e. as high a price as is possible. In fact these days, seems there is very little price fixed by colusion, monopoly, gov regulation, or taxing scheme?
        Sole proprietor and mom & pop business’s, the guy down the road who has a truck garden and sells his produce out of a road side stall, and the ladies at your church bake sale are probably the only exceptions.

  20. Also I know healthcare wasn’t the main point of this blog post. To your point, it does feel very much like we’re LARP’ing Idiocracy. These sarcastic New York liberals are almost too much to take, particularly if you can see through their shtick.

  21. Good write up. You deserve more comments here.

    Yeah, health care… I hate this topic because in one way it’s so simple to see why costs have skyrocketed, yet so difficult to get anyone to pay attention if you can’t get in under 140 characters.

    A major contributor to warped market was FDR’s wage controls leading to employers offering healthcare as a way around it while still being able to attract talent. Anyone with a high school freshman level of economics would immediately recognize this, and yet I get glazed blank stares from people who have a Master’s Degree…. We’re screwed.

  22. Last time I checked, the only right I have to “health care” is the right to seek health insurance, as much or as little of it as I want, entirely outside of Obamacare’s pronouncements. The Marxist idea that I have a right to the labor and expertise of those in the medical profession as well as demanding that someone else pay for it is just plain un-American and wrong. My compatriots are getting on my nerves.

    • The marxists double think is you don’t even have the choice of not choosing, like how you are fined for not buying something. If that isn’t the definition of Mass Stupidity right there.

      • Try doing that in a hospital.

        I had to recently. Wanted to pay cash for services properly rendered.

        Asked for an up front quote, they said, “$5k, all-in, tops”

        Had the surgery. They fucked it up and I was out of work for 16 weeks instead of 6 like they said. If I wasn’t self employed, I’d have been fired for sure. As it was, I only almost starved to death.

        In the mail came the invoice. Billed amount?

        $22,500 for the hospital + $1,750 for the surgeon + $975 for the anesthesiologist == $25,225

        Offered me a $9k discount if I paid in full within ten business days.

        I was in surgery for 45mins, and recovery for two hours, left the place that same day (outpatient surgery). Total contact time with the hospital was <5hrs. Total contact time with the surgeon was ~20mins.

        Seriously, fuck these people. All of them.

        I used to advocate for just letting the Dr's do their jobs, but having had contact with them recently, I have shifted my opinion to "Nuke it from Orbit, Twice".

        Burn the whole fucking thing down and build something better in its place.

        What we have now is nothing but a clusterfuck of hacks being backed by thieves and fraudsters. The whole thing is corrupt and beyond help.

        • ZMan already addressed, this case government forced, rationing which causes price. I’m merely stating that one may buy health care services and most places openly welcome or even prefer cash.

          • Hospitals are predatory institutions which stick hard-working Americans like NunyaBusiness with massive scam-fraud-bills in order to pay for the bums, thugs, single mothers, and other assorted Third World refuse who don’t pay. It isn’t the government that makes your healthcare so expensive; they take a large slice, but most of your tax money is being redistributed to Mexicans and Africans and to a lesser extent white trash.

    • Fodder, you are on the right track. I also see PE Trump on the right track in attacking medical insurance plans and Big Pharma, in addition to revamping the way Americans can obtain medical care (ObamaCare) and pay for it. Right now, many doctors have their incomes dictated by insurance companies and considering the amount of education and expense they go through, and for the general quality of first rate minds in the field, that is shameful. What we have in place is plans that are simplified for the Deplorables, made inexplicable on purpose (thank you Zeke Emanuel and others who lied to us), and to make certain “friends” wealthier.

      The missing word in this dialogue is competition. I like what Trump is doing. He is bringing in real world business practices into the equation, something that has been sorely missing, and has been a key element in crony capitalism. COMPETITION while painful will benefit everyone. He is making people accountable and is using his bully pulpit to effect change.

  23. You answered the question of rationing very nicely. The question of health care as right you did not directly answer. I assume that you think it isn’t a right. This assumption, if true, would be wrong. Health care is a right and a responsibility. Failure to take care of yourself is an immensely immoral act, it is unnatural. We have the Natural Right to all the health care we want. What we don’t have a right to do, is to make somebody else pay for it.

    • I think the right that matters is to be able to choose what is right for ourselves, individually, certainly unfettered by government, or anybody. That is primal and the first thing. The basic idea behind obama care is almost scripture in cultural marxism, in fact it’s more marxist, but it is to create a system of total control over the most essential aspects of peoples lives, of every facet in the sphere of their lives, the advantages of corrupt economic total control of one third of the economy, is secondary, and icing on the cake of totalitarianism. Not unlike total control of energy, food, water, even how we go to the bathroom and the air we breath, even control of the weather through the ruse of globull colding. It is all about conditioning the population where they don’t even know what choice is, never mind what liberty is. Then you can make an entire nation of people do whatever you want them to do.

        • The great question is why is it only a few end up with the money and the power to rule over everyone else? This obamacare is allegory for everything that went wrong when the US Constitution of Administrative Tyranny was ratified. To me it is the epitome what the Declaration of Independence stated in it’s grievance against a tory statist King: “…He has erected a multitude of New Offices, and sent hither swarms of Officers to harrass our people, and eat out their substance…” We almost had it once, we are going to have to try again or we ain’t gonna make it, but we DO get the chance to choose to try again, and that is a great thing indeed. It is all the difference. Something the David Brook’s of this world have devoted their lives to destroying.

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