A Facebook Debate I had - It's long.Submitted by CSA1861 on Sun, 05/06/2012 - 01:09
This was a Facebook debate i had in response to the recent article about the FDA maybe allowing some drugs to be dispensed without a prescription. It's a long one, but it covers all the bases and I feel like I did pretty good. I don't join the discussion for a few responses, so that's when it gets good and turns into a debate. I didn't convert anyone and did not realize how much a couple of classmates from pharmacy school love their angelic government, but it was fun. By halfway into the debate the article is never mentioned again as the debate moves into deeper individualist capitalism vs collectivist socialism, but here is a link to the article: http://www.washingtontimes.com/news/2012/apr/29/fda-may-let-patients-buy-drugs-without-prescriptio/?page=all#pagebreak
Jeff Diabetes, infections, high cholesterol... This is a terrible idea. I have a hard time believing the same agency that is so strict on drug approval, importation, etc. would allow the layperson to diagnose their own conditions and self medicate.
Jonathan This would be disastrous. Physicians can't even get antibiotics right all the time with the help of computer programs and 10+ years of education. If this happens we might as well kiss any useful antibiotics good bye because resistance will soon run rampant and we'll have no way of undoing that. Then strep will be a deadly infection again. This is a terrible idea. Also knowing all the side effects of seemingly simple meds such as hyperlipidemia meds and high blood pressure meds I'd say this would be a very dangerous senario. Patients would have no way of seeing their physician to monitor their progress or their tolerance to whatever med they're on. On top of that this is one more step that will allow lazy americans to be lazy. They already go to the doctor for a pill and often the doctor will make them try and get their blood pressure or lipids down with diet and exercise. If that doesn't work they'll give them a Rx. But if this gets passed, fat americans will just go to the kiosk and get the ultimate lazy quick fix. Now I think if you allowed pharmacists to play a major role then I'd say this a good idea (obviously I'm biased). But a pharmacist has the training to watch for side effects, read labs, and do minor diagnosis (especially with the help of a computer). I think asthma patients should be able to get medications without paying to go to a doctor and same with other conditions. So I guess I just disagree with the patient doing their own diagnosis through a computer program with no personalized decisions or monitoring by healthcare professionals. But many of these conditions are not as simple as the general public thinks and they require expertise.
Joshua I think it was typed poorly in this article. It says specifically later on that pharmacists will ultimately be in charge of determining the drug regimen for these patients. I'm not sure how I feel about it yet. I think it could potentially be good, but if the insurance co's won't cover it and this backfires and results in a higher cost to patients then I think it will be bad.
Joshua@Jtron . . . read the article before posting your rant. The article specifies later on that the pharmacist will be the mediator here.
Also, I'll give you both that this article is terribly written . . . they make it seem like a layman will be like "Hey I feel like I probably have high BP" then go to a pharmacy and pick up a bottle of lisinopril from a tech. But if you check out the actual debate going on, thats not really whats being discussed. I will try and find a better article.
Welp, I can't find any news articles yet . . . this was just posted less than 24 hrs ago . . . so hopefully some more accurate one's will surface over the next few hours/days as this seems to be the only one on the interwebs on this topic. If someone else can find something, please share.
Michael what bothers me among other concerns is there is no mention of reimbursing the pharmacist if it does fall on us to start taking care of these OTCs....
Michael fix that and keep the OTCs behind the counter a la Plan B and i may be more on board...
Joshua I think it is saying they will be behind the counter. It's not saying we are gonna have statins and bp meds sitting on a shelf next to gas-x.
Jeff But if this is to be believed, where do people get their labs checked? You can't just stick yourself, see your blood glucose is 200, and then randomly select a drug and strength for yourself. What use do PCPs serve after this? There has to be more to it than this story lets on.
Joshua From what I have heard, pharmacists will not be doing primary diagnosing. I agree that we need a lot more info and I won't feel comfortable giving a patient statins for instance unless I have access to their labs and med records. But as far as minor infections and such are involved, that do not require culturing, I think it makes more sense for pharmacists to be in charge of at least selecting which drug regimen that patient should be on, rather than the doc writing amox or zpack for any suspicious rash.
Michael no way - zpack is the wonder drug - it works for EVERYTHING!!!
Jeff Pharmacist is a funny profession in that it includes people who are basically physicians (like Dr. Cox) down to the old codger that could care less, working for a paycheck, knows next to nothing because they don't keep up with new drugs, etc. That is a lot of responsibility to throw on the profession from out of nowhere. You can't assume that all pharmacists are like us - want responsibility, have knowledge, etc.
Joshua MD's are the same way.
Jeff I don't think they are to the extent pharmacists are. It is an extremely wide knowledge gap.
Joshua I think that might just be due to the perspective you have. There are clueless MD's out there who don't know their ass from their elbow when it comes to modern medicine just as there are ridiculously brilliant MD's who are on top of their game.
Jeff Having actually worked in many pharmacies, I have had personal encounters with pharmacists on the verge of losing their license due to too many medication errors. School gives us an ivory tower view of the profession, but I assure you there is a very wide gamut of knowledge and ability. One that isn't present in many other fields. I'm not saying there aren't doctors who suck.
Joshua Oh I agree with you entirely, but I am saying that is pretty ubiquitous in most professions.
Jonathan Yeah I think pharmacists should be required to have increased CEs and certifications if they wanted to take part in the diagnosing and managing of chronic diseases. Also begin incorporating this training in schools. It could be done the same way immunizations were done (obviously a little more comprehensive).
CSA1861 I think this is great. People are still free to go to Docs for testing. The more we can tear down arbitrary walls of protectionism and regulations the more the free market will drive down costs and drive up quality.
Freedom requires personal responsibility though, and the government shouldn't pay to fix people that make dumb decisions as result of this. People aren't going to go to nurses for brain surgeries and pharmacists for EKG readings. Private certifications and accreditations protect consumers appliances and services in other industries, why not here?
I would rather be exposed to the inconveniences attending too much liberty than to those attending too small a degree of it. - Thomas Jefferson
Jeff I would have to disagree completely. Sometimes regulations aren't just arbitrary. Sometimes we need checks and balances. This is one of those times. For instance, if I were on trial, I wouldn't represent myself. I would hire a lawyer, because I need their expertise. What this is essentially doing is asking the public to be their own representation. The money saved will likely be spent caring for adverse events and sub-optimal therapeutic outcomes.
CSA1861 But there is no end to how much the government could protect us from ourselves. We could conceivably implement a government that protects us from our own mistakes, but we would be slaves, having every decision and value chosen by someone else. The foundation of a free society is self-ownership. If we don't own ourselves we are slaves. But you're right, saved money would be spent on adverse events... but only if individuals did not bear the cost of their mistakes. When people bear their own consequences, risk their own capital, etc, they are much wiser and prudent in their decision making. You could apply this to the recent housing crisis... banks were assured to be bailed out, so there was no financial incentive to be wise with they're loans. They didn't bear the cost. We're 15 trillion dollars in debt and can't afford to police the world and take care of everyone from cradle to grave anymore.
Freedom is better option.
Jeff So why do department stores need staff? Allow customers to browse freely and trust them to find what they need, not need questions answered by an expert, and being honest and responsible by paying for what they get. I predict that situation quickly devolving into a free for all.
CSA1861 Because people want that specialization, that division of labor... that's a market force. The owner of the store risked his own capital to hire that staff because he saw an opportunity for profit. That's competition at work. The store wasn't mandated to hire x amount of people by the government.
Jonathan Just like our awesome healthcare pre-regulation right?
CSA1861 Ya. America was known worldwide for having the best healthcare. People weren't dying in the streets without our loving government protecting us... They create the FDA when 100 people die but the average person knows nothing about Vioxx killing thousands. Check out the graphs of healthcare costs since the 1960's - costs having risen much faster than inflation as government intervention increased. The free market has much stricter regulations because companies have reputations and capital at risk.
Adam Is like to go on webmd and print out my own prescriptions, then have it shipped to me via a Canadian pharmacy site. That would really cut out all the useless middle men and arbitrary regulations.
CSA1861 You're correct, that would probably save you lots of money and time, but it would also be lower quality likely and you may end up paying more for it in the long run. The need for higher quality but at a similar price is what would incentivize an entrepreneur to create a higher quality diagnostic product or a doctor to lower his prices or some other business model that a capitalist hasn't come up with yet. The new competition would also force webmd to improve their standards.
Likewise, private accreditation and licensure would require standards to be met in order for physicians, pharmacists, websites etc, to show their logo as a symbol of quality, much like what Underwriters Laboratories does with industrial products (our toasters wouldn't be exploding in our kitchens without the government).
Eric tldr; but I did recently buy contacts from canada. After wearing contacts for 20 years, I thought it a tad bit silly to have to go pay a doctor again to write me a prescription for the same contacts once again.
Adam I was being facetious. I think that would be a terrible idea....
CSA1861 Why is freedom such a terrible idea? Why shouldn't people be allowed to buy raw milk, use big toilets, smoke what they want, self-diagnose, give out loans to whom they please, etc as long as they don't force others bail them out for their mistakes? Some of those things might not sound like a big deal, but years ago they'd all sound like dumb ideas to regulate such aspects of our lives. Should we have the gov't regulate what type of shoes, cell phones, or vehicles we purchase based on whether or not we really need them as well?
Daniel why should children be made to go to school?
Eric why should we have environmental regulations? if companies were dumping waste into water sources, consumers would obviously know this and buy from another company (who properly dispose of their material, thereby having a higher price on their final product), therefore making the first company think long and hard about whether they should continue dumping their waste ammonia into the river...Unfettered capitalism at work. Am I right.. guys?.. guys?
CSA1861 You know you're both right! Especially when millions of high schoolers are graduating from government schools unable to read above a 6th grade level, when average cost per pupil is twice as much in public schools than in private and apathy and violence are growing out of control in the classrooms. Cutting gov't education will result in less requirement for taxes. That money would then be left in the people's hands to educate their children the way they see best (resulting in creative, innovative models of education instead of our current early 20th century style of education). Now if the goal is to crush diversity and independent thinking, than yes, public schooling is the way to go. Edison, A.G. Bell, Einstein, Mark Twain, Robert E Lee, Jefferson, Dickens, Frost, Carnegie, General MacArther, General Patton, Stonewall Jackson, Henry Clay, Churchill, Patrick Henry, Teddy R., FDR, 11 other presidents - what's in common? Not compulsive government education.
And in regards to environment regulations, private property laws would make it illegal to pollute people's rivers, lands, and air. Pollution, whether it be noise, smell, smoke, etc is a form of trespass. These would be torts, not crimes, that could be proven in court to have caused damages. People used to have property rights to defend against such infringements. It was for this reason that railroads were prevented from allowing sparks to fly hundreds of feet from the tracks onto people's land and chimney makers were incentivized to create meshes to capture burning products in the mid-19th century. The first major problems with environmental pollution came in the 1880s when railroad companies and manufacturers were permitted to pollute other people's property 'for the common good.'
Daniel those positions are pretty fantastical, and would not stand up to realistic criticism.
CSA1861I think it makes for a good discussion, and neither statism nor individualism should be dismissed without a discussion of the criticisms (that was a lot of 'isms'). But I would suggest that these positions were those held by many (not all) of this country's Founders ("Sometimes it is said that man cannot be trusted with the government of himself. Can he, then, be trusted with the government of others? -T. Jefferson). And I would suggest that it's the CURRENT mainstream ideology that is pretty fantastical and will not stand up to a sovereign debt crisis.
Jonathan Our debt crisis is obviously no good but it is not synonymous with government programs and regulations. The debt crisis is due to a lack of fiscal responsibility. It is possible to have a balanced budget with the current government regulations/programs. Sure waste in these programs should be cut but you don't have to throw the baby out with the bath water because of the debt crisis. The government just needs to be held responsible on fiscal issues, which they aren't.
Also it'd be great if everyone could do exactly what they want but in reality there is always a cost associated with it. Not just because people aren't responsible for themselves but also because we as humans, no matter what the screw up, don't like to permit another human's suffering. So if I want to ride a motorcycle and I get in an accident from reckless driving and I do not have insurance, people, not the just the government, will not allow me die or go without treatment because humans have a high degree of compassion and empathy. The same would apply for people wanting to self medicate. So in trying to prevent a myriad of self/drug induced diseases the government made the line of demarcation between OTC and Rx. Also I have high suspicion that people weren't dying in the streets in the early 1900's haha (not literally but lots of people died from medical "cures" and treatments). The average life expectancy was only around 50 y/o and that is absolutely terrible. Without the early regulations forcing pharmaceutical companies to show efficacy and safety we wouldn't have started seeing useful drugs for many more years. If people are allowed to scam they'll keep on scamming. And as far as Vioxx goes there are a lot more people in the US today, superior reporting practices, and the stats aren't definitive that Vioxx was the cause of every reported death. I'm not defending Merk for their shady under hand dealings but I think it'd be rather ingenuous to believe that Merk would have pulled Vioxx sooner, if ever, from the market had the FDA not been around. We let asbestos companies do whatever they pleased by presenting their own research on the dangers of asbest (documents show that asbestos companies knew as early as the 1930's that asbestos was a killer). But they kept using asbestos and exposing workers to it until the government told them to quit. They didn't care that people were getting asbestos exposure that would almost certainly lead to their deaths. They were going to keep on using until they were forced to stop.
Jonathan Also a quick aside in regard's to property protection laws and the reason that doesn't actually protect you at all. It is nearly impossible to prove who polluted someone else's land especially when everyone is doing it like they were pre 1970's. That's why a lot of these laws were passed. A lot of private land owners kept getting screwed and it was so difficult to prove who was at fault. The government devised regulations and laws that were stringent and placed overwhelming liabilities on anyone caught polluting that it significantly reduced the frequency of such events. Now the US water ways and soils are ten fold cleaner than they were even in in the early 1900's (pre regulation). Not to mention the EPA is fairly self sustaining when compared to most government programs. They recover all of the costs associated with major clean ups and permitting fees pays for the inspectors. Though not without it's faults, but lets face it nothing is, I'd say the EPA has been pretty successful overall.
CSA1861This is a well written article by an environmentalist addressing concerns about private property rights protecting the environment.
Jeff This is Ron Paul logic: something isn't working at maximum efficiency? Don't attempt to fix it - completely scrap it. Everyone do as they please and be responsible for yourself. The problem is that people aren't responsible. The average person has a sixth grade education. How can we trust an irresponsible, unintelligent person to diagnose their illness, purchase the correct medication, and treat their condition effectively? Not to mention the potential for drug abuse. This is a completely awful idea. It really has very little to do with personal freedoms, and more to do with proper channels of purchasing a substance that is controlled.
CSA1861I understand that's how Ron Paul's ideas are commonly portrayed, but it's not what he believes. It's not 'everybody do what they way and hope they're responsible' it's 'do what you please so long as it you don't hurt others and you bear you're own risk.' If a bank wants make a loan to someone with bad credit history and a poor job, fine, but do don't ask the tax payer for a bailout. Wanna build a house on an ocean coast that's at higher risk of flooding? Fine, but pay for you're own insurance. Wanna take a risk and diagnose yourself from some internet blog? Fine, but don't ask the tax payer to pay for ER bill. When the costs are socialized but not the benefits, people, banks, businesses, etc behave much riskier than they would if they bore the burden of personal responsibility.
CSA1861And it's not just for individuals either... You wanna manufacture and sell a drug after 5 weeks of research? Fine, but if you kill someone, you're going to jail and will get sued and your scarred reputation will destroy any hopes of selling another pill.
Jeff You must realize these ideas are terrible. Are you all playing a joke on me? All this would do is promote irresponsible behavior on the part of the manufacturers and consumers. Why waste money on testing when we can wing it? Why should I have to spend 7 years in school when I want to be a pharmacist now? Because these aren't pancakes or chocolate bars, but dangerous medications that can ruin lives. Because looking stuff up on Wikipedia is not good practice. It isn't fair to anyone, and it would make for a horrible society.
CSA1861 Because there is profit to be made in selling products of good quality. Why are cell phones today cooler and in wider use than 20 years ago? Because competition produces quality and affordability. - (and I think I'm the only one holding these views, Jeff)
CSA1861People aren't going to go to nurses with 2 years of undergrad under the belts for brain surgery and they won't go to Wal-Mart cashiers to learn how to control their cholesterol.
Jeff So they'll just be in charge of their own care for simple things like dealing with infectious disease, diabetes, and high cholesterol? Companies have regulations in place because, like people, they will push the envelope further and further until people start getting screwed. I tend to think that no man is an island - situations can't be viewed in a vacuum. We have to take into account the good of the society when we make decisions. This guy feels his civil liberties are being infringed upon because he has to go to the doctor before he gets an antibiotic. I see it as a protection of mine because it cuts down on bacterial resistance.
CSA1861 Being in charge of my own life is not a bad thing. If my transmission goes out, being in charge of my life and property is what gives me the choice of saving a few bucks by installing a new one myself or taking it to a specialist that the free market division of labor has produced to install it for me. Personally, I would probably take it to the specialist and pay the premium for his expert labor because I don't want to do more damage than what is already there. If I new autos inside and out, my decision would be different.
Because humans don't live in a vacuum is why free markets work. Because mutually agreed upon transactions benefit both parties. I value a service more than a certain fee while the other person values the fee more than the effort required for the service.
The issue of antibiotics and resistance is a good point and is one issue I have not completely reconciled, but enough that's it not a huge concern to me anymore. Since the CURRENT trend is that Abx are overused and going towards resistance, than I assume that supporters of state paternalism desire even more restrictions on abx utilization (the individuals desperately needing emperic therapy won't appreciate that). I have a couple thoughts on it though. It might be that antibiotic usage would actually go down in a free market since Drs would no longer be subsidized simply for how many prescriptions they wrote but rather for the perceived quality of their practice in the eyes of their customers. Also, if an antibiotic failed, it would be a market signal that new products were needed in the innovation ring. Plus, people aren't going to just start popping bactrim like vitamins. There'd be no value in that, so it'd be a waste of their money (a result of bearing their own cost).
Jeff There are two problems with this line of thought. First, you are coming from a perspective that everyone is as intelligent and responsible as you are. The second is that what you do in your own life can affect someone else. If you install your transmission to save money, but do it incorrectly, it isn't just your life that is in jeopardy. I think you are overestimating the intelligence of the public. No one can be an expert in every field. We need mechanics just like we need doctors and pharmacists. The average American has a sixth grade education. Asking them to be totally responsible for diagnosis and treatment of their medical conditions would be just the same as asking me to fix my own transmission. It would be an utter disaster, and people would likely be hurt. "Freedom to swing your fist ends where my nose begins" - Oliver W. Holmes.
CSA1861 I think you just agreed with my points... The very reason we shouldn't think everyone will start self-diagnosing is because most people aren't intelligent in that area. I don't go to a car mechanic because I'm mandated to by the gov't, I go because I'm not trained in auto skills and value their expertise. The division of labor is a result of free market competition. Free markets are what led us away from having to do build our own houses, raise our own food and sew our own clothes.
Justice Holmes's quote explains the very basis of liberty. You can do as you please until it infringes on another person's life, liberty, or property. (Though it's very different than the way he judged. He actually wrote the opinion for the case that upheld forced sterilization of women deemed not bright enough to be a mother).
A lot of people eat unhealthy also. Perhaps we need the government's permission before going through the check out line at the store as well. Let's outlaw cigarettes, beer, and twinkies because some people apparently aren't smart enough to use moderation.
Jeff Which is the same reason people need to go to the doctor for medical issues. There is no government mandate saying that you have to go. You can self-treat any illness you wish. If you want to treat your prostate cancer with OTC herbals, you can do that all day long, but if you want these certain medications, you need to go through the proper channels. This is necessary because people are not trained or skilled in the field of medicine. It would be irresponsible to allow many of these medications to be obtained without first consulting with an expert (doctor, pharmacist, NP, etc.). To compare medicine to junk food and cigarettes is a bit of a straw man, in my opinion. It would be more reasonable to compare it to the purchase of explosives or automatic weapons. One can't walk into Home Depot and purchase a pallet of dynamite or an automatic assault rife. To obtain these things, you must go through the proper channels; being seen by an expert to determine your need for these items. While some people may feel this is an infringement on their right to dynamite, I see it as a necessary precaution.
Jonathan For starters the reason jurisprudence of the 1820's quit working is because you have to prove that someone's pollution caused damages. Sure in 1820 you could show up and court and the court woud just take you at your word. But if there is any form of injustice it's bringing someone to court under the assumption of guilt, which is exactly what was happening back then. This article has so many holes, inconsistencies , errors, hasty conclusions, and straw man arguments in it that I don't know where to begin. I disagree with almost every sentence because they are not logical conclusions. I'd be glad to explain and elaborate but I would do a way better job in person just because there is so much here to address.
Jonathan Also idealistically I agree with you, but sadly we don't live in an idealistic world and those ideas would never actually work for so many reasons. And like in my previous post my explanations are far to complex to post so we'll just have grab a drink some time and, in the words of Nacho Libre, get down to the nitty gritty.
Adam theres a movie where those ideas worked Jonathan, its called mad max!
CSA1861Jeff, I'm not saying it's a bad idea for people to go to doctors and specialists. In fact, because it's because it's a GOOD idea is why I believe people would still choose to do so. But I'm saying people shouldn't be FORCED to go in order to get their medication or certain procedures, because there are some people who ARE smart enough to self-medicate. To say that healthcare is currently freedom-centered because no one forces people to go to doctors and people can choose to treat cancer with OTC's would be like saying auto repair was free because I wasn't forced to go to mechanics but my alternative was to go without access to the proper parts.
I purposefully chose junk food and cigarettes as an analogy because there are active groups currently pushing for such bans under the same philosophy of protecting people from their own poor decisions. In fact, regarding prohibition, that's already been tried in the '20s and it was an colossal failure that resulted in black markets, organized crime, and no access to alcohol used for good purposes. (Supporters of marijuana prohibition should learn some history).
But your analogy to guns and explosives is also a fine comparison. It's a little bit different because the motivation behind such regulations is protection of others whom the buyer might hurt, not necessarily for the protection of the gun-buyer. But I'll go along, because if the law was still centered on natural law, then we would be free to buy dynamite and full automatics so long as we do not hurt other people. Your dynamite damages other property? You'd be held liable. You kill someone? You're tried for murder. Why should law abiders be disarmed when murderers (who already lack respect for laws) will obtain their devices via illegal means?
Jonathan, I'm unfamiliar with the notion that evidence was not required to prove guilt in the 1820's, but I haven't studied the issue deeply. I'll admit that your points regarding evidence of harm and microparticles is difficult to resolve. For example, obviously a case would be thrown out that one car's exhaust was damaging my health because the harm would be so small it'd be insignificant, but millions of cars' exhaust could be, yet I'm not sure how one person could sue millions of people for their cars. However, I do believe a strong forensic field would fill some needed gaps. But you're right, it's difficult to get into every point on here.
Jeff I think I see where we are differing: I think that prescription-only medication regulations are intended to protect more than just the buyer. That's because the person taking the medication is not the only one affected by it (adverse events, DWI, resistance, drug crime, possible increase in drug expenditures, etc.). A book I read says that 20-30% of every healthcare dollar spent goes toward unnecessary procedures and treatment for adverse events. Now you might say that the buyer is taking a known risk when purchasing a drug (I would agree), but if this person has an adverse event that requires hospitalization, ultimately the taxpayers/people with insurance will be left to foot the bill. I can only predict that all of these scenarios would just increase if people were taking to WebMD to diagnose and treat themselves.
A more disturbing note for me is that a system like this could create a state of "haves" and "have-nots". I can see this turning into a scenario where those who can afford to see doctors would be getting a much higher quality of healthcare, while people who could not, would have to diagnose and treat themselves.While this is just speculation, I think this type of system would take the healthcare system back to the 1900's.
CSA1861 Yep. That's where the difference is. But having hospitals/taxpayers/insurance foot the bill is not what i'm arguing for. Under the system I advocate, individuals bear their own risks (unless that risk is voluntarily contracted out to an insurance company obviosuly) all the way through. Hospitals (and those who have to pay higher hospital prices to absorb the costs) shouldn't be forced to pay for someone just because the individual made poor choices or neglected to get a major medical policy. In the old days, before extensive regulation, there were hundreds of charity hospitals that offered care for free to those who could not afford it or had neglected to prepare for risks (Ron Paul used to work for one, delivered hundreds of babies for like $5/hour or nothing at all).
I don't believe the system would create haves and have-nots as much as it would be haves and have-not-as-much. Yes, wealthier people would be able to afford higher quality care, is this not the same in housing, food, automobiles, and leisure activities? And just because a certain product is 'out of reach' of someone with less wealth does not mean that the product will always be out of reach. If people had a right to cell phones, or a right to Whole Foods products back in the beginning of their markets the prices never would've come down. In fact, the increased demand would've kept them substantially higher and competition would've been crushed since gov't subsidies to the new cell phones or Whole Foods goods would've prevented newer, competitive products from coming to market by keeping the prices lower than market value to the consumer. Competition brings prices down. Even in a free market, there would still be a few that still fell through the cracks which could generally be caught by charities and churches (there's be no way charities and churches can afford the burden under today's system).
Historically, the middle class is largest in the freest economy, shrinks under bureaucratic weight, and is completely wiped out in a fiat currency collapse (that's coming too.. good for another discussion).
No system is perfect, but seeing as it's the areas where government has gotten the most involved that have seen the most dramatic increases in cost and expanded gap in quality over the past 5 decades (healthcare, housing, education, etc), it's pretty evident that maintaining the status quo approach is not the solution.
Jeff The money to pay for hospitalizations has to come from somewhere. When someone files a claim, it is paid for from the pool of money that other people have paid into. As more claims are filed, rates will go up. This means that the individual's poor choice (or caught unaware by a drug with only 5 weeks of R&D, as drug companies can now choose whether or not to do proper trials) is now affecting not only him, but all purchasers of insurance. The same holds true for charity hospitals. They are taking a severe cut in pay to do something for little to no cost - a negative impact to these individuals. The other option is to refuse to treat someone who can't afford to pay. That's a more morality discussion that we could get into. The point I'm trying to make is that almost every decision that is made impacts others. If this weren't the case - in a perfect world - then everyone would be free to do what they wanted, and only worry about themselves.
I'm not insinuating that top-notch healthcare is a right, by any means. What I am saying is that it could potentially put decent healthcare FURTHER out of the reach of the middle/low class. That's something that doesn't need to happen.
I guess to me, this situation seems as irresponsible as letting people drive drunk because "hey, it's your funeral when you crash". Maybe it is, but maybe they harm someone else in the process. What about the insurance to pay for damages; where is that money coming from? When much of this can be avoided through regulation.
CSA1861Yes, under a system where you own you're own property and body and also are responsible for own life and property, hospitals could choose to refuse care if there was no payment (remember, prices are cheaper in a competitive system however), because I have a right to my own justly acquired property, not a right to the hospital's property. And that's where this really becomes an ethics/morality issue. Historically and economically, I really think it's tough to make a case for central planning. We could look no further than the past 60 years of new regulation after new regulation. I often compare it to a patient on 30 meds after years of adding med on top of med just to treat the side effects created by previous medications. But to take central planning to the extreme would be to observe those grand experiments of collectivism for the greater good under the USSR, nazi Germany, fascist Italy, or Mao China. But ya, I think we're definitely gettin' down into the roots of the issue and that's the nature of justice, positive vs negative rights, etc, which is GREAT topic to discuss, but I'll tell ya the truth, if I don't quit checking this awesome group a couple times a day I'll never get through this therapeutics material!
Eric this is all totally absurd. It all relies on a society where everyone is either honest or they are dishonest *but get caught and punished*. This line of thinking leads to the belief that victims of scams actually deserve being a victim of a scam. ie. they were too stupid to know they were falling for a scam, therefore they deserve to be scammed. I know many people, typically young guys, who feel this way. Got hooked on cigarettes, that's your own fault (not the company that purposefully sells a product they know you'll get physically addicted to). Somebody sells you a lemon of a car (doesn't reveal car's history, etc), it's your fault for not knowing everything about a car. Hire a guy who tells you he can design/build an addition on your house? Guy uses cheaper, smaller nails and no strong-ties; Year later addition collapses and kills a family member.. it's your fault for believing the guy in the first place; for having trust in him. But he doesn't need gov. permits, contractors license, etc. You, the consumer should be a proper judge on all of these matters, or somehow magically know he is a crook. But free market free market free market, you will now post a negative review on the contractor to warn others and he will no longer receive business and he will be properly punished... one little problem he's long since left and is already screwing over someone else in some other state. These types of people exist in the current state of the U.S., with public/consumer protections in place.. and you can be sure they will flourish if we took them away. I, for one, would not want my wife (type one diabetic) to die from some company who is allowed to bring insulin to market that was stretched with chemicals to save them money. The free market correcting itself by having that business closed and its owners punished after the fact would do nothing to bring me peace.
Jeff But the market will right itself when nobody buys their insulin anymore!
CSA1861 Hey You're gettin' the hang of it Jeff! But seriously, entrepreneurs have a financial interest to deliver good products. How is that so difficult to see? People will still get licenses because customers want assurance, and the groups that distributes the licenses would have a financial incentive to only license individuals with proper training. Fraud would not be legalized in a free society. That'd be like legalizing counterfeit money! If people by nature are so evil and selfish, then how can it be a good idea to place power over other individuals in the hands of a few people with that same evil nature? Do bureaucrats not have incentives to seek their own good? When bureaucrats are asked to sign off on the safety of a drug, are they not influenced by future prospects of working for that company after their stent at the Agency? Sure in a VERY loose way they are answerable to voters, but an individual voter has very little power to hold bureaucrats accountable like in the market. In the market, every single dollar is a vote. It's the most precise accountability and democracy of any system out there. Why would you buy insulin from a company that did not have a reputation for quality drugs or a certification from a reputable certification group?
Eric people with no scruples want to make money the easiest way possible, which is typically at the expense of others. They do not want to work hard to do it. You are smoking some good stuff if you think guys would go get licenses if they weren't required to. Guys do whatever they can to operate without licenses and permits right now, and they are required. 10 years in architecture field has taught me this. I don't know you, so I truly mean no offense, but the things you say only exist in some idyllic utopia that simply is not possible.
Adam Entrepeneurs also have an interest in cutting corners whenever feasible in order to be more competitive. How is that so difficult to see? Shitty products are everywhere dude, do you really want shitty drugs floating around. This just seems completely assinine to me.
Adam Rich guy buys insulin from the reputable drug company, poor guy buys it from the fly by night company because its all he can afford. Dies because of the lack of regulation. Guess that's his fault for being poor and lazy. Thanks to the free market we don't have to deal with his lazy insulin dependent ass.
CSA1861 Well, I feel like i've answered most all of those objections already, but I understand your concerns. I'm glad the discussion happened. I also used to feel the same way y'all did until I did some further reading and that I hadn't been exposed to yet. Self-ownership/freedom is not nearly as frightening as today's status quo would have you believe. If anyone is interested in further reading, I recommend Human Action, by Ludwig von Mises. He was primarily an economist (his "austian school of thought" accurately predicted the Great Depression and collapse of the Bretton-woods gold standard.. Economists of the austrian school also predicted the housing crisis and the coming dollar collapse) but he also wrote extensively on philosophy and ethics. It's good stuff.
Jeff This is assuming there's still quality drugs to buy. There's a reason 50% of the drugs on the global market are counterfeit. Without regulation, companies are typically going to make the crappiest product (that people will still buy) as they can. Have you read The Jungle? Hell, even with regulations, we still get fed ground beef with colored, ground up bits of unmentionables and ammonia.
Adam I recommend reading the jungle by Upton Sinclair for a nice dose of unfettered capitalism.
Adam LOL. Jeff I just posted the exact same thing!
Jeff Hah! This book is a prime example of why regulations are necessary. It digs the grave to bury the ideal of free markets without regulation. And it does so using real examples. The "good old days" were definitely not as awesome as we may sometimes think.
CSA1861Ummm... The Jungle is a fictional novel (yes, novels can bring truth to light, but this one did not). Upton Sinclar was a socialist bureaucrat who himself admitted to not know much about the meatpacking industry but rather wanted to teach socialism in a novel format. Lol even other socialists dismissed the claims of the conditions of the meat packing industry. Even the 1906 report by the Bureau of Animal Industry refuted the book's claims. It is interesting that some two million visitors came to tour the stockyards and packinghouses of Chicago every year, yet it took a novel by an anti-capitalist ideologue to unveil the 'real' conditions to the American public. But you know who loved the effects of the book? The large meatpacking businesses! They'd been lobbying for those types of regulations literally decades because the increased cost in production crushed the small family owned meatpacking businesses.
Adam Dude, you have s very strange view of history. Yes its a fictional novel. So is 1984, the iron heel, a brave new world, etc.
CSA1861That's why those books shouldn't be the basis of policy either? I don't have much time for fictions of any flavor. But saying Sinclair was a socialist is not strange. He proudly proclaimed it. Saying that meat packers like Swift, Armour, and Morris supported the Inspection Act of 1906 is not strange. It's a verifiable position they held for the reasons I stated (even in government hearings, since y'all might find those more trustworthy). That the socialist Ralph Chaplin, who also hated capitalism, said of Sinclair's book "I thought it a very inaccurate picture of the stockyards district which I knew so well" is not a strange view of history. That 11th grade history teachers trained in government colleges and employed by the government neglect to teach some aspects of history that might make the government look less than angelic should not be strange either.
Jeff Yes it's a novel, but it was based on actual examples of things that occurred in industry at the time (wage slavery, unsafe working conditions, deplorable quality, etc.). Protip: it's about more than the meat packing industry. Many of these things still happen today, and there's no reason to believe it wouldn't be worse without regulations.
If corporations are allowed to do what they will, with money as the sole driving force, they will employ a system of dangerous, near-slave labor. You cannot argue with this. It has happened in the past. Coal miners worked in extremely unsafe conditions for next to no pay (which they were then forced to spend in the company's general store).
Socialism and Libertarianism are two sides of the same coin. They each depend on every individual being responsible and ethical, while completely ignoring human nature of greed and laziness.
CSA1861 I have not studied the history of coal miners, so I can't make too many comments on that, but I will say that the coal miners would not work in the mine if they did not feel the pay was worth more than the alternative of not working in the mine. Unions also play an important part in relieving such conditions. In a competitive system employers must compete for employees. If they don't pay enough or provide adequate conditions, the laborer will go to another employer.
I've never heard of socialism being related to libertarianism however. The very basis of socialism is that individuals give up certain rights to property (and therefore to liberty) for the general good of the society at large whereas libertarianism believes that allowing the individual full access to his or her rights is what is actually best for society at large. So I don't see the connection. I feel like this entire conversation has been a dispute between collectivism (of which socialism a subset) vs individualism (of which libertarianism is a branch, if not the whole).
See my post above regarding the accuracy of The Jungle's claims. They were decisively refuted when the book came out. It's a tragedy that the refutations were forgotten and that the book has become such a sacred cow (pun very much intended) to socialists and central planners.