The Trunk

The Libertarian (non) Plan for Healthcare

I was asked in the comments to explain what a libertarian healthcare plan would look like.

Bob Barr, the Libertarian candidate this year, describes his healthcare views here and here. He’s pretty vague. Generally he wants to remove some of the government regulation of healthcare.

If you’re looking for something more detailed, the Cato Institute has some good, libertarianish healthcare ideas collected here.

I’m a hard-core libertarian, so my views are a bit more radical. I would get rid of all government regulation of healthcare. No FDA. No medical licensing. No need for prescriptions. No insurance regulation. Getting rid of all of these things, unquestionably, would bring the cost of healthcare way, way down in this country. Still, I suspect you think this sounds awful and absurd. You want the government to license your doctors, so that you know they are qualified. You want the government to require approval of drugs, so that you know they are safe. You want the government to regulate the insurers, so that you know they are fair. You want the government to require prescriptions, so that you know people only use drugs if they are medically necessary.

Well, guess what? The government is involved in all of these things, and yet there are still bad doctors, still bad drugs, still bad insurers, and still drug abusers.

If the government didn’t license doctors, I would probably only go to an AMA accredited doctor. You’d probably only go to an AMA doctor too. I’d only take a drug that my doctor recommended, and he’d probably only recommend one that had survived studies and peer review. My insurer would probably treat me right, but if it didn’t, I’d sue.

I believe that the market regulates itself, as long as you have the right to sue in court to protect your rights. That doesn’t mean that everyone will always be safe and happy. But the government can’t always make you safe and happy either.

Not every medical provider needs to go to medical school. If someone wants to take 2 years of study to become a foot specialist, let him do it. Having somewhat less-expert medical care is better than having no medical care. If Walgreens and CVS want to hire health care specialists, let them do it. If Walmart wants to set up a primary care clinic, wonderful. I remember when bookstores were small and carried only a handful of books, usually just the bestsellers. Then Barnes and Noble came along, and suddenly we had incredible and varied choice. Let’s have some big box medicine, if that’s what the market rewards. And if it fails, let it fail. The point is that we need to try different things and let the best system develop, rather than imposing just one thing while having to accept the consequences.

Here’s something else I would do: No Medicare. No Medicaid. There are two reasons for this. The first is just plain liberty—it is not fair to use force to take money from one person to pay for another person’s healthcare. The second is economic—the all-you-can-eat buffet of healthcare options induces gluttony. People who don’t pay for healthcare overindulge … and this drives up the price of healthcare for everyone. If you get rid of the buffet line, you’ll find demand for services drops and that a drop in demand means lower prices for everyone.

After law school, I joined a big law firm that prided itself on the pro bono work it provided to poor people. Over the next several years, I represented many people for free. It was the most awful work I’ve ever done. Usually, I’d represent a deadbeat tenant in court against a slightly less-poor landlord. The landlord would show up in court without a lawyer because he couldn’t afford one. I would show up for the tenant with a stack of motions and legal loopholes and maneuvering to keep my deadbeat client in their apartment for a few more months without them having to pay rent. I hated myself for doing this, but I was ethically obligated to pursue my client’s case to the fullest. The client was rarely grateful. Sometimes the landlord would try to settle the case. Because my client wasn’t paying any legal bill, he had no incentive to settle. It was free for my client to take his case as far as it would go, and that’s what he wanted to do.

When you don’t charge a client for your time, your time means nothing to him. So if a client had a weak claim for $1000 and the other side was willing to pay $950, the client would refuse, wanting every penny of what he thought he deserved. And for the sake of this undeserved $50, I’d probably spend 40-100 hours working on the case without charge. It was a waste of my time, but since the client wasn’t paying for my time, my time was essentially valueless to him.

I remember helping one client renegotiate payments on his $18,000 truck. Somehow, he was considered poor enough to qualify for the program. At the time I helped him with this renegotiation, I was driving a nine year old, beaten down Geo Prizm. It was worth about $1000, maybe. I can’t tell you how miserable I was trying to help this guy keep a car that was worth 18 times more than mine. I couldn’t afford his car, but no one was helping me.

Since pro bono clients didn’t pay for my services, they’d call all the time, demanding updates on their cases, demanding more action, faster action, berating me when things didn’t move fast enough for their liking, even though their cases moved just as fast or faster than any other. They’d call just to complain, or bring up tangential legal gripes about their neighbors or their relatives or other bill collectors. Paying clients, by contrast, called only when necessary, and kept it short, since they were paying for the time I’d spend talking to them.

With all of the pro bono cases I worked, there was only one client I felt good about helping. He had bought some furniture, and his mother had cosigned on his installment plan. The guy fell behind on his payments and the furniture company was going to go after his mother or garnish his wages. I negotiated a new payment plan for him, all of which was contingent on him dropping an envelope through a slot with the first of the new installments by the following Monday. Every other time I’d negotiated something like this for someone, they’d promised to deliver and then failed, and then I was stuck trying to use legal loopholes to delay further their obligations. But this one time, the guy delivered the check as promised. He also, unlike every other pro bono client, thanked me profusely. I checked with him over the next few months to make sure that everything was going okay, and it was. Maybe I handled two dozen pro bono clients. He was the only one who was nice and honest and fair and respectful.

If free legal representation is such a disaster, how can free medicine be any better? Our medical costs are high because a lot of the people getting free care are overindulging. If you don’t pay for someone’s time and efforts, you probably won’t respect it. Nothing should be free. And if we have to keep Medicare and Medicaid, raise the co-pays. Raise them a lot. Healthcare is one of the most important things in life … it should cost something.

And if we get rid of government programs, what should we do about people who are poor, old, or young, and need healthcare? I don’t have a great answer. Rely on the kindness of others. Hospitals already treat people for free. Doctors will too. Churches and charities will help. None of this is perfect, but taking from some by force to provide for others isn’t perfect either.