|Doug Casey on the Crisis "Medicare for All" Will Cause
|by Doug Casey
International Man: Medical-care spending in the United States is more than double that of any other developed country. The extra spending doesn’t amount to better quality care or a healthier American population.
What’s your take on the US system as a whole?
Doug Casey: It’s full of problems. And they’re likely to get worse.
First of all, it’s highly politicized. Almost nothing can be done without government approval. It’s becoming more and more like your local DMV.
The system revolves around the FDA. In theory, it should protect the consumer, but in fact it does the opposite. The FDA should be renamed the Federal Death Authority, because it kills more people every year than the Defense Department does in a typical decade.
Why do I say that? For one thing, it takes 10 years for a new drug to be approved, and it averages not just $1 billion dollars, but now more than $2 billion for the typical drug to be approved—and only very few are ever approved. That’s because there’s only a minimal risk to the FDA in not approving them but a huge risk that they’ll be embarrassed if something goes wrong with one that is approved.
Second, the whole system is very bureaucratized. When you go to a doctor’s office, you’ll notice that probably half the staff is not engaged in delivering medical services. They’re shuffling papers: insurance forms, regulatory forms, and various cover-your-ass records.
Third, the medical system is law driven more than science driven. Doctors have to be very careful about what they say and do; the society has become very litigious. One of the major expenses of being a doctor is malpractice insurance. Particularly for some specialties.
There are thousands of lawyers in the US who specialize in suing doctors for real or imagined mistakes. For that reason, some specialists pay hundreds of thousands of dollars per year for their malpractice insurance.
Because of the dangers of being sued, doctors are practically forced to engage in defensive medicine. They prescribe all kinds of tests that don’t make sense, but they figure that it’s better to be safe than sorry—not for the patient’s sake but for the sake of a potential lawsuit.
All of this started with Franklin Delano Roosevelt. During World War II, he installed wage and price controls, and it was impossible for companies to give raises to workers. So they substituted benefits for cash, namely employer-paid medical insurance. One of the many disastrous distortions FDR cranked into the US economy.
On the bright side, despite these things, medical care has gotten much better because of advances in science and technology. The cost of medical care should have and would have been dropping—like the cost of computers—if not for State intervention. But that’s beside the point we’re discussing.
International Man: You’ve often emphasized the importance of using words properly. What are your thoughts on the term "health care?"
Doug Casey: Health care is something that you provide for yourself with proper diet, exercise, and lifestyle choices. Nobody—certainly not an insurer or the government—can provide health care. What they can do, at most, is cover a portion of your medical expenses should you have a serious injury or illness.
There’s a big difference.
It’s a subtle corruption of the language to call "medical insurance" "health insurance." It doesn’t insure your health. All it does is cover medical expenses. But they like to use the term "health care" because it sounds friendly and loving. "We’ll care for your health." That sounds great! Sign me up! "Medical," however, implies surgery, dangerous drugs, hospitals, and pain.
It’s a euphemism, and like all euphemisms, it’s dishonest. Health care or health insurance should always be called "medical insurance," because it will at best cover your medical expenses. Calling it "health care" and saying it’s "free" is just dishonest marketing.
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International Man: Most Americans are insured privately by their employer or through self-purchased coverage.
About 34% of Americans are insured through a government plan such as Medicare or Medicaid.
If the quality of medical care in the US is unsatisfactory, why is the conversation centered on insurance? Are we missing the point?
Doug Casey: To start with, the 34% of Americans who are "insured" through a government plan aren’t actually insured. They’re not paying market-based premiums based on actuarial tables—considering age, preexisting conditions, and the like—intended to spread the risk of serious sickness or injury.
Medicare and Medicaid are actually welfare programs. They have nothing to do with insurance. Using that term gives them and those who use them undeserved respect.
Medicaid is one hundred percent welfare, and Medicare is mostly a welfare program. They shouldn’t be termed "insurance."
The important point is that they shouldn’t exist. Why should the State cover a person’s medical costs? If it should, maybe it should also cover their food, shelter, and clothing—oh, wait, I forgot, it does. And even the cost of their cellphones. But cars are also important. When someone’s car stops working, shouldn’t that be covered as well?
How about their dog? How about farm animals?
Is somebody else’s bad health a mortgage on my life?
Bad things happen. That’s why you buy insurance. If you can’t afford insurance, that means you managed your life badly. It’s not up to strangers to kiss it all and make it better for you.
Most diseases and many injuries are a result of people not taking care of themselves. They overeat, don’t exercise, use alcohol and drugs, and engage in bad lifestyles. Those are moral failures. I don’t want to pay for those people’s moral failures. Neither should you.
International Man: Over 59 million Americans are on Medicare. Bernie Sanders and other presidential candidates have made "Medicare for all" one of their biggest campaign promises.
What type of care can Americans expect to receive in a single-player system, with national coverage for all?
Doug Casey: It would mean disastrous and degenerating care.
They like to bring up Canada and Britain as examples—and they’re very good examples.
The medical systems of both countries are in crisis. If you need an operation, it can be delayed for many months, sometimes more than a year. Forget about something that’s noncritical. The reason is simple: When you have scarce commodities like a doctor’s time and medical equipment, they have to be rationed.
There are three ways you can ration a commodity. By dollars, time, or political connections. In other words, you can pay for it and get it when you want it. Or you can wait in line—for who knows for how long. Or if you’re a VIP with friends in high places, you’re moved to the front of the line.
In places like Canada and Britain, you hardly have a choice. The single payer determines if you get treated, when you get treated, and how you get treated.
Furthermore, if something is "free," which care from a single payer supposedly is—although it’s paid for by taxes—everybody wants as much as they can get. And as with any free good, people won’t economize.
Certain people are going to live at the doctor’s office. It’s going to turn some people into hypochondriacs. The idea of Medicare for all—or for that matter, Medicare for oldsters—is stupid and uneconomic from every point of view. More important, it’s morally depraved, because it uses the State to force some people—namely doctors and productive people—to pay for those who were too imprudent to provide for their own care.
As a fringe benefit, it will destroy the medical system. Doctors will wind up as veritable government employees. That will discourage them from spending six years and hundreds of thousands to learn their trade. There will be a lot more demand but a much smaller supply of doctors. At the same time, the amount of capital available for developing new drugs, new technology, and basic research will collapse. Why? All governments today are running gigantic deficits. This is likely to get much worse. They’ll put off the important in favor of the urgent, and the results are inevitable.
International Man: Bernie Sanders’ Medicare-for-all plan would cost $97.5 trillion over the next decade.
The US government debt has already reached astronomical levels. How is it possible to pay for this?
Doug Casey: It’s not possible. It’s a swindle and a lie.
There are three possible explanations. These people can’t do simple arithmetic, they’re purposefully lying, or they’re crazy. It may be all three.
Let’s look at this, however, not from a philosophical but from a practical point of view. If you’re sick or get into an accident and you don’t have your own insurance, what are your options?
If you need an expensive procedure and can’t afford US prices, there are lots of places where you can get high quality medical care other than the in United States. Lots of Americans routinely go to Latin America for dental work at from 10% to 50% of US costs.
It’s called "medical tourism."
Thailand is probably the best location for serious stuff. The medical care you can get there is equal in quality to that in the US, more pleasant, and about 20–25% of the cost. If I needed a serious operation and I didn’t have insurance, I’d get on a plane to Bangkok.
If I were paying for insurance myself, I would get the highest possible deductible. I don’t want to trade dollars with an insurance company for basic and trivial things. I’m interested in insurance for only truly major medical expenses. That’s what most people should do.
But suppose you just don’t have any money. One possibility is to hope that charity will cover your bills.
Incidentally, before Social Security and welfare programs like Medicaid, there were hundreds of beneficial societies in the US. They sorted out which of the afflicted were deserving and helped them. Few, like Lions, Rotary, and Kiwanis, remain. Most of them were made redundant by government welfare programs.
If you don’t have money or insurance, and charity isn’t a practical option? If you have friends, maybe your friends will help you.
If you don’t have friends, why not? I’d suggest it may be because you’re actually not a good person or at least not a very valuable person. If someone is without friends, it’s because they are viewed as liabilities, not assets, by those who know them. They suffer from serious moral flaws—they lie, cheat, steal, are violent, lazy, or have other vices. If they have no friends to help them out, why should a stranger?
We all have to die at some point. Nobody wants to think about it, of course. Or perhaps even believe it will happen to us personally. From a strictly ethical point of view, nobody should be narcissistic enough to try to make the continuation of his life a mortgage on everybody else’s life.
Let me give you an example of what I mean. If you see a person, a bum, dying on a street corner, would you give a dollar to save his life? Many people would. Would you?
How about $10? OK, what about $100? I’m not so sure.
Maybe the world’s better off if the bum dies—there’s a reason he’s a bum. The reason will have something to do with a bad character. Would you give him $1,000? Some would, I suppose, out of some kind of guilt or perhaps to make themselves feel righteous. $10,000? Nobody would do it, unless they were both wealthy and interested in conducting a social experiment.
I’m saying this idea that human life is priceless is ridiculous and destructive. We put a price on human life all the time, depending on who it is and the circumstances. And we should. In the example of the bum I just gave, we’ve determined that some stranger is likely worth only a few dollars.
Just the other day I got an email from someone in Aspen who’s a member of a luncheon group I attend. Most of the guys are typical Aspen rich guys. One member, who’s in temporary (I presume) financial straits, wrote that his dog has a type of operable cancer. But it’s an expensive operation, and he can’t afford to pay for it.
He’s asked the guys at the luncheon group and his other friends to contribute to the cost of the surgery.
I have zero doubt he’ll raise the money. I don’t believe in charity, for reasons I’ve spelled out in the past. But I sent him a hundred dollars.
I wouldn’t, however, send anything to someone in the Third World with a problem (not to mention the fact it’s probably a scam run by some Nigerians). There are roughly 7.5 billion people on this planet. They all have problems and would all like $100.
But I sent him $100 for his dog. Why?
The fact that I did might generate further good feelings between us. (He seems like a decent guy, although I don’t know him well.) If I had just sent it into the ether for the medical care of some person in Africa, as opposed to this man’s dog, I know I’d be getting nothing back for it. In fact, maybe the African is a member of Boko Haram and would want to kill me just on general principles. This is one of many reasons giving money to "charity" is usually a mistake. Giving to an individual, even as a test of their character, is much wiser
Frankly, sometimes you value the life of a dog more than the life of some poor person outside of your circle. And sometimes you should. If it were my dog, there’d be no question about it.
That’s what this whole thing about insurance, Medicare, and a single-payer system is all about. It’s up to individuals—not State bureaucrats, not "the system"—to decide who lives and who dies. Including you yourself.
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