Irish Liberty Forum

Repeat Three Times: Liberty is Possible

with 9 comments

Several thoughts occurred to me as I was writing the latest article on Irish healthcare, regarding how libertarians can spread their message. In a previous post, When Everything is Political, I noted how little real awareness there was of the magnitude of government power, and I proposed that we firstly need to be drawing attention to this again and again, so that people might have a decent basis from which they could begin to understand our positions.

When it comes to healthcare, my proposed strategy would involve bringing attention to two simple facts.

1. Broach the subject by describing how the Irish healthcare sector is a socialist, centralised system. As Damien Kiberd writes in today’s Sunday Times, where he argues for the introduction of market mechanisms through universal private health insurance:

As things stand, the state is everywhere in health: it employs up to 120,000 health workers, it picks up 95% of the annual tab for healthcare, it controls the pace at which health services are supplied by means of its budgetary processes and it owns the largest health insurer.

2. Once we have established that the current system is in fact socialist, we need to gently introduce our alternative. Probably the easiest way to do this is to note the fact that a non-statist healthcare sector, whether or not it is desirable, is certainly possible.

Most people have never considered the possibility of a non-statist healthcare sector, and many of them will have an immediate emotional reaction to the idea, so a strong combination of caution and patience is well-advised. Always bear in mind that the virtue of governmental healthcare is one of the great collective fantasies, and that undermining it can be no less explosive than undermining any other form of myth.

The gentlest way to move on may be to find agreement that there is no metaphysical, supernatural or religious reason which would prevent the government from getting out of healthcare. Argue that the space-time continuum would not be torn if government healthcare spending was cut radically, and that the Earth would continue to spin about its axis even if the Health Service Executive ceased its activities. This is a highly cautious strategy but can perform a useful function by introducing the ideas in a non-threatening way as proposals which, despite being outside of the mainstream, actually could be executed.

At this point, if you think your audience is genuinely open to the discussion, you are free to describe whatever arguments for liberty you like the most, with a reasonable chance of success. However, I would contend that you’ve already accomplished something if you get this far. Now your audience knows something about the current reality, and they know that liberty is possible. And that is probably a lot more than most people.

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Written by Graham

February 17, 2008 at 4:53 pm

Posted in health, strategy

9 Responses

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  1. Graham, perhaps you were merely being ironic and I missed understanding the full meaning of your comments above. But if you really think that privately run health care works well you should look carefully at the U.S. system. Money migrates to the top and the upper echelons of administrators in the health care profession are profit motivated people who have garnered extreme wealth.
    The one area that should never be allowed to be run for profit motives is healthcare. Contrary to the impressions put forward by media here in the U.S. the health care system here is ranked among the lowest in the developed world in overall care. The one or two areas that it does well is in emergency care and in certain specialties such as surgery.

    hugh curran

    February 18, 2008 at 5:35 pm

  2. Hey hugh, thanks for commenting!

    I’m curious as to why you say “the upper echelons of administrators in the health care profession are profit motivated people who have garnered extreme wealth“. If that is a criticism, could you please explain the nature of your complaint? You might bear in mind that elite administrators in Ireland’s governmental HSE also have a reputation for being well paid.

    Similarly, the statement that “The one area that should never be allowed to be run for profit motives is healthcare” seems to me more like a moral edict than an economic argument. Please tell me if I’m wrong!

    I am quite happy to discuss in purely economic terms the differences in the quality of healthcare provision under different systems. However, such a discussion could not be separated from overarching questions of economic methodology, and, if we are talking about the US, I would strongly contest the idea that US governmental interference in healthcare should be viewed as light.

    I hope you will write back and explain a little more.

    Regards

    Graham

    February 18, 2008 at 7:20 pm

  3. “Always bear in mind that the virtue of governmental healthcare is one of the great collective fantasies, and that undermining it can be no less explosive than underming any other form of myth.”

    Hmmm. I can’t understand where you’re coming from with this one Graham, as all empirical data is contrary to your claim. (as I believe I mentioned on the CLR thread….) The claim is akin to saying there’s no correlation between smoking and lung cancer!

    Every peer-reviewed study has shown for-profit health care to cost more and produce contraindicative results. And I believe the very same health corporations from the US system, now have contracts here. And that there is no example in the Irish context where private health care does not work out significantly more expensive than the publicly provided alternative.

    Just a few of those studies,

    (1) ( The high costs of for-profit care http://www.cmaj.ca/cgi/content/full/170/12/1814 )

    (2) When Money is the Mission — The High Costs of Investor-Owned Care
    http://content.nejm.org/cgi/content/short/341/6/444

    “Market medicine’s dogma, that the profit motive optimizes care and minimizes costs, seems impervious to evidence that contradicts it. For decades, studies have shown that for-profit hospitals are 3 to 11 percent more expensive than not-for-profit hospitals2,3,4,5,6,7; no peer-reviewed study has found that for-profit hospitals are less expensive…. ”

    Effect of the Ownership of Dialysis Facilities on Patients’ Survival and Referral for Transplantation
    http://content.nejm.org/cgi/content/short/341/22/1653

    Conclusions: In the United States, for-profit ownership of dialysis facilities, as compared with not-for-profit ownership, is associated with increased mortality and decreased rates of placement on the waiting list for a renal transplant.

    (3)
    Payments for care at private for-profit and private not-for-profit hospitals: a systematic review and meta-analysis
    http://www.cmaj.ca/cgi/content/full/170/12/1817

    (4)
    Costs of Care and Administration at For-Profit and Other Hospitals in the United States
    http://content.nejm.org/cgi/content/short/336/11/769

    “Conclusions Administrative costs as a percentage of total hospital costs increased in the United States between 1990 and 1994 and were particularly high at for-profit hospitals. Overall costs of care were also higher at for-profit hospitals.”

    (5)
    The Association between For-Profit Hospital Ownership and Increased Medicare Spending
    http://content.nejm.org/cgi/content/short/341/6/420

    “Conclusions: Both the rates of per capita Medicare spending and the increases in spending rates were greater in areas served by for-profit hospitals than in areas served by not-for-profit hospitals.”

    (6)
    Going for the gold: the redistributive agenda behind market-based health care reform
    http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=9159711&dopt=Abstract

    (7)
    Can markets give us the health system we want?
    http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=9159710&dopt=Abstract

    Pax

    February 19, 2008 at 12:16 am

  4. “I’m curious as to why you say “the upper echelons of administrators in the health care profession are profit motivated people who have garnered extreme wealth“. If that is a criticism, could you please explain the nature of your complaint? You might bear in mind that elite administrators in Ireland’s governmental HSE also have a reputation for being well paid.”

    To partly answer for Hugh here….Again I’m surprised you’re surprised! The nature of the HSE and the history of its inception is generally accepted as being most aligned to Ms Harney’s political ideology. I think an examination of that history would be most useful here.

    The Prospectus report advocated the formation of a Health Services Executive, (HSE), modelled on a corporate board, to take charge of all executive functions pertaining to the health system. The report was carried out by Prospectus Consultancy, it’s chairperson is Sean Donelly, who was a former director of the IDA and is a board member of several other companies. The managing director is David Duffy, who is a member of the Dublin regional committee of IBEC. Prior to this report it had done a major report on the opportunities for private health care for a private health care insurer. Its particular corporate ethos meant there was little likelihood that it would recommend universal free health care or any extension of democratic decision-making.

    One of the recommendations of the report was the creation of a divisional structure for the HSE with a National Hospital Office being responsible for allocation funding to hospitals and, significantly, ‘managing the interface with private acute providers’.

    After Harney became minister for health in 2004 she named Kevin Kelly, a former Managing director of AIB and President of the Irish Bankers Federation, as interim head of the HSE. PWC were then hired at the cost of 36000 euros to recruit the permanent CEO of the new body.

    The HSE board was dominated by people from a business background.

    Its chairperson was Liam Downey, the former chief executive of Becton Dickson, a medical technology company and a member of the National Executive of IBEC. It also included Joe Macri, the managing director of Microsoft Ireland and also a member of the National Executive of IBEC; Eugen McCague, a partner with the solicitors firm Arthur Cox and council member of Dublin Chamber of Commerce; Donal de Buitleir, a General Manager with AIB; Professor John Murray, President of the Marketing Institute of Ireland and Niamh Brennan, a chartered accountant and academic director of the Institute of Directors Centre for Corporate Governance in UCD, among others.

    It’s no wonder they supported co-location contrary to the recommendations of the Department of Health. Or why Harney was off to see the endgame here in the US recently….

    Pax

    February 19, 2008 at 12:31 am

  5. “Probably the easiest way to do this is to note the fact that a non-statist healthcare sector, whether or not it is desirable, is certainly possible”

    Whether or not it is desirable is, you know, a bit important. Most people have no problem at all in imagining a privatised health care system – they just look across the atlantic and shudder.

    chekov

    February 19, 2008 at 1:15 am

  6. Hey Pax, your first comment was automatically moderated because of the number of links it contained.

    I’d like to thank you sincerely for the effort you put into your comments. But, if you post here again, you might bear in mind the possibility that I am already cognisant of arguments such as yours, so presenting them as if they are obvious proof of your position may not be effective, certainly not if convincing me is your goal.

    I would also ask you to note that very long comments will probably be at risk of moderation here, and more so if they seem tangential to the post. I invite you to set up your own blog if this seems unreasonable, though I hope you will continue to visit here all the same. Best regards.

    Graham

    February 19, 2008 at 3:37 pm

  7. I’ve no problem with the automatic moderation Graham. The comment (and its references) is probably best seen in context of the debate on CLR. And your own comments on that thread.

    I’ll bear in mind that you are congniscant of such arguments. However I find it hard to square with “the virtue of governmental healthcare is one of the great collective fantasies, ” and various comments about economics etc on the CLR thread.

    Pax

    February 21, 2008 at 6:25 pm

  8. Fixed your link to CLR.

    Graham

    February 21, 2008 at 6:31 pm

  9. Thanks. And thanks for the info on your moderation policy with respect to tangential arguments.

    Pax

    February 21, 2008 at 6:33 pm


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