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Libertarian-LifeguardsWhen I was a child there were only 3 channels on the television (and yet, folks found something to watch, go figure). One of the commercials that it turned out was foreshadowing for the loss of our textile industry to Chinese sweatshops was included a catchy song that went “Look to, the union label, when you are buying that coat, dress, or blouse.” We as kids would sing it as our mothers took us to the discount store to purchase knock-off tee-shirts for half the price of those high-falootin Jockey ones. Although they were clearly of poorer quality (and the tags itched) they did cost a lot less.

In America today, goods have become fungible. The source of origin is unclear, in part because Egyptian cotton might go to Bangladesh to create a tee that has an American rapper’s face on it. Since I work in a service industry with access limited by licensure, I don’t worry about outsourcing. Here in Alabama, though, there are a group of economists who want to change that.

Troy University’s Manuel H. Johnson Center for Political Economy, which I have written about before, has decided to take on Alabama’s licensing laws. Daniel Smith, professor of Economics, has published a “study” where he determined that 25% of Alabama workforce being required to have an occupational license is too many. Health professionals are one of the groups he singles out for his bureaucratic reduction act. In doing so, he cites a position paper from the libertarian leaning Cato Institute that argues 1) Defensive medicine is what protects you from incompetent physicians, not licensing; 2) Defense lawyers  are actually quality control monitors; 3) Specialty boards provide more quality control; and 4) People would pick quality over price if given enough information.

What bought the study to my attention was “Koch Brothers endowed professor” Scott Beaulier’s, editorial at It includes the circuitous argument that licensing limits the supply which limits access so more people get sick, and if only we could expand access by allowing unlicensed health workers there would be fewer sick people. Huh? He claims that once one person’s house wired by Bubba the shade tree electrician burns, others will shun Bubba and he’ll go out of business. Same thing for doctors, I guess.

In the 45 years since the commercial, unions have lost almost all of their sway. Americans demand clothes made so cheaply and with so little regard for those involved that when we find out 800 Bangladeshis are injured annually while making $7 tees we shrug and continue to seek out even cheaper options. I look forward to the Libertarian state of Alabama where we all get to be quality monitors. As they say on the Simpsons, “Hi Dr Nick…”


cartoon-plastic-surgeryAs a physician, I am continually amazed at what people tell me and what I can figure out for myself. I have heard tales that would curl your hair. A question from me such as “well, is there anything else?” gets us into the depths of the human condition. A wife whose “sore down there” ends up in an admission of infidelity by her husband and a divorce. A man who admits to being depressed on the anniversary of his son’s death and it turns out he was going to the son’s grave site and drinking. A lot. A woman whose husband had a vasectomy but she wanted to stay on birth control because, well, because she is seeing someone else. Almost always, these folks come in with a complaint of “headache,” “stomach ache,” or “I’m tired.” My job is to get them to talk about the real problem so I can help with the healing process.

Access to me is, as often as not, provided by an insurance company. That is the way we provide health care in this country. Most folks get access through their (or their spouses’) jobs, by virtue of being over 65, or by virtue of being extremely poor. When folks change jobs, they tend to change insurance and subsequently doctors. If folks lose their job and if they are fortunate enough to end up on Medicaid, they tend to change doctors. When folks turn 65, they end up on Medicare and may have to change doctors. These things were happening before Obamacare and will continue to happen unless we choose to go to a single payer system. My job, upon seeing a new patient, is to make them feel as if I am an old friend. What amazes me is how a person who doesn’t know me from Adam’s off ox will trust me with their secrets. I guess folks really want to talk about their problems, especially if they think it’ll make them feel better.

I am not particularly a fan of our current method of paying for health care.  I think it is far too convoluted and has too many moving parts. In addition, prior to the Obamacare mandate, there were far too many people (corporations are people too) trying to game the system to get out of paying what the system obligated them to pay. Although the Obamacare website is now working better, there are still many who are vocally dismissive of the entire law. Many of my friends were proponents of more intensive intervention such as single payer (as are 14% of Americans still). I have become more interested in how the less “liberal” folks would have allowed Americans to keep their doctor, keep their insurance, not increased expenses, and reduced the total cost for America. I found the answer in a recent article on They cite the falling of LASIK prices (you don’t want to wear those clunky glasses, do you?) and the ability to get dermatologic procedure pricing (how much did Sharon Osbourne pay for her vagina lift?) as evidence that the market will work in health care then proceed to describe the complete dismantling and reconfiguring of 20% of our economy. The details are below:

  1. Eliminate the tax preference for employer-sponsored health coverage in favor of very large, tax-free health savings accounts (HSAs) giving Americans direct control over their health expenditures. Wow, I can see that one being sold to the 85% of employed folks under 65 who get insurance through their jobs.
  2. “Guarantee renewability” to address the problem of people being dropped by insurers. Bet the insurers go for that without a mandate. If only Obama had asked for this instead of “getting rid of pre-existing conditions.”
  3. Health status insurance as a hedge against “the risk that one’s health status deteriorates in the current period—and thus, that future medical insurance premiums will increase.”  This is really complicated and a confusing explanation can be found here but  the bottom line is your health status becomes a financing instrument, kinda like the mortgages did before the Great Recession. This allows the financiers to bundle your health risks and trade them on a futures market. What could possibly go wrong?
  4. Eliminate mandatory benefits. For example, the federal government, to much fanfare, now dictates “mental health parity,” which raises costs by five to 10 percent, all by itself. Guess I’ll need to stop asking those pesky questions such as “Are you depressed?”
  5. Eliminate licensing restrictions on health care professionals. We can import more docs from countries where the pay isn’t as good. They must be as good as those trained in America, right? Who needs English skills?
  6. Loosen the noose of FDA regulations to ease the path of drugs to the market and reduce costs. This time, I’m just going use their words: The FDA might abandon its gatekeeper role and move to issuing the equivalent of a Good Housekeeping Seal instead, so providers and consumers could make informed choices for themselves. 

WOW…let’s see President Paul get this one passed.