Thursday, November 20, 2008

Still Crazy About Freedom and Responsibility After All These Years 

By Mark Todd Engler

Lew Rockwell podcasts with 88-year-old Dr. Thomas Szasz, the legendary libertarian mental health theorist and "leading opponent of the psychiatry profession as it exists in league with the state."

Szasz reiterates the views he first articulated in his controversial 1960 book, The Myth of Mental Illness, that "the concept of mental illness," as commonly understood and diagnosed, "undermines the principle of personal responsibility, the ground on which all free political institutions rest."

Here's a sample of the interview:

Szasz: Psychiatry developed about 300 years ago as an arm of the law. Its actual purpose was always to get rid of unwanted people - unwanted in any way, because they were a nuisance, because they were deviant or because they were poor, or if they were rich, because they upset their families, and so on.

...

Rockwell: I notice that the Obama administration, in wanting to increase the amount of socialized medicine in this country, wants to vastly increase the subsidization of psychiatry. That seems to me an alarming prospect.

Szasz: If you look at what has happened in the last 100 years or 50 years in the United States, you will notice one thing: There is absolutely no difference between Democrats and Republicans, liberals and conservatives, when it comes to two subjects - mental illness and incarceration on the one hand, and drug laws on the other. One of the major reasons people end up in mental health care is (due to) the violation of the drug laws. If there were no drug laws - which there were none until 1906 or 1916, depending on how you want to date it - then there would be no drug violations. It would be a private matter between the person himself and his family.

...

Rockwell: What is mental illness?

Szasz: It is behavior that other people dislike. That was essentially Mark Twain's definition of addiction - taking a drug that other people disapprove of.

...

Rockwell: The government, the psychiatry profession and the psychology profession seem to keep finding new definitions of mental illness.

Szasz: Once you get into that language, you have already capitulated. There is no mental illness, there is no psychiatric diagnosis, no psychiatric treatment. These are words - words used by more powerful people against less powerful people in the name of helping them, but actually to control them or to punish them, or both.

• posted by Mark Todd Engler
• 5:41 pm
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Thursday, November 20, 2008

Dr. Feelbad 

By Mark Todd Engler

Categories:  Individual Mandates, Insurance Regulation, Retail Clinics

A survey released this week by The Physicians' Foundation reveals an epidemic of dissatisfaction with the current U.S. health system among primary care doctors.

What's bringing up all the biliousness? Well, it certainly isn't because physicians feel they're enjoying too much freedom to offer patients the best and most affordable care possible.

On the contrary, the most prominent professional diagnosis of what ails the practice of basic medicine today is that reams of red tape is tying up care-providers' time, and too many meddling bureaucrats are manipulating relationships between MD's and care-consumers.

"The reported reasons for the widespread frustration among physicians include increased time dealing with non-clinical paperwork, difficulty receiving reimbursement and burdensome government regulations," according to the Foundation website."Physicians say these issues keep them from the most satisfying aspect of their job: patient relationships."

Some of the key findings of the Foundation's survey, which the authors tout as "one of the largest and most comprehensive physician surveys ever conducted in the United States":

• An overwhelming majority of physicians - 78% - believe there is a shortage of primary care doctors in the United States today
• 49% of physicians - more than 150,000 doctors nationwide - said that over the next three years they plan to reduce the number of patients they see or stop practicing entirely. In that same time frame:
• 11%, or more than 35,000 doctors nationwide, said they plan to retire
• 13% said they plan to seek a job in a non-clinical healthcare setting, which would remove them from active patient care
• 20% said they will cut back on patients see
• 10% said they will work part-time
• 60% of doctors would not recommend medicine as a career to young people
• 63% of doctors said non-clinical paperwork has caused them to spend less time with their patients
• 94% said time they devote to non-clinical paperwork in the last three years has increased
• 17% of physicians rated the financial position of their practices as "healthy and profitable"
• If they had the financial means, 45% of doctors would retire today
• "Patient relationships" rated highest on the list of things physicians find satisfying about medicine, while "reimbursement issues" and "managed care issues" rated the highest on the list of issues physicians find unsatisfying about medicine
• 6% of physicians described the professional morale of their colleagues as "positive." 42% of physicians said the professional morale of their colleagues is either "poor" or "very low"
• 78% of physicians said medicine is either "no longer rewarding" or "less rewarding"

• posted by Mark Todd Engler
• 1:27 am
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Wednesday, November 12, 2008

They're All Fascists Now 

By Mark Todd Engler

Categories:  Nanny State

Wikipedia's featured article for today:

The anti-tobacco movement in Nazi Germany was the first public anti-smoking campaign in modern history. Anti-tobacco movements grew in many nations from the beginning of the 20th century, but these had little success except in Germany where the campaign was supported by the government after the Nazis came to power. It was the most powerful anti-smoking movement in the world in the 1930s and early

1940s. The Nazi leadership condemned smoking and several of them openly criticized tobacco consumption. Research on smoking and its effects on health thrived under Nazi rule and was the most important of its type at that time. Hitler's personal distaste for tobacco and the Nazi reproductive policies were among the motivating factors behind their campaign against smoking, and this campaign was associated with both antisemitism and racism. The Nazi anti-tobacco campaign included banning smoking in trams, buses and city trains, promoting health education, limiting cigarette rations in the Wehrmacht, organizing medical lectures for soldiers and raising the tobacco tax. The Nazis also imposed restrictions on tobacco advertising, tobacco rationing for women, and smoking in public spaces, and they regulated restaurants and coffeehouses. The anti-tobacco movement did not have much effect in the early years of the Nazi regime and tobacco use increased between 1933 and 1939, but smoking by military personnel declined from 1939 to 1945. (more...)

Anybody know what direction tobacco-use trended among German military survivors after Hitler's anti-smoking programs got snuffed in the ashes of war? One suspects the smoker-reduction gains engineered through progressive Third Reich health-policy initiatives probably subsided among soldiers destined to live out their days in the West. On the other hand, it seems generally accepted by policymakers today that the scientifically planned, temptation-deprived social laboratories behind the Iron Curtain proved better equipped to curb a range of unhealthy, self-destructive, subversive behaviors than societies addicted to unfiltered consumerism.

• posted by Mark Todd Engler
• 9:00 pm
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Friday, August 29, 2008

Everything Central Planners Know is Wrong 

By Mark Todd Engler

Categories:  Certificates of Need (CON), Nanny State

John Stossel's critical assessment of certificate-of-need programs got picked up in two West Virginia newspapers today, the Charleston Daily Mail and the Beckley Register-Herald.

Speaking to attendees at the West Virginia Chamber of Commerce Business Summit, the ABCNews 20/20 co-host likened CONs and the agencies that administer them to - what else - Bolshevik-era peoples' commissariats.

The Register-Herald:

"Regulators don't make life better, they make it worse," Stossel told the group. "In West Virginia, if you want to build a new medical facility, you have to get a certificate of need to prove that it's needed. This means instead of just building the medical facility, you have to figure out how to convince the bureaucrats that what you're doing is needed. That's what they did in the former Soviet Union. It doesn't work very well."

The Daily Mail:

To obtain a certificate of need, you have to show that your health service will be provided in a manner that discourages duplication. "But in the auto business we have gross duplication," Stossel said. "And yet the competition brings us cars that are much better than a planned economy can produce. But West Virginia politicians think they know best when it comes to health care."

Both papers also quoted Stossel, most recently the author of Myths, Lies, And Downright Stupidity, riffing in contempt of the bipartisan nanny state that ever endeavors to control or regulate otherwise peaceful human behavior so as "to protect us from ourselves."

"Patrick Henry didn't say give me absolute safety or give me death," said Stossel. "What happened to liberty?"

• posted by Mark Todd Engler
• 2:28 pm
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Tuesday, August 26, 2008

1 in 9 Privately Insured Have an HSA 

By Tarren R. Bragdon

Categories:  HSAs, etc., Maine

According to a new survey by United Benefit Advisors Inc, an employee benefit advisory company, enrollment in Health Savings Accounts (HSAs) has almost doubled in the past year. Now 11% of those privately insured are enrolled in HSAs compared to 6% last year. HSA-compatible plans now account for 13% of all health plans offered by employers.

A Health Savings Account ties a savings account with a low premium, high deductible health plan. That means that the individual, not the insurance company, is controlling the first few thousand spentin health care consumption. Typically, after a $2,500-$3,000 deductible is met, the insurance company pays 100% of health care costs.

HSAs encourage the individual to take ownership of their own health, focus on preventative care, make good health choices and to be smart price and quality shoppers when using health care.

(Note: To learn more, read this overview of HSAs.)

• posted by Mark Todd Engler
• 5:07 pm
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Tuesday, August 26, 2008

Tapping the Flow of Joe 

By Mark Todd Engler

Categories:  California, Nanny State

Legal Newsline interviews Pacific Legal Foundation attorney Timothy Sandefur, who says it isn't all that outrageous, given recent history, to imagine "Big Caffeine" as the next Big Tort target.

"It's like the weather, you really can't tell what's going to happen; but the caffeine idea is not beyond the realm of imagination...It's a product that, just like tobacco, can be portrayed as some kind of diabolical thing being used against innocent people by wealthy corporations."

Sandefur said caffeine's image can be "manipulated and abused" to suit individual needs.

"If you said in 1970 or 1980, that people are going to bring enormous lawsuits against tobacco companies, accuse them of fooling people into smoking cigarettes and then use that as a pretext to take a lot of money from them to run government programs, people would have laughed at you," he said. "They would have said 'of course, people choose, as a matter of their own decision-making, whether or not to smoke'. Nonetheless the lawsuits happened; and I think caffeine is a plausible new target."

Sandefur cites litigation against gun makers, lead paint companies and fast food restaurants as examples in which plaintiff's attorneys were more interested in lining their pockets with cash than improving public health and safety.

The article includes an interesting discussion on the relationship between tort reform and regulatory expansion.

• posted by Mark Todd Engler
• 4:00 pm
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Tuesday, August 26, 2008

Drunk With Power: Been There, Still Doing That 

By Mark Todd Engler

Categories:  Nanny State

Nashville's metro daily ran a thought-provoking guest piece recently ("Prohibition wasn't the cure-all that Tennessee wanted") commemorating the 75^th anniversary this month of the state's ratification of the 21^st Amendment to the U.S. Constitution.

Sociologist David J. Hanson soberly summed up the hallucinatory Utopian optimism that intoxicated so many otherwise down-to-earth, commonsensical good folk in Tennessee and elsewhere as they gamely agreed to play along with the Volstead Act, pretended to swear off Demon Rum and cheerfully set course with the rest of the nation on "one of the biggest policy debacles in American history."

"The popularity of national prohibition in Tennessee reflected the fact that most residents expected it to lead to improved health, less violence, greater safety, increased public morality and a better environment for young people," wrote Hanson.

They were profoundly wrong, of course, having been coaxed into quaffing down a "noble experiement" brewed up by the ideological progenitors of today's Drug Warrior class. As a general legislative rule of thumb, when idealistic ends-justifies-the-means progressivism is served over religiously-inspired might-makes-right fundamentalism, a really bad trip is about to ensue: Lives get destroyed, freedom devoured, public health compromised, property rights violated and confiscated, law and morality undermined, great swaths of social fabric shredded asunder, etc. Wrote Hanson:

With easy, untaxed money to be made, police and sheriffs were routinely bribed. Politicians were also widely on the take. The revelations of such corruption lowered respect for the law, which was widely violated.

The rampant graft and corruption caused by Prohibition created a deep lack of respect for law. It became fashionable to flout the law, especially among young people, and many people became alarmed at the decline in public morality.

Prohibition also led to the pattern of infrequent but very heavy drinking.

People didn't go to a speakeasy to have a leisurely drink with a meal, but to guzzle alcohol while they could.

Bootleg alcohol was carelessly made and often contained toxic substances such as creosote, lead and embalming fluid. Consumers sometimes suffered paralysis, blindness and even death. This led some drinkers in the state to switch to hair tonic, mouthwash and illegal drugs.

Today, in and around jurisdictions still flirting with alcohol prohibition - like some American Indian nations, for example - these problems persist. Similarly, as explained in the pages of National Review more than 20 years ago, the unintended but unavoidable consequences of black-market economics propagated by the war on drugs did much to perversely facilitate the popularization of evermore health-wrecking and wellness-debilitating substances, like crack cocaine and home-cooked methamphetamine. (Call it bathtub gin all over again.)

Steps are being taken - small ones, but progress nonetheless (sort of) - in both Congress and at the state level to confront and rectify the U.S. government's institutionalized inability to learn obvious lessons from staggering blunders.

Pathetically, though - as with alcohol prohibition - politicians won't simply recognize the errors of their foolish ways or reject the folly of their flawed ideas for sounder judgment: It'll take pure, uncut bureaucratic greed for that to happen. Already the budding medical marijuana industry is yielding $100 million a year in aboveboard tax take for the State of California. There is, of course, plenty more green where that came from.

Wrote George Mason University economics department chairman Donald Boudreaux in a column last summer for the Pittsburgh Tribune-Review (later reprinted in Reason):

(I)f the history of alcohol prohibition is a guide, drug prohibition will not end merely because there are many sound, sensible and humane reasons to end it. Instead, it will end only if and when Congress gets desperate for another revenue source.

That's the sorry logic of politics and Prohibition.

• posted by Mark Todd Engler
• 6:32 am
• 1 comment

Friday, August 22, 2008

3 Swings, 3 Misses 

By Mark Todd Engler

Categories:  Oregon

The latest revenue-generating scheme for financing the state government's efforts to provide medical insurance to all Oregonians is exactly what it isn't supposed to be, writes Cascade Policy Institute's Steve Buckstein in today's Salem Statesman Journal: inequitable, narrowly based and of questionable affordability.

"Here in Oregon, our Legislature passed a bill in the 2007 session that created an Oregon Health Fund Board charged with proposing a universal health care system to the 2009 legislature," said Buckstein. "The bill (SB329) set out a number of principles for a new health care system. One key principle states: 'Financing of the health care system must be equitable, broadly based and affordable.'"

The pitches from the funding board's executive director -- an insurance premium tax, a hospital tax and a tobacco tax -- run counter to those principles. Buckstein explains why those ideas are strikeouts:

Taxing the premiums of those who are fortunate enough to have insurance is a way to make insurance even less affordable than it is today. Taxing hospitals is simply a way to shift the burden to patients who are unlucky enough to need their services. And, taxing tobacco is the least equitable, narrowly based, unaffordable way to make a minority pay for the health care of others. Oregonians soundly defeated the tobacco tax idea when they voted down Measure 50 last year. If voters won't tax smokers to pay for children's health insurance, why would they want to tax smokers to pay for anyone else's insurance?

• posted by Mark Todd Engler
• 10:58 am
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Thursday, August 21, 2008

Policy Reform, American Style 

By Mark Todd Engler

Writing for NRO, Manhattan Institute Center for Medical Progress director Paul Howard delivers a four-point plan to "unleash a new wave of entrepreneurial energy" and put American health care on a rapid road to recovery.

1. PLAY FAIR IN HEALTH CARE: The tax penalty against individually purchased health insurance (30 percent or more, depending on income) is regressive and unfair. A tax deduction or tax credit for everyone who purchases their own health plans would be much more equitable, giving millions of uninsured access to insurance. A risk-adjusted voucher for our poorest, sickest patients (think cancer) would allow them to buy into insurance markets and encourage insurers to seek them out.
2. ONE NATION, ONE MARKET: It's time America became one market when it comes to health insurance - allowing consumers to buy insurance from across state lines. Freed from expensive state mandates, insurance would become more affordable, consumers would have more choices, and companies could target marketing efforts at the uninsured, newly empowered with tax-advantaged dollars.
3. STOP BEING PART OF THE PROBLEM: Retail clinics prove that high-quality care can be delivered by skilled nurse practitioners in non-traditional environments - but some states, like New York, prohibit the "corporate practice of medicine" (which limits the ability of for-profit companies to employ health care professionals) or try to slap retail clinics with restrictive regulations that drive up costs. State "certificate of need" laws also prohibit competitors from challenging local hospital monopolies with higher quality or more affordable services. Rather than stifling innovation and competition to protect existing providers (like nonprofit hospitals), policymakers should throw out their old assumptions and find new ways to encourage choice and competition in health-care markets.
4. THE FEDS NEED TO LEAD BY EXAMPLE: Government spending on health care, particularly for Medicare, is out of control and unsustainable...If Congress is serious about lowering health-care costs and sustaining Medicare for the long haul, it will have to embrace competition and choice throughout the program.

The best medicine for health care, writes Howard, isn't, as many argue, to treat it entirely different from every other sector of the economy and have government ration, micromanage, mandate and centrally plan.

Rather, the prudent and genuinely American course is to encourage the same type of "competition (that) drives entrepreneurs to offer a wide range of affordable products and services to consumers - like $300 laptops, cut-rate vacation packages sold online, and discount brokerage firms."

"This is the formula that explains America's leadership of the global economy - and it's a long overdue prescription for health-care reform," says Howard.

• posted by Mark Todd Engler
• 4:31 pm
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Wednesday, August 20, 2008

Canadian Health Care Situation 'Alarming,' says new CMA Chief 

By Mark Todd Engler

The incoming president of Canada's largest association of physicians, Robert Ouellet, today implored medical professionals and policymakers in his country to "pull their heads out of the sand" and acknowledge that theirs is "one of the most costly and least efficient health systems of any industrialized country."

Reports The Canadian Press:

Dr. Robert Ouellet told the (Canadian Medical Association)'s annual meeting in Montreal that he envisions a mixed public and private health-care system in Canada.

"The fact is that the private system exists, and like it or not, it is here to stay," Ouellet told hundreds of doctors gathered in a downtown hotel ballroom.

"We need to accommodate it in order for the public system to prosper."

• posted by Mark Todd Engler
• 4:13 pm
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