The Medical Industry Sucks

It doesn’t have to suck. There’s nothing about medicines and treatments and diagnosis and surgery that needs to suck by nature. It’s pretty awesome stuff.

But the quality of the experience is almost always awful.

The majority of doctors don’t do anything at all. They look at a chart that shows the weights and measurements the nurses took and a few notes on what the patient said. They ask you the same questions again. Maybe they shine a light in your eyes. Then they go away for the same amount of time it takes a cop to write you a ticket – somewhere in that twenty-five to forever minutes range – come back and tell you to buy some pills they looked up on their computer. Two or three redundant ones to be “safe”. They don’t mention side effects. They don’t know anything about them. You ask them what’s in the pills and they don’t really know. The waiter at a local restaurant knows more about what’s in the stuff they sell you than doctors know about what they prescribe. None of this is helpful because you already looked up your symptoms and figured out what pills you wanted on your own. But you couldn’t buy them without the doctor’s royal imprimatur.

That’s about it. That’s what most doctors do most of the time and most of them do that badly.

Of course there are some awesome docs. And there are some awesome advanced procedures and research in medicine. But those are rare. Most of the medical industry is a giant school-like cinder block monstrosity filled with unaccountable government protected rule followers.

The solution is simple, and one that existed long before the modern medical establishment. Get government out of medicine altogether. Start with removing government from medical certification and license. The license laws were implemented with the express intent to restrict the number of doctors and make medical care less accessible and more expensive. Medical costs were too low and insurance was too accessible for the tastes of those who had control over government. So they “fixed” it.

Any time you restrict the supply of labor and make government hoops the only legal way to offer services, you get higher prices and lower quality. From taxi medallions to medical licenses, it’s the same principle at work. Those willing to jump through the hoops get an automatic guaranteed customer base because supply has been so restricted. And licensing is sold to the public as a viable quality control, which of course it isn’t. It’s competition control, and competition is the greatest quality control of all. Protecting low quality providers from competition is a danger to the public. Monopolized medical licensing is a danger to the public.

Insurance requirements and restrictions, subsidies, the FDA, and many more egregious government interventions exacerbate the problem. Most were touted as solutions to the problem originally created by government, and all only make it worse.

It’s a terrible, low-quality, sub-human experience most of the time. Barring big crisis interventions and surgeries which can be life-saving, most treatment is a crappy soup of mediocrity and blind paternalism. Nobody knows what the hell is going on and nobody realizes how much better it could and should be.

So what’s the most likely unexpected angle of innovation and competition? Nobody saw ride-share apps coming and upending taxi cartels. What will upend the medical cartels?

Thinking about it gets me excited.

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Arresting Homebirth Midwives Just Reduces Women’s Birth Choices

After being arrested and charged with practicing medicine without a license last fall, a midwife in upstate New York is wondering whether or not she will go to jail for the work she has done for decades.

Elizabeth Catlin is a beloved certified professional midwife (CPM) who has caught hundreds of babies in the tight-knit community of mostly-Mennonite women near her home. According to a recent in-depth article on her ordeal, the state is cracking down on her actions, which they say are illegal.

Another Tale of Occupational Licensing

New York is one of 19 states that does not recognize the national CPM certification, a private, standards-based, intensive training and certification program for midwives across the country. Instead, New York requires midwives to have state-approved midwifery licenses through a Certified Nurse Midwife (CNM) designation, requiring a nursing degree, specific training, and state registration, or a Certified Midwife (CM) certification that requires a master’s degree and other stipulations.

These state licensing requirements have little to do with safety and a lot to do with bureaucratic special interests and job protectionism. Not only do they threaten the freedom and livelihood of women like Catlin, but these regulations also severely limit women’s birth choices by creating midwife shortages and driving up costs. They also make safe birth choices, like a planned homebirth attended by a trained midwife, much less safe as women choose less qualified providers or opt for an unattended homebirth.

Women choose homebirths and other out-of-hospital births (like those at a birth center) for a wide assortment of reasons. Some want more control over the delivery process, a less rushed or sterile atmosphere, and fewer restrictions while in labor. Some find homebirth fees to be lower than what they would need to pay out-of-pocket for a hospital birth. Others choose homebirth for religious or cultural reasons. Like some women, I chose homebirths for my last two children after negative hospital experiences with my first two.

Homebirth Is Fine for Most Women

Most pregnancies are uncomplicated, and many labors and deliveries, when allowed to progress without intervention, proceed as normal life events and not medical procedures. Recognizing this, Britain’s national health service recommended in 2014 that low-risk women give birth at home or in a birth center rather than in a hospital.

As The New York Times reported,

For these low-risk mothers-to-be, giving birth in a traditional maternity ward increased the chances of surgical intervention and therefore infection, the [British] regulator said.

But midwives remain heavily regulated by, and mostly funded through, the British government’s National Health Service (NHS), creating a severe shortage of available midwives and preventing many women who want a homebirth from having one. Moreover, the few midwives operating independently of the NHS face increasing regulatory pressures that threaten their ability to practice.

Hospitals Are Dangerous

In the US, demand for non-hospital births is increasing, prompted in large part by dismal maternal health outcomes. A sweeping 2018 USA Today investigative report found that the “U.S. is the most dangerous place to give birth in the developed world,” with more than 50,000 women “severely injured” during childbirth each year, and approximately 700 annual maternal deaths.

Many of these adverse outcomes can be linked to the rising rate of C-section deliveries that increase maternal risks associated with surgery and infection. In the US, the C-section rate climbed from 23 percent of births in 2000 to 32 percent of births in 2015. By comparison, the World Health Organization (WHO) suggests that a reasonable C-section rate is about 10-15 percent of all births.

If these adverse maternal health outcomes persist, it’s likely that more women will seek alternatives like out-of-hospital births. That is, as long as state regulators, politicians, and special interest groups don’t continue to take steps like those in New York to criminalize independent midwives and actively limit women’s birth choices.

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Killing the American Meritocracy

The American Dream is under attack like never before—not just the ability to fulfill the dream—but its very concept and history. At the core of the American Dream is the idea of meritocracy. There is no royalty in America, no titles of nobility, no entrenched caste system. You could be born anywhere, to anyone, and still achieve success. It was not just a story. Many real-world examples show exactly this trajectory. Poor children, and sometimes even penniless immigrants, grew up to achieve great success. Some even become titans of industry.

Why then is there such an effort underway to denigrate the idea of meritocracy? It is my belief that those who prefer a centrally planned society to one based on freedom, liberty, and personal achievement are intentionally rewriting history so as to make people believe that so-called “privilege” rather than merit has been the primary factor in achieving success throughout American history. This lie is then combined with the fallacies of communism (such as the labor theory of value and the fixed pie fallacy) in order to bolster the argument for central planning and massive government.

In order to understand the nature of the attacks on our meritocracy, we should start by understanding what a meritocracy is—and what it is not. Some definitions of the word smuggle in the concept of central planning: Merriam-Webster defines it as “a system in which the talented are chosen and moved ahead on the basis of their achievement.” Others try to divorce the concepts of wealth from success: The Cambridge Dictionary defines it as “a social system, society, or organization in which people get success or power because of their abilities, not because of their money or social position.” Neither of these definitions fully explains what meritocracy is as it relates to the American Dream, however, so perhaps a new term is required. I propose we call this the American Meritocracy.

Unlike what some of these other definitions imply, no one is necessarily being selected or moved ahead nor are wealth or social position irrelevant to success. In the American Meritocracy, a free market allows individuals to leverage all of their intelligence, talents, knowledge, wealth, connections, and even luck to get ahead. Those who are successful are correctly regarded as having earned their success, while those who are not successful are rightly considered less ambitious… or worse.

One of the most pernicious fallacies in public discourse today is that someone having wealth represents “inequality” in some meaningful manner. This idea ties in directly with the myth of “privilege” which expands the possible sources of “inequality” to include race, sex, religion, education, and any number of other things depending on who is defining it. The purveyors of the “privilege” doctrine conspicuously fail to explain the myriad success stories involving un-privileged members of society, however; it is as if these achievers do not merit their consideration. They will happily prattle on with anecdotes of the single mother working three jobs while accumulating more credit card debt each month, yet fail to mention the single mothers who save money, start businesses, win awards, and send their kids on to college. If confronted with these inconvenient tales of success, they will hand-wave them away as irrelevant outliers, falling back on statistics that prove little more than that people who are successful tend to be exceptional in many ways.

Behind the fallacy of “privilege” are two fundamental communist doctrines. The first is the labor theory of value, which posits a direct correlation between the value of a good or service and the labor required to produce it. The irrationality of this concept is easily seen in comparing two works of art. Both could be the same size, use the same materials, and take the same amount of time to complete, yet one could be worth millions while the other might be worth little or indeed be judged as truly worthless. The only difference between them is the perceived talent of the artist.

I say “perceived talent” because value is not actually an inherent quality of a good or service. Utility and scarcity may be inherent qualities in some cases, but value is always externally ascribed. Both pieces of art may be one-of-a-kind creations, so they would theoretically have equal scarcity, and both would fill an empty wall with equal aplomb, so again, their utility should be equal. Why then is one worth a million dollars and the other unsold? Because their value (like their beauty) is in the eye of the beholder. Be it because of the identity of the artist or certain ineffable qualities in his work, prospective buyers will ascribe far more value to one piece than to another with little or no regard to the quantity of labor involved in its production.

One could labor for a great many hours digging an unwanted ditch and then labor for hours more refilling it without ever having created any value for anyone. Likewise, one can spend their life in a dead-end job asking if folks “want fries with that?” without ever producing $15 worth of value in an hour. Indeed, with the proliferation of self-serve kiosks with flawless knowledge of ingredients and prices combined with perfect memories and increasing speeds, we may soon see a day when the ability to mumble about the availability of supplemental fries has no marketable value at all.

The second fundamental communist canard that underpins the delusion of “privilege” is the fixed-pie fallacy. Economist Milton Friedman summed up this pervasive error well when we said, “Most economic fallacies derive from the tendency to assume that there is a fixed pie, that one party can gain only at the expense of another.” We hear this daily rhetoric expressed as concerns about “income inequality” and the supposedly unfair achievements of the “top 1% wealthy” who are nearly universally regarded with suspicion and envy thanks to the prevalence of this particular fallacy.

Skewed statistics suggest that these “Monopoly Man” caricatures have achieved their wealth by plundering the poor, yet these one-sided figures conveniently ignore that “the poor” are richer than ever before, enjoying far more luxuries and longer lives than their historical counterparts. Yes, the “rich” may enjoy a larger percentage of the pie today, but the pie itself is many times larger—and here’s the kicker—it has grown so much larger primarily because of the investments and contributions of those supposedly “evil” rich folks.

Look at it using simple math. If there is a 10-inch pie and you have two slices, how much pie would you have? Now imagine a 10-foot pie of which you have only one slice. To some people, this would be a tragedy, an unconscionable increase in “pie inequality” because you have just one-eighth of a total pie rather than the one-fourth you had before. But is this a reasonable way to measure things? (For the record, if you had 2 of 8 slices of a 10-inch pie, you would have approximately 19.6 square inches of pie. If you had 1 of 8 slices of a 10-foot pie, you would have 1,413.7 square inches of pie, an increase of 721%.)

While it is certainly true that state intervention has made the free market far less free than it could be, the American Meritocracy is still alive and well. Yes, due to taxes, regulations, and occupational licenses, it is more difficult to achieve success than it would be in a fully free market, but there are still virtually limitless opportunities for anyone who is willing to put in the necessary effort and to make the necessary sacrifices.

It is okay to be poor. Some people do not prioritize wealth creation, and that is their right. The problem is when they start blaming their poverty on other people or on “the rich” or “privilege” or some other external force that they claim is keeping them down. If you are poor in America, it is because you have not put in the effort necessary to become wealthy. This may seem harsh and judgmental, but that does not make it untrue. You can achieve success in the American Meritocracy, and if you do not, it is almost certainly your own fault.

Those whose ultimate goal is the eradication of the free market point to the existence of poverty as evidence that the free market has “failed.” They suggest replacing it with “universal” handouts in the form of fully subsidized education, healthcare, family leave, and even income itself. They imagine that these subsidies can be funded indefinitely by plundering the rich—ignoring that even at its current size, the government would blow through the net worth of the rich in a matter of months. In short, they want to kill the American Meritocracy and replace it with a one-size-fits-all communist utopia where the state controls everything and all the little people live in perfect equality.

Quite the fairy tale, is it not? Without “the rich” to keep growing the pie, the pie will naturally begin to shrink and each person’s “equal share” will shrink too. Add in an ever-expanding population, and the predictable economic contractions will guarantee worse outcomes across the board. Instead of some people living in poverty, everyone will live in poverty, and there will be no system in place to facilitate escaping it.

The American Meritocracy is not perfect due to government intervention, but it is still far superior to the abject failure of central planning that is on full display in Venezuela right now. After all, no one is eating zoo animals to stay alive in America.

The American Dream has always been that anyone could achieve success with enough effort and perseverance. This is still true for almost everyone who lives here. The fact that other people may achieve even more success than you does not diminish your success. Despite the fabricated doctrine of “privilege,” there is no ceiling through which you must break or systemic inequality you must overcome. If you can provide quality goods and services to which buyers ascribe value, you too can achieve success in the American Meritocracy. If you fail, you can blame your parents’ wealth (or lack thereof) your race, your sex, your religion, your education, or your astrological sign, and many people will accept your excuses—I will not.

Success in America is not a lottery, it is earned; and if you do not make the effort necessary to earn it, you do not deserve it. I am sure that holding these views makes me a heretic to the church of statism and a disbeliever in the gospel of privilege, but I make no apologies. Your life is of your own making—now go make it better!

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Canada’s Universal Child Care Program Suggests Elizabeth Warren’s Plan Would Be Disastrous for Children

The state does such a stellar job of nurturing and educating children from preschool through high school, we should expand its role from birth onward. That’s the new proposition unveiled this week by US Senator Elizabeth Warren of Massachusetts. On Tuesday, the Democratic presidential candidate outlined a vast federal program of free and subsidized child care for children from birth until school-entry, including creating a network of government child care centers modeled after the federal Head Start early childhood program. Warren states: “Child care is one of those things we’ve got to do for working parents and we’ve got to do for our children.”

The popular idea that the state should do things for parents, rather than allowing parents to do things for themselves and their own children, illustrates the pervasiveness of the welfare state mentality. What is framed as helping families instead strips them of their individual power and autonomy, making them more reliant on, and influenced by, government programs.

Defying Economic Laws Has Consequences

Warren’s program is to be financed through a “wealth tax” on the most asset-rich American households and reportedly assures that all child care workers will earn wages that are on par with those of local public school teachers. Like other attempts at government price-setting, however, the economic impact of such a program would inevitably be to drive up prices, reduce variety and competition, and lead to more widespread shortages.

The intentions of universal, government-funded child care may be good. Supporting children and families is a worthy ambition. But as Nobel Prize-winning economist Milton Friedman warned: “One of the great mistakes is to judge policies and programs by their intentions rather than their results.” We should reject Warren’s proposal both on principle and on consequence.

The results of similar universal, government child care programs are dismal. In 2005, economists with the National Bureau of Economic Research, including Michael Baker of the University of Toronto, Jonathan Gruber of MIT, and Kevin Milligan of the University of British Columbia, analyzed the effects of Canada’s government-subsidized, universal child care program. Similar to Warren’s proposed child care plan, the Canadian program is available to all families—not just those who are disadvantaged. The researchers discovered that demand for child care increased significantly under the government plan, as more parents abandoned informal child care arrangements with family and friends in favor of regulated child care programs.

While demand increased, the researchers found that children’s emotional and physical health outcomes declined dramatically with the introduction of government-subsidized, universal child care. Children in the Quebec program experienced increased rates of anxiety and decreased social and motor skills compared to children elsewhere in Canada where this program was not offered. The researchers write:

We uncover striking evidence that children are worse off in a variety of behavioral and health dimensions, ranging from aggression to motor-social skills to illness. Our analysis also suggests that the new childcare program led to more hostile, less consistent parenting, worse parental health, and lower-quality parental relationships.

Last fall, these economists published updated findings on their analysis of Canada’s universal child care program. Their recent research revealed similarly alarming results of government-funded child care, including a long-term negative impact of the program. They assert: “We find that the negative effects on non cognitive outcomes persisted to school ages, and also that cohorts with increased child care access had worse health, lower life satisfaction, and higher crime rates later in life.” This early institutionalization of children may have enduring, undesirable consequences.

While it’s not clear exactly what is causing the negative outcomes of Canada’s universal, government child care program, the research hints at some possibilities. A primary explanation is that the program funneled more children into government-regulated, center-based child care facilities and away from more informal child care arrangements. There was also a drop in parental care, as the opportunity cost of stay-at-home parenthood rose.

Centralizing Child Care Is Not the Solution

Proponents of universal, government child care programs often tout the expansion of allegedly “high-quality” child care options, suggesting that parental care or other unregulated child care arrangements are subpar. But who determines quality? If Canada’s program is any indication, the government’s definition of “high-quality” child care may, in fact, be harming children.

In his recent article on the economic causes of current child care shortages and correspondingly high prices, Jeffrey Tucker explains that the key to affordable, accessible daycare for all is to reduce government regulation of child care programs and providers and allow parents to choose the child care setting that best suits them and their child. Let parent preferences drive the market for child care options, not government interventions that squeeze supply, devalue informal caretaking arrangements, and unnecessarily raise the cost of stay-at-home parenthood.

We should all heed Tucker’s conclusion: “Daycare for all is a great idea. A new government program is the worst possible way to get there.”

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A Preference for Peace: Not the Same Thing as Support for the Bogeyman of the Week

I’m not ashamed to admit it: I’m a peacenik. I think war is a bad thing. I’ve seen it up close and personal as an infantryman, and I’d like to see less of it, preferably none at all, either up close or from a distance.

In part, this desire also makes me a “non-interventionist.” That is, in a world with 195 “sovereign nations,” it makes sense that the political officials in each one should mind his or her own state’s business and not try to decide who gets to run the other 194, or how they should do so.

And this, in turn, leads to scolding claims that I am “soft on”  politicians from states who happen to be at odds with the politicians from “my” country, the USA.

If I don’t want a return to Cold War with what’s left of the former Soviet Union, I’m Vladimir Putin’s puppet.

If I don’t support US sanctions on Iran, it must mean that I support whatever agenda my critic imputes to “Supreme Leader” Ali Khameni.

If I don’t support the US invasion/occupation of Syria, I’m clearly a fan of president Bashar al-Assad.

If I don’t think the US government should waste American treasure (and conceivably even American blood) trying to get Venezuelans to rally behind Juan Guiado’s “interim president” claim, it’s obvious that I want Nicolas Maduro and the Chavistas left in charge.

Well, no, not at all. Not in any of those cases, nor in any of the other places around the world where American presidents, American Congresses, and American bureaucrats continuously try to seize control of the wheel from the people who, you know, live there.

Do I have opinions about politics in Russia, Iran, Syria, Venezuela, Libya  … or, heck, Germany, Greece, Israel, Japan, North and South Korea, and so on?

Yes, I do.

Do I think that it’s the job of American taxpayers to finance, and if necessary American soldiers to compel, those foreign politicians to do the will of American politicians on pain of being replaced by new politicians who will?

No, I don’t.

Not any more than I want Xi Jinping, Emmanuel Macron, or Justin Trudeau imposing their political will on my neighbors in my country.

Nor any more than I want my next-door neighbor barging into my house and ordering me to move the furniture around and serve spaghetti for dinner.

Yes, it can be made a lot more complicated than that, and some people insist on doing so.

But yes, it’s really that simple.

I’m not a fan of the state as we know it, which has been defined since the 1648 Peace of Westphalia in terms of mutually recognized “borders” and “national sovereignty.” That model is disintegrating, and I’m hopeful that it will give way to something better.

Until it does, there are far worse ideas than the notion that politicians should limit their claims of “sovereignty” to the spaces within their own “borders,” leaving other people and other politicians to work out their own destinies.

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Poverty and Success

Perhaps the most unpopular opinion I hold is that—in spite of the myriad obstacles to success instigated by the state—success is still achievable by a significant percentage of the population (>95%) and poverty is a result of one’s own choices in a similar percentage of cases.

I am not suggesting that everyone’s idea of success necessarily requires financial wealth or that poverty (a lack of financial wealth) is always an undesirable state of existence. Some people do indeed choose to prioritize other goals above wealth, and that is certainly their right. I also acknowledge that there are some people (<5%) in any population who, due to severe disability or state maleficence (typically through the so-called “criminal justice system“), have limited or no ability to achieve financial success.

Caveats aside, my basic thesis is that greater than 95 percent of people are capable of and have the opportunity to achieve financial success, but that many (and even a majority) do not take advantage of their opportunities. There are numerous decisions, reasons, and alternative priorities that explain this phenomenon and the following are far from an exhaustive list.

  1. Not taking advantage of educational opportunities. In the U.S. and most developed countries, basic education is available to all at no charge and higher education is available inexpensively or even at no charge to those who can demonstrate financial hardship. In addition, the information age has led to an unprecedented increase in the quantity and quality of educational materials available at little or even no charge. Nearly anyone can learn to do anything if they are willing to put in the effort. Those who choose to live their lives in ignorance have almost always chosen that path.
  2. Having children (they cannot afford) too young. This is another huge predictor of one’s likelihood of achieving financial success. Having children represents nearly a quarter-million dollars’ worth of expenses taken on which will have to be paid in a span of fewer than two decades. Why do people make this foolish choice? If your finances would not support the purchase of a Lamborghini Huracán, they also don’t support you having a child. Wait or abstain!
  3. An unwillingness to relocate. Here we see another significant problem that plagues the perpetually poor. Sometimes opportunity doesn’t knock on your door. Sometimes you have to go hunt for it. Cost of living is also a major factor here. The Apartment List National Rent Report found that the median rent for a two-bedroom apartment in New York City was $2,523. It was even higher at $2,621 in San Jose, CA. Compare that to Phoenix, AZ or Houston, TX where the averages were $1,061 and $1,024 respectively.

It is not just rent either; today, the average cost for a gallon of gas in San Jose, CA, is $3.27 while in Houston, TX, it’s $1.93. Play with a Cost Of Living Calculator and observe the difference. Right now, the cost of living is 44.33% lower in Houston than in the San Francisco area and 56.82% lower than in the Manhattan area. Why do poor people stay in expensive cities?

What about finding a job? The lowest unemployment in the country right now is in the Ames, IA Metropolitan Statistical Area (MSA) at just 1.4 percent. That’s less than half the 3.6 percent unemployment rate in the New York MSA, and yet the cost of living in Ames, IA, is 59.19% lower than in Manhattan. If you are working full time earning $20 an hour (well above the minimum wage) in New York, you could move to Ames, IA, and take a job making $8.50 an hour and you would be better off ($8.17/hr. is the breakeven point.) Oh, and gas at Sam’s Club in Ames is going for $1.86 a gallon today.

So what is my point with all this information? My point is that if people would make smarter decisions—particularly about their education, when they have children, and where they live—they would have a far greater chance of achieving financial success. I’m not suggesting that it is always easy or that there are not obstacles to overcome, but I am suggesting that it is not nearly as difficult as some people claim. Poverty is not the fault of billionaires or of “greedy capitalists” or of some systemic injustice that keeps “po’ folks” down. Poverty is the natural and predictable result of ongoing poor choices, and until people realize this and start taking responsibility for their own culpability in their financial situations, we will continue to hear the growing chorus of complainers demanding political intervention to redistribute money from those who earned it to those who did not.

With few exceptions, it is fair to say that poor people make poor choices.

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