The Therapeutic State
Health care systems all over the world are, to varying extents, dominated by government intervention. Whether it is a largely ‘private’ system driven by state funding and regulation, like that in the US, or a ‘socialized’ model like those of Canada and the UK, the state manages to insinuate itself into the most intimate contacts between individuals and their medical providers. Such intervention in the health care market is advocated by its supporters for two primary reasons. First, government is seen as the best protector of consumers, through such methods as compulsory licensure and accreditation of health care providers and institutions, as well as regulation of what medicines can be prescribed and distributed, and under what conditions. Second, in a world where health care can quickly become prohibitively expensive and private insurance is not always available or reasonably priced, government funding, either to individual consumers or the health care system as a whole, can often appear to be the only means by which people can afford to utilize modern health care providers and technologies.Despite the arguments of the defenders of government meddling, however, the state has shown itself not to be a good steward of our health care. It denies us the freedom to avail ourselves of the services of the practitioners of our choice. It has produced an incredibly expensive health care system which we are all forced to pay for, either out-of-pocket at our doctor’s office, with our insurance premiums, by taxation, or through a combination of these. It lies about disease prevalence and incidence in order to further bloat the budgets of public health bureaucracies. It has kept life-saving drugs off the market, and made some of those available so expensive as to be beyond the means of many who could benefit from them. It requires people to wait months for simple operations. It forces potentially dangerous vaccines on children. It restricts access to pain-killers because of myths, propagated by its own ‘experts,’ about addiction. It has turned physicians into an economic and social elite who often treat their customers with a complete lack of respect. And the individual people seeking and receiving health care, the supposed beneficiaries and focus of this system, are deprived of any real decision-making power, while at the same time they are prevented from taking their business elsewhere if they are dissatisfied.
A Different Vision
Anarchists believe that people are capable of managing their own affairs and providing for all their needs and wants without the state and other authoritarian institutions. In a world without government like that envisioned by anarchists, people would still get sick and sustain injuries and require health care, surgery, and medicines. But, because people have become so accustomed to government involvement in health care provision at all levels, it may be difficult for many to imagine how such needs would be taken care of in a libertarian society. Anarchists differ among themselves about how people’s medical needs and wants would be met in the absence of a government. Some believe that all health care should be provided free of charge with costs absorbed by the community at large, while people’s good intentions and dedication to the interests of the group would be sufficient to guarantee quality, ethical healing services. Others, of a more individualist bent, believe that health care, like all other products and services, could be provided on the free market, with prices restrained by competition and quality and safety insured by voluntary watchdog organizations and educated, self-reliant consumers. Such a market-based system would not only be capable of providing high quality, affordable healing services, but would also maximize the range of choices in providers and therapies available to people in need of medical or other therapeutic services or information.
The Current Model & Anarchist Alternatives
Government-run or -regulated health care systems rely on mandatory licensure and accreditation to ensure the competence and safety of providers and institutions. While this method is somewhat effective in achieving its goals, it has consequences that are detrimental to consumers. State control of who can and cannot practice medicine or other healing arts severely restricts the number of providers available to people in need of health care. By allowing the professionals themselves, whether doctors, nurses, therapists, or whatever, to accredit training schools and set standards for entry into practice, it allows established practitioners to limit the entry of new workers into the various approved health care fields, and either severely restricts or outlaws the practice of healing by those who advocate alternative models of health care.The libertarian approach is to allow anyone to offer their healing services on the market, and let customers sort out for themselves who is worthy of their business, as they currently do with so many other products and services. Consumer watchdog groups, on the model of the Consumers Union or People’s Medical Society in the United States, could investigate and rate the various health care providers, clinics, and hospitals and make their findings available to those seeking health services, enabling them to make an informed decision as to where to procure treatments and consultations. Voluntary certification societies, which already exist in the medical and nursing specialties, would also play a role in ensuring competence by giving their ‘seal of approval’ to providers who meet certain criteria. Meanwhile, those who reject western scientific (allopathic) medicine, would be freely able to seek out and purchase the services of practitioners of their choice, who would no longer be barred from the health care market. Many more physicians and other healers, of many different philosophies and orientations, would be available to those seeking out advice and treatment, introducing competition into the health care market that would require providers to deliver better and more humane health care in order to keep their customers.Medical education would still take place without government oversight and control, as it once did in the past. However, without state-imposed rules, it would likely take less time and be much less expensive. Here, as well, competition, now eliminated by government regulation, would bring changes, producing more and cheaper training programs, as well as more varied curricula. Potential health care professionals could choose from a variety of learning models, whether academic, apprenticeship, or some mixture of the two, and could learn at their own pace. Students would not be forced to spend their time and money studying subjects in which they have no interest, and could focus on and excel in the areas of their choice. The hierarchical and often heartless methods now seen in medical schools and post-graduate training programs would likely disappear, as it is hard to imagine anyone voluntarily submitting to such demeaning treatment if other options were available. Doctors who are treated in a kindly and respectful manner by those who help them learn their trade would then be more likely to relate to their customers in a humane and courteous way, unlike so many of today’s physicians.As in the case of professional licensure, government regulation of the production and distribution of medicines through agencies like the Food and Drug Administration, as well as the prescription system, by which people are prevented from purchasing medicines without a doctor’s note, purportedly exists to protect consumers. However, although some harmful or ineffective drugs are kept off the market by the FDA, and the need for prescriptions sometimes prevents people from using medicines inappropriately, these governmental methods come at an unacceptable cost. Helpful medicines are often kept off the market, tied up in regulatory channels for years, resulting in the death of people who could have been treated, and prescriptions force people to consult physicians or nurses whether or not they wish or need to, driving up the costs of health care and further enhancing the status and power of licensed health care providers. Government classification of some drugs as having a potential for ‘abuse’, and the attendant close monitoring of their prescription and distribution, cause many physicians to limit their patients’ access to narcotic pain-killers, often the only palliative for people with cancer and other serious illnesses.Just as there are non-governmental methods that would enable customers to wisely and safely choose their healing practitioners, there are alternatives to state control that could provide those who take medicines with the means to protect themselves from excessively dangerous or ineffective drugs. Consumer organizations are capable of guiding people in their use of medications or other treatments, and the studies published in medical journals available to the public are a source of information critical to choosing appropriate medications. Private health libraries could even be set up to collect medical literature to facilitate individual self-education. Knowledgeable buyers would then be able to make informed decisions about what remedies to put into or onto their bodies.Besides being able to provide health care and therapies that are safe and effective, the free market can also assure that treatment and professional advice are affordable. The competition introduced among providers and institutions by the removal of government restraints would drive down the cost of health services and consultations dramatically. Unlike the situation today, there would also be at least one less incentive for providers to try to charge exorbitant fees, since the costs of their education would be much lower in an unregulated system, leaving them free of the debt many now face on entering independent practice. Drugs would be much cheaper without the government regulatory system now in place that drives up the costs for manufacturers, while abolition of state-protected patents would allow increased competition among producers, forcing the price of pharmaceuticals down even further. And, when one does not have to consult a physician just to obtain a prescription, more savings will be realized.Despite the overall lower costs produced by a free health care market, there would still be circumstances where someone will require financial assistance to be able to afford a certain medical procedure or treatment. Even here, however, there is no need for government to step in. Inexpensive insurance of various kinds could be obtained on the free market, including the sort provided by voluntary organizations like the friendly societies of years past, which died out after the birth of the modern welfare/corporate state. Additional sources of monetary aid could also be found in the advocacy groups organized around health care issues, like the American Lung Association or the AIDS Action Committee. Such organizations now spend large amounts of the money they obtain from private donors to influence government agencies to direct ever more taxpayer-provided cash towards their favored cause, often using padded statistics and half-truths to influence policy and funding decisions. With no bureaucrats to influence and no lobbyists to pay, these groups could instead dedicate their resources to either helping people in need of services directly, or funding the medical research that would still be needed after the state is eliminated.Besides being able to provide for all the health care needs of individuals, a society without government would also produce a new, more egalitarian relationship between health care practitioners and their customers. Instead of a relatively small, privileged class of people who control the access of others to medicine and treatment, physician, nurses, homeopaths, and other health care workers would become service providers like any other. People would be able to shop around for doctors, as they now do for plumbers and car mechanics, and would not feel they needed to defer to their health provider anymore than they do to their grocer or bookseller. While health care is essential to our quality to life, so is food, plumbing, and intellectual stimulation. Our doctors deserve no more deference than do the other people who supply us with the means to go on living our lives as we see fit. A respectful relationship between equals is as appropriate in a doctor-patient relationship as it is in any other.
Freedom Requires Personal Responsibility
Of course, in order for government to be eliminated and a free market in health care to be instituted, individuals would have to change in important ways. A free market and a free world require people willing to take chances and be responsible for themselves and their voluntarily-chosen associates. People at present have accepted a sacrifice of their freedom to choose their health care providers, treatments, and medications, in return for a promise of safe and effective treatment from the medical-industrial-government complex. When they give up this real or imagined protection from the vagaries of the market, they will have to look out for their own interests when they seek out health care. This will require that they educate themselves about health and illness, current treatments, and available medicines and their adverse side effects. They will need to investigate the health care providers available to them and perhaps interview a few before deciding with whom to contract for their care and advice. This can be a time-consuming process and is not without risk. But nothing worth doing is risk-free.
This essay first appeared in the October 2002 issue of The Individual, the journal of the Society for Individual Freedom (www.individualist.org.uk), pp2-4.