welcome back to the real news network I'm Paul Jay in our studio in Washington joining us now is Matt Welch Matt is the editor in chief of Reason magazine he used to write at the Los Angeles Times thanks for joining us thanks for having me back so for those who don't know and maybe you don't know Reason magazine and reason.com is a libertarian in the broadest strokes libertarian website and magazine and Matt you you wrote something recently on healthcare which wasn't normally thought of being some things would come from a libertarian actually like the health system in France so talk a bit about what's going on here and what you wrote my wife is French so I experienced health care a little bit differently than the average libertarian or average person in America I every year go there for Christmas and yeah I think I was there last time I went to the dentist I think I had a filling I don't even really know wasn't paying attention and I get routine health care done there and I've always been struck by a what high quality it is generally speaking both for me my wife and our small child and extended family and how it doesn't match up with the caricatures that are given towards in general socialized medicine but specifically France you see a lot on the right especially over the years bemoaning oh it would be terrible to have socialized medicine and not just the right you've heard it from the leadership of the Democratic Party as well sure how horrendous it would be to have so we're not so we don't want socialized medicine we want a public option and no they don't even want that yeah I mean it is entirely possible even probable that socialized medicine wouldn't work however when they do talk about this Bugaboo they describe elements that actually exist in the American system but not in the French system they say for evil they say oh you know if we do this we won't be able to choose your own doctor well I don't know what kind of health care that these people have had their whole lives but I know at various times through Blue Cross and other people you have to look for an in-network doctor it's not very easy to choose one they talk about long waiting times that never experienced anything like waiting time in France they talk about you know people don't pay out of their own pocket or there's some like confusion between the consumer and the provider in France you go and to be fair this is totally subsidized it's a big entitlement and they're having difficult time paying for it however you go to the doctor you pay every time you pay at the point of contact the price is very small it's it's very coke subsidizing but but they just described this mirror-image world that doesn't exist whereas in America because we have this really convoluted you know third party system I have no idea how this stuff works honestly I mean I I go to the doctor you get you pay $40 at the door and then you get the first bill but you're kind of supposed to ignore it because you're waiting for the it just doesn't make sense more business Byzantine when you go to a hospital you go to a hospital my wife went to a hospital for an infection and she winds up they give her antibiotics she gets a two thousand dollar bill for an antibiotic sort of a prescription and then several months later there's another bill from another doctor who stuck his head in the door for something like another thousand dollars yeah really and if you like cannot understand this we were well no the one time my wife had to go to an emergency room she just was feeling very bad to turn out to be not much but we were stone broke at the time this is in California and we asked it every step of the way look we know she's dying but how much is this gonna cost because we really couldn't afford it if it was above you know X hundred dollars and at every step of the way they said oh honey don't worry about it it's not an issue basically we can't tell you and then we got that $3,000 you know bill at the end of the process we can't we can't afford this if we would have known this so in the American system for my money in my point of view it is in many ways the worst of a lot of different worlds it does produce at the top end great health care you know the best innovation happens in this country as far as you know the best medical procedures happen here if you know I'm getting older now so it when I get the serious diseases that older men tend to get maybe I would rather be here than there I don't I don't actually know but what I do know is that the existing system is completely convoluted and there's price sensitivity this so I mean I know a little bit about the Canadian system I'm worrying a little bit as viewers know I'm dual citizen the hospital I was talking about my wife went to was in California we're on a trip but in Canada we have somewhat similar system to France government insurance private delivery we choose our own doctors the the American debate about this has been so filled with misinformation about other country system so imbued with AD ology and the critique is all about big government takeover of health care that's why I'm particularly interested in your point of view your your back your politics in your magazine is all about libertarianism is all about smaller government so what do you make of the ideology of this American debate well I mean I think it's a combination of things it's the ideology that's always going to be with us and there's also the very American complete lack of understanding of what happens outside its own borders and the use of other countries as as sort of a bludgeons with with which to hit people I think that there is an understandable American fear across all sectors of large governments there's a very American tradition which you know puzzles foreigners to no end but we are inherently suspicious of a government that gets bigger and bigger and bigger every year the health care debate is part of that suspicion that's happening right now and it's enough it's an understandable one and there's an understandable employee we're talking about one-sixth of the economy to have the state assume a much bigger role in that makes people nervous and it's a very intimate kind of personalized health care thing from my point of view as someone who believes that in competition and market competition wherever possible I think that we would get a lot more we would be able to maintain a lot of this innovation that we enjoy here legitimately but we would also get to where we want to be in terms of driving prices down and increasing the amounts of assurance available to people if there was more competition if people individuals had control over their own health care destiny instead instead of having it tied to their employment or through Cobra or something like that if I could just pay for my you know X hundred dollars for my plan and it goes with me next time I get fired on I would feel much more the sanguine mental we really know that means about our healthcare policy here because I wouldn't have that fear of what happens when I go in between jobs also I'd be able to shop around if the system was set up that I could really shop if there wasn't just as is in California like three insurance companies because when you add a thousand regulations it's just gonna weed out anyone who so that's the thing from putting on my Canadian app that's so bizarre to try to understand is that people become practically practically like bonded laborers to their employer because they're terrified if they leave they won't get another job with health care so they stay in jobs they hate which is the which is the very definition of lack of choice the the original sin in health care in this country is what happened after World War two it is when they said actually was Harry Truman imposed wage controls basically you can't give you any more money for this year because we're all tightening our belts and so what did people do this at haha if we can't increase salary to try to get a tract our best talent we will give them a big fancy healthcare package because that's not wages from that moment on in the tax code and in other areas of life employers have been incentivized to do health care and the government policy has been basically let's tie it let's extend that relationship that was back in the company man era that's back that's like pre madmen when we all stayed at the same job for 25 years that era is gone and most honest health care economists from all sides of the debate including our crazy little side over here will say that was the original problem however you'll notice that Barack Obama isn't touching that with a ten-foot pole no one wants to upset that status quo the status quo of third-party delivery the status quo it's all employer related if there was equal treatment for individuals and employers our health care system here would look a lot different than a lot better well if they had actually done the public option and defended it in a robust way that people had that choice and we're so defensive about what was going on in France and Canada and say here what can we learn from it but the message coming from the leadership of the Democratic Party is it's so confused I don't think people actually know what their fishing oh no I mean Nancy Pelosi said I think just yesterday like look let's pass this only by passing this bill will we know what's in it and I mean you want to think that's a joke or a misquote and it's neither its actual it's a 2400 page bill no one really understands it and if we just pass it will like work out the details later that's just insane that is terrible governance on every level what you have also is I think a democratic conflation with insurance and health care so you have Obama not just saying I want to insure everybody which is an understandable goal but like I want to also make sure that everybody's insurance contains this this this this and this we will pay for these things this will be free this is creating more of a top-down system and also making people buy into a more expensive system and and you know insurance from my point of view especially as I was young and healthy and I'm someone who didn't couldn't get insurance for three years in this country I'm very bitter about it to this day you know the insurance that I want to back then was what happens if I hit by a car tomorrow I don't wanna be bankrupt I don't my children to be bankrupt what can I do there that's basically all I wanted I didn't want to get you know of free testing for this disease and that disease in my 20s you know just give me the catastrophic stuff and if Democrats would have gone into this debate saying okay here's a way to open up competition in the general sector and then we're going to have this option over here for people who have pre-existing conditions or whatever that is if there's what there is that the pool doesn't include the young people who only really want the car accident insurance sure then it cost gets way too much and you're gonna need it when you get old so the only way over the course of everybody's life time to make Affairs there has to be one great big pool doesn't that make sense doesn't it makes sense until you get to the point where you're talking about making a making something compulsory for Americans to to do and I think I mean that there's an open constitutional question whether that is it would actually pass constitutional muster if it passes it won't pass you know an interesting we are talking policy but the reality of politics right now is I think this thing has zero chance of passed the current bill current bill has zero chance of passing I would bet you know what little money is in my bank account had that it won't pass and I would made that bet as soon as Scott Brown did one election and Teddy Kennedy's old seed from that moment on Democrats didn't have a filibuster-proof majority and this thing is just unpopular it's usually unpopular right now and but but you like the French system so if do you think Obama should it come out pitching something like the frame system I don't and here's why the French do things better than other people do when it comes to their public sector well as good as the French health care system is it is it is so much better than the British health care system which is also a similar type of system the Brits are not very good when it comes to their productivity of their public sector the French are famously very good at both productivity of public sector and sort of a the general sense of solidarity among their citizens which reads into they feel okay about the fact that people don't make a lot of money but we all have this generous welfare state not none of that is true in America and none of it is going to be true in America if you were to transplant that system onto the American host the water service states that are talking about legislature in California has passed the single-payer system governor Wolf's ina Pennsylvania seems to be heading there governor says he will sign it so there are states that are talking about essentially public health care insurance system and it would be great if there was some element of state experimentation you know I mean Matt Massachusetts famously did what they found is that it's super expensive and it's getting more expensive every year for the state and also for the individuals who are in the system and that's the system that Obama's been trying to sort of copy or we're taking at least as part of his inspiration and it's the problem with France too frankly there is a very negative side effect to their health care system and their general lies sense of welfare system it's it's putting an incredible stress in their public finances demographics are all set against it and there's a generalized I would say malaise in French society where people are rarely create stuff on their own they look to the state for everything there's not much dynamism among young people in terms of creating things just doing stuff music aside and a few other things and jumping on buildings in a weird way I have to get someone from France here to do to talk to you about that yeah no I mean you like the idea the movement to the States the idea that states would experiment with different kinds of public insurance systems you know traditional that has been a great laboratory in in America at the same time I think that there's a strong argument to be had basically if you would just open up the competition between the states if I was in California and I could buy a Nevada insurance policy why the hell not you know I want to be able to choose from as many as possible you know the counter-argument kind you get states that have so little regulations to the bottom arguments it certainly has happened in many areas of life yeah I have a difficult time understanding what that race to the bottom looks like if I'm in Mississippi to throw out a Bugaboo kind of state and they have very little regulations on their insurance companies and then presumably let's say I as a citizen there can shop in from California provider which it does have regulations why wouldn't I just shop from one of those well cause it'll be more expensive so you're gonna wind up have a pressure going to the cheapest state and then the it just in terms of price competition people are going to be who especially can't afford it are gonna go more and more to the more deregulated option again without the big big pool you can't give a good system to everybody so you wind up again with cheap companies undercutting anybody that wants to be regulator I think that the the answer lies in a more limited idea if you're going to entertain notions of the public option and the government getting involved in the provision of health care then which it already is frankly mid 50 percent of health care spending what's wrong with Medicare for all you know it's we'd be in a situation where medical decisions are inherently politicized I mean there was a case I think two or three months ago where they talked about I think even under existing Medicare and I could be getting some of this wrong there was a discussion of at what point do we start cutting off you know annual mammogram tests is it for age forty years doing it now sure buddies don't pay for everything they decide of course not of course everyone does their amortization but if it's just Medicare for all and that's all that there is then there is no exit you know what I'm looking for is as the maximum number of exits or entry points so that if I want X system I can do that I can choose that as an individual if I'm happy with this system then I can choose that to well everywhere else in American society for the most part with the prison with the exception of the provision of government services consumers because they have this hysterical amount of choice have been able to drive down prices and drive up quality but in the provision of everything from health care to education all these things where it's more difficult to leave a system when you don't have that kind of a competition then you have much more sort of limitation on the quality of things and stuff gets more expensive that's the problem Medicare for all would be more and more expensive every year it already just stretching out you know look at the trend lines on Medicare and Social Security the private systems worth I don't know that the private systems were currently the private systems were well worse on what's the cost of the cost increases but worse on the private side well sure but I mean I mean one of the things people don't talk about is to cost the pharma which is essentially the prices are unregulated in fact if anything there's been a protection of Pharma in terms of Canadian cheaper rights but there you have a public system cheaper drugs much cheaper cost per individual care same is true in the other countries that have public insurance systems so if you're talking about costs it's the public systems that are reducing cost not the private system but but then you know who's paying for the cost I mean that the the whole society equally yeah but I mean we're talking about a taxpayer you know trillions of dollars that go like this stretching on into infinity and that you just can't keep going that direction unless Society you know no but w.zahn productions you have cost containment in the public systems and in Canada and France like it every you know you've seen the numbers all the public systems per capita pay I think it's a third of what the US based on health care well I mean cost controls in the public says but if you look at the experience in Massachusetts that's that is absolutely not the case it's not cost containment that those costs are literally going down control right now drug in national systems with great big pools I mean the Canadian health care system can say to the pharmaceutical companies you know we're not going to pay you a we're gonna pay you B and you really don't have a choice Massachusetts never had that kind of right I mean I think I think that gets arm as an enormous piece of this cost which the Democrats aren't talking about very much because Obama made a deal with Pharma so they don't talk about which went against his own campaign promises if I'm not mistaken I mean that gets into an area of you know at what price and under what terms innovation I mean there's a reason why we develop pharmaceuticals here in this country pretty well part of that is the protection of monopoly pricing for some amount of time the seven-year period or whatever and so I think we are understandably nervous about saying okay let's just cut that off at the knees and someone's going to produce those marvelous drugs that everybody else gets to have for for very cheap I'm not sure that we're at a place where it's a great idea to kneecap that kind of innovation I don't know what the right balance is there at all I'm hardly an expert on that but this is a very interesting study that Brits did on the number of new patents that have come from Europe bananaman from within the EU countries and it rivals the American patents yeah it was very interesting that all the innovations coming from u.s. pharmaceutical no certainly not I mean Hungary is where I used to live is a great innovator of pharmaceuticals and it even was under communism just to completely yes screw everybody's mind that's actually familiar yeah all right we're gonna do this regularly and this not a problem we're going to solve right now but thanks for joining us thank you very much and thank you for joining us on the real news network we're gonna do a regular gig with Matt Welch every week or so and please join us for it you

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Methew Wade

34 thoughts on “A libertarian take on health care”


  2. The guest seemed decent enough, but he clearly reasons one way for people he cares about (e.g. his wife who was ill), and a different way for everyone else. That's a terrible mindset to have dominate policy.

  3. all very well, but you can't exactly shop around if you live in a small community where there is one choice of doctor, and the next available one is 50 miles away (or less)

  4. It was not a job for twenty years. It was a job for life. Those jobs disappeared during my father's lifetime (he noticed it in the 1970s.) He did have a job for life, getting promotions and rising in management.

  5. Insurance companies provide ZERO health care, they only take money from the individual and from government then do all they can to turn a profit for their shareholders and CEO's. We just need to eliminate the insurance companies from the equation. Regardless, we need everyone IN and everyone paying their fair share. That is the only moral and fiscally proper way to address this. Why can't we take care of one another?

  6. Try India. Many Indians don't understand the concept of health insurance just like Americans cannot imagine healthcare without insurance. Because of not going for insurance, healthcare is pretty cheap in India and every income group has a medical institution they can find affordable. Of course quality decreases with decrease in affordability, but I know a lot of Americans who are denied insurance that would love to get some help from those Indian hospitals for just a handful of bucks they can make within hours.

    I fail to understand why India is not brought up more as somewhat a libertarian solution for free market healthcare. Because Indian healthcare is as free market as any country can get. And because there are no health insurances for majority, people are responsible. Of course there is some corruption over there too, particularly in the form of kickbacks from Pharma companies. But which system is perfect?

  7. France is not as socialist as they get stereotyped as. They have a public-private health care and health insurance system. 

  8. Watching this supposedly libertarian video, why do I feel like I'm listening to a couple of left wingers?

    I am French and all I see in France is a system expertly crafted to produce human misery through taxation, unemployment and coercion. I've also heard that its gigantic national debt is not getting any better.

  9. The best Health Care System for America would be a system with unlimited Freedom of Choice for the people. Where they decide for themselves where they get their Health Insurance and Health Care. That could even include a Non Profit Public Option thats run independently of the Federal Government. But where the people decide for themselves where they get their Health Insurance and Health Care. Not Private or Public Monopoly's.

  10. Regulation has been the reason for the breakdown in the American healthcare system, and the incredible increase in costs as reflected in household income. The only kind of regulation that physicians would need is from the medical school that issues the medical diploma, and perhaps, those medical professional organizations for the respective medical specialties. Any other regulation, as in the bureaucratic-administrative kind has, in the main, been more bane than boon for individual consumers.

  11. @thurstjo1963 There are types of medicines (i.e. Chinese, Ayurvedic, Homeopathy, etc) of which have been effectively used for thousands of years. These medicines offer treatments for different illnesses (such as cancer) that are alot cheaper and in many cases more effective than conventional treatments. People should be free to choose what the feel is the best and most cost-effective means of treating an illness. In the west, that choice is not available to the public because of "regulation".

  12. @SandCmpbll Don't agree. If you look at the history of the US, especially the latter half of the 19th century, you will see very clearly that companies hate competition. If you need proof, search for this video by Murray Rothbard "The Decline of Laissez Faire" on YouTube. In terms of health care, everyone talks about competition between insurance companies but nobody talks about competition between different forms of medicine. Continuing in next post.

  13. @cvcdgftr7676545 What "studies" commissioned by who? using what methodology? If its a group known for preaching the supremacy of the state then all you have to do is move the goal post about to get the "result" you want.

    In any case private schools would be better even without a performance edge as government has an incentive to make people ignorant to what freedom really is. Most poor parents vote with their feet to private schools when given vouchers. Reality is better seen that way.

  14. @cvcdgftr7676545 Obama Care has not been around long enough to have these effects YET. It may take as much as 3 generations for socialized medicine to disincentive all the talented folk out of the system.

    Doctors need high pay or their quality falls to the pay you give them… period. This process of adjustment take a LONG time which makes socialism look great until then.

  15. @Raptoreyes studies show private schools ,and colleges are no better than public schools, and sometimes they are worse, or cost so much more.

  16. @Raptoreyes we have had a shortage of primary care doctors for years, and not because of obama care.

    you believe anything you are told don't you, like obama being a Christian citizen.

  17. @jotunobsidianeyes Of course politicians were going to gut the money from medicare they are politicians. Leaving unattended piles of money their for them to use in buying their re-elections is too much temptation for a politician. Public works typically are spent badly by the nature of electoral politics itself. Better that most of the money was taken out of the hands of politicians period. Politicians do "stupid" things because their incentives are not your incentives.

  18. @cvcdgftr7676545

    Wow you hit the nail on the head Cvcdgftr

    Most people would not support government run health care if they understood that money does not grow on trees. (or that talented people gravitate to fields with low government involvement). Talented people will not take up medicine. Eventually the high level of competence we expect from doctors will disappear under socialized medicine. Such competence has disappeared already for teachers under a government run system.

  19. @judd73 True but this is Paul Jay we are talking about so he will likely find the most wavering libertarian he could find.

  20. @Raptoreyes but we already have that system, it's called Medicaid. And it pisses a lot of people off because it's free health care for the poor, free health care for the elderly (Medicare), and everyone else has to pay for it. If it were everybody in, nobody out, we'd have lower costs, and people would be able to spend that leftover money in a sector of the economy where there's actually a free market, as opposed to shovelling it over to the useless private insurance monopolies.

  21. @greyflcn lol, some of the data is so stark that Libertarian types simply ignore it. Tell them that such-and-such gets universal coverage, at nearly half the cost, with better outcomes, and it's in one ear and out the other. Magical thinking about markets always triumphs.

  22. So when I get pulled over will the new line be DL, registration, insurence, and health care papers please?

  23. @SweatLaserXP

    Add in government debts that are unpaid and
    the true costs of govt healthcare are staggering
    compared to any private option. Just because
    the government uses funny math to compute
    its own cost does not mean we should be
    fooled by their a-moral accounting.

  24. @nly8nchz

    Excellent point Nly8nchz. It isn't excessive
    profit when government taxes the hell out
    of a producer and the producer must pass
    those costs on to stay in business.
    All we are seeing is sociopath politicians
    pretending the problem is anything but their
    own lust for power and control.

  25. @greyflcn
    Actually private mutual aid societies existed
    before the welfare state perverted basic
    human impulses toward sociability. Adjusted
    for the limited resource base of the 19th
    century and the earlyer state of technology,
    these organizations (all private) did do
    libertarian healthcare as you put it. It
    worked very well given the limted tech of the times.

  26. Yes, but Patent Law also impedes progress.
    So the two needs to come to balance, and 5 years is a good Balance, 12 years is not…

  27. Well, Mr. Welch kicks things off by boasting how great the health care system is in France, not acknowledging that France has a mixed single payer/private insurance system. Also, he didn't seem to realize that inflation in private insurance is far far worse than it is in Medicare. Libertarian types always seem to assume that governments can't do anything efficiently, an idea the collapses under the mildest scrutiny; perhaps Mr. Welch should learn what the French pay for their health care.

  28. one thing you may not be taking into account is the fact that there's actually a lot of public funding behind some medical/pharmaceutical innovation, and the corporations get to name their price with no competition anyway, and even claim they have to make the price high to pay for the research, even when it was paid for by public funds. Especially with rare diseases, there's not enough consumer money to make some new drugs profitable and public funding is necessary, but it should lead to access.

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