The Freedom Bulletin

The Massachusetts Bureau of Health Care Safety and Quality recently approved a system that increases doctors’ ability to monitor people’s prescription history. Previously, the Department of Public Health monitored a database tracking prescriptions for only a few drugs, but doctors did not have the ability to view the database. Now, even more medications are included in the database, pharmacists are required to update it, and doctors have full access to it.

Needless to say, paternalistic and anti-liberty people fully support this attempt to fight “doctor shopping” – going to more than one doctor to get prescriptions for the same drug. But I see it as the government stamping out the last tiny, pathetic remnants of freedom that are left in the American medical system.

It is bad enough that people are required by law to have a doctor’s permission to have medications. To give doctors access to people’s prescription history, making it even harder to obtain medications, just violates people’s rights even more. As I recently explained, people have the right to control what happens to their own bodies. Doctors have no right to deny people medications that they want and are willing to pay for, and they have no right to know anything about our medical history unless we want to tell it to them.

Here’s a radical idea: Why not repeal the Durham-Humphrey Amendment and the paternalistic medical culture that goes with it? Why not have all medications available in stores and allow people (with or without a doctor’s advice) to decide for themselves what to purchase? Then we wouldn’t have to worry about “doctor shopping.” People would have no need to lie to doctors or beg for their permission for the medications that they want. We could independently and autonomously make our own decisions and would have the final say over what happens to our bodies.

People have the right to do anything, as long as it does not violate the rights of others. The fact that an action is risky or unhealthy does not change this. The new prescription monitoring system might improve people’s health, but more importantly, it decreases our liberty.

“Medical professionals must take to heart the edict that their responsibility is to the health of the patient, not the patient’s wishes.”

So proclaimed a recent Boston Globe editorial. This belief, which seems to be shared by the vast majority and was made law by the Durham-Humphrey Amendment, epitomizes what is wrong with the medical system.

Medical professionals have a moral obligation to respect their customers’ wishes, not to paternalistically take away their freedom in the name of their so-called best interest. People have the right to live their own lives however they wish, as long as they do not infringe upon the rights of anybody else. No freedom is more fundamental than the right to control what happens to your own body.

If someone wants a medicine or medical procedure, and they are willing to pay for it and absorb the costs of any side effects that might result, they have a right to have it. Doctors are highly trained so that they can perform medical procedures correctly and give people advice when asked, but they have no right to interfere with people’s medical decisions, and it is wrong that our laws and culture give them this power.

Only when people have the liberty to make medical decisions for themselves will America truly be free.

I usually don’t think that any group of people makes too much money. I don’t have a problem with the fact that famous people, like movie stars and professional athletes, are millionaires. I dislike it when people bash government employees because I think that if you work, you have a right to make enough money to live comfortably. However, there is one group of people that should make less money: doctors.

Take a look at this chart from the Bureau of Labor Statistics showing (among other things) the mean salary for every occupation. (It takes a long time to load but it’s worth it.) Almost every category of doctors makes far more money than nearly any other occupation. Most people think that the richest people are doctors, lawyers, and businesspeople. In reality, however, the richest people are doctors. Period.

Dentists, on average, make $154,000. Oral surgeons make $190,000 and orthodontists make $194,000. General practitioners make $161,000. Obstetricians and gynecologists make $192,000. Surgeons make $206,000. Lawyers, on the other hand, make $124,000. General and operations managers make $107,000, sales managers $110,00, marketing managers $118,000, and CEOs $160,000.

If the system of paying for health services is going to be reformed, someone is going to be worse off. Currently, poor people and even middle class people suffer because they are unable to afford services that they need. If an individual mandate passes, then people who choose not to purchase insurance will be hurt. If insurance companies are forced to accept everyone who applies, they will be hurt because their profits will go down. My suggestion of price ceilings on medical services would make doctors’ incomes go down, but what’s wrong with that? Everyone knows that the exorbitant costs of medical services are a problem, but few people seem to recognize the connection between the amount of money medical services cost and how much doctors make. Maybe medical services cost so much because doctors charge so much. I think it would be completely reasonable if doctors’ incomes went down to the same level as lawyers.’

The biggest problem with the medical system in America is that people do not have the freedom to make their own decisions. This is the result both of laws passed by the government and deeply anti-liberty attitudes that are ingrained in doctors. This article exemplifies what is wrong with our health system. It’s about the “problem” that doctors often prescribe medications that their customers ask for. I find it a little ironic that an article about how patients shouldn’t be able to choose what medications they get is in the “Empowered Patient” section of CNN.com. Anyway, here are a couple of the best quotes from it:

“There’s constant pressure to say yes to things even when it’s not in the patient’s best interest,” said Dr. Joseph Weiner, chief of consultation psychiatry at North Shore University Hospital in Manhasset, New York. “It’s become an everyday dilemma.” For example, he said doctors sometimes say yes to demands for antibiotics even in cases of the common cold, or submit to demands for drugs advertised on television when that drug isn’t the best choice.

“In the current environment in which patients are supposed to be treated like customers, there is sometimes the expectation that the customer is always right and should get whatever is asked for,” said Dr. Danielle Ofri, assistant professor of medicine at New York University School of Medicine.

News flash, doctors: patients are customers, and your job is to give your customers what they ask for. If people want a medication and are willing to pay for it, then they have the right to that medication, and as someone they’re paying, you have an obligation to give them what they want.

America was founded on the principle that people have a basic right to pursue their own happiness, and therefore people have a right to take the medicines that they choose. Doctors have no right to deny people medicines. Every person has the right to be the judge of his or her own best interest, and to act on whatever judgments he or she may make (as long as those actions do not violate the rights of anyone else).

I should make it clear that doctors do legally have the right to deny medicines to people. This unfortunate fact is due to the Durham-Humphrey Amendment, which, in my opinion, is unjust and unconstitutional and should be abolished. But the passage of this unconstitutional law does not change the fact that doctors have no moral right to stop people from obtaining the medicines that they want.

Doctors never “submit” to their customers by allowing them to make their own decisions; they merely fulfill the obligation that they have in a supposedly free society. Unfortunately, in our society, the role of a doctor is to tell people what they can and cannot do about health-related matters. Instead, their role should be to perform procedures that people ask for (kinda like movers, electricians, plumbers, and hairdressers) and to give advice when asked for (like financial advisors and consultants). Doctors shouldn’t be involved in the decision about what medicines to take unless a customer asks their advice. Just as we aren’t legally required to obtain a stylist’s permission before buying clothes, a feng shui expert’s permission before moving our furniture, or a financial advisor’s permission before investing money, we shouldn’t need a doctor’s permission for medication. Until doctors’ roles change, the medical system will never have any hope of working right, and America will never be free.

The medical system in America is in crisis and needs reform. But the problem isn’t that 47 million people are uninsured, or that people don’t have access to health services. There are three main problems, listed below in order of importance:

1. People have no freedom. In today’s society, people do not have control over their health decisions; doctors do. People can’t get medications without a doctor’s prescription, thanks to the Durham-Humphrey Amendment. Doctors think it’s their job to take notes on people and tell people what procedures they should get, what they should eat, and how their should live their lives. The FDA bans many medications that would benefit people. Instead, a doctor’s job should be to serve customers and give advice when asked for, and the FDA’s job should be to protect the public from deception by drug companies.
2. Payment methods are too complicated. You never see signs in doctors’ offices listing how much each procedure costs. Instead we have a huge mess of insurance companies paying doctors for some procedures and not others, insurance companies paying for some medications at the pharmacy and not others, the government paying for some people’s insurance but not others, employers paying for some of your insurance, you paying for some of your insurance, you paying a co-pay or a deductible or co-insurance…the confusion never ends.  Plus, the insurance companies won’t tell you up front what’s covered and what’s not. They have the power to refuse to cover you altogether, to refuse to cover any procedure they say isn’t medically necessary, to require proof that you’re a student, to require all sorts of incomprehensible paperwork, et cetera. This system is disorderly, messy, ugly, and intuitively displeasing, and it rips people off and sometimes even kills people.
3. The government spends too much money on health services. It’s wrong for the government to take money from the rich and use it to pay for Medicaid, SCHIP, and other health programs for the poor. It’s also wrong for them to take from the young and give to the old, like they do with Medicare. The only things that tax money should pay for are the military, roads, and the legal system.

Unfortunately, all three of these things are deeply entrenched in our society, and anyone who questions them is considered a radical. In my next post, I’ll go more into detail about problem #1 and show some examples that I’ve noticed in the news recently that really epitomize what is wrong with our medical system.