Govt Med Relationship | Mark A. Hurt, MD

What should be the position of government in relation to Medicine?

The goal should be the complete separation of medicine from the state.  This means that the power of the government to regulate medicine is abolished, and in its place the government takes the position of securing the individual rights of physicians and patients.
 
This kind of change in the relationship of the state to the practice of medicine is also my position on the relationship of the state to economics in general.  There should be complete separation.  The government should not be in the "business" of providing goods and services for anyone.
 
The implications are profound.  It means, and this is a short list:
  1. The repeal of Medicare & Medicaid (2011 Federal Budget = $765 Billion)*
  2. Repeal of the The Food and Drug Administration (at least in its regulatory power, which currently exceeds $1 Trillion and requested $208 Billion in the Federal Budget in 2008)
  3. Dismantling the bricks and mortar VA hospitals (the funding of medical care for service-related injuries is another matter; the Department of Veterans Affairs for 2011 budgetary funding request is $211 Billion.  Apparently, about $21 Billion funds currently the VA Hospitals.)
  4. The phase out of government funded medical research
  5. The privatization of the National Institutes of Health
  6. The privatization of the Centers for Disease Control and Prevention (there is a case for having a government to investigate cases of highly infectious disease and infections immigrants to America, but having an specific government agency for that purpose is another matter.  2006 funding was $7.5 Billion)
  7. The repeal of government funding of physicians in training (funding currently in Medicare & Medicaid budget)
  8. The repeal of government regulation of the medical insurance industry.
  9. The repeal of government licensing of physicians (Estimated at $150 Million/year).

 

*Note that the US Department of Health and Human Services is an enormous unelected branch of government with 26 "Offices", 11 of which are part of the Public Health Service.  In 2011, the budget has a $911 Billion outlay, about half of which is for Medicare, and a third is Medicaid.  This is the equivalent to about $3,000 for every person living in the USA.

 
Securing rights means that the individuals who participate in the medical industry are free to produce and trade their production for mutual benefit, but not free to violate the rights of others, their patients or anyone else.  The government's sole function, in this context, is to police rights violations, not to regulate the agreements between patients and physicians.  The government, in this model, serves to enforce contracts.  Physicians trade their knowledge for money, as a rule, and patients trade their money for the physician's knowledge and skill.  Both benefit.  In cases when either party decides not to enter into a contract, each goes his own way, looking elsewhere for the kind of values each seeks.
 
As in all trade relationships, there are some tedious issues that must be considered.  Keep in mind, however, that all human relationships are contractual relationships, including the physician-patient relationship.  A physician, for instance, must give notice to a patient in order to terminate a relationship, but the physician also must state objectively what services he provides (he has no right to deceive the patient), and it is reasonable to know what the charges are in advance if at all possible, similar to any business.  Moreover, it is immoral for a physician to simply abandon a patient without making arrangements for referral or ensuring that there is proper continuity of care for the patient; it is a kind of fraud not to do so.  Yet, all of these practices have always been the mainstay of the physician-patient relationship when it has been possible legally to do so.  The purpose of government in these kinds of situations centers on contract enforcement, prosecution of fraud, and settlements of civil disagreements in the case of non-payment of the physician or disputes over the kind of care promised versus what was delivered.  Furthermore, the court system is and ought to be available to deal with  cases of physician negligence or perceived negligence; however this occurs, it needs to be clearly understood and applied, unlike cases today where the rules for expert witnesses are arbitrary and fraudulent.
 
Under capitalism, which I advocate, and which is the system of private property based on the principle individual rights, these kinds of contract negotiations are the soul of the system, and they eventually set precedents about what is usual and customary because the market makes it impossible for physicians to charge more than people can pay in the long run, and it raises the standards of service continuously. If the charge is too high, people go without or go with less -- something more affordable -- or ask for private charity, or invent something better.  However one does it in the sphere of political freedom, he does it by using his own judgment -- judgment that no one can prevent by government fiat.