snousle

The current health care reform flap has got me really down. It seems clear that enough of the American public is so paranoid, stupid, and/or easily led that an even vaguely rational solution is just not going to happen. This irrationality, of course, is promoted by the great mass of parasites that leech off the health care dollar. Do you really think that armies of bureaucrats who shuffle incomprehensibly complicated insurance paperwork around are going to let that paperwork go? No, they are not - the obstruction of useful work is their cash cow.

Any sensible person would recognize that under a rational system that optimizes overall health and maximizes quality-of-life-years, they aren't going to get all the health care they might want, or even all the care they might benefit from. Unfortunately, Americans seem unable to accept this - if there's a million dollar procedure that might save Grandpa, somehow it's an automatic entitlement, and the deniers of that care become "government death panels".

It has occurred to me that what Americans want is not actually health care. They want individual attention and validation of their suffering. They don't want MRIs, they want Marcus Welby holding their hand when they die. Health care reform is ostensibly about health, but its opposition is driven by self-importance and magical thinking.

And you know what? Maybe that's just fine. The solution to giving everyone what they want is really very simple: the deregulation of medicine. The majority of Americans already disbelieve the foundations of biology and have no clue about statistics. They are completely unable to evaluate or appreciate the idea of public health. And more importantly, they are actively hostile to scientific medicine and its implications. So why not abandon science entirely, at least as far as national policy is concerned, and let Americans go to any practitioner they like? There is little reason for human medicine to cost substantially more than veterinary care, which is less than 1/10th the price. The cost problem is the result of regulation and monopoly power. Open up the practice to anyone, give doctors strong limits on their personal liability, and let the free market - a truly free market - do its thing.

Of course, doctors would still want to seek accreditation, and there is no reason the AMA couldn't continue to accredit doctors. I would seek out an AMA physician myself. But if barbers want to go back to doing general surgery, or new-age crystal therapists want to branch out into radiology, I say let them. A new generation of Dr. Feelgoods could dispense opiates at will. And the whole system would be caveat emptor - which is what people seem to want anyway. Lots of people will die for lack of appropriate treatment, or from incompetent treatment, but that will at least be their own choice. Far more people will have access to reasonably effective but vastly less expensive care once the floodgates are opened to real competition. It's not a 100% solution, but the current situation is so awful that it's hard to imagine anything worse.

This will never happen. But it's the solution the US - and only the US - actually needs, this being the only first-world country that lacks the baseline rationality required to implement a more sensible one. Or, perhaps, this is the solution the Americans deserve. It might not improve care, but it would go a very long way towards ending the systematic injustice and intractable conflict over who will pay for it.