Here are some comments I recently posted in reply to some of the commentary on yesterday’s Freeman column. I repost them here because they are long and detailed enough that they may be of some independent interest.

In an early comment, John Irby writes:

If it was so that medical care and mutual aid was so easy to come by, then why was their a perception that the poor and elderly were dying sick in the streets?

It depends on what period this “perception” is supposed to apply to.

1. If you’re referring to the heyday of the mutual aid societies in the late 19th century through the 1910s, the answer is simply that this “perception” exists because statists often promote bogus perceptions of crisis without much supporting data, in order to put over the need for their desired programs with the politicized public. Some actual data on the circumstances faced by the poor and elderly, rather than impressionistic and sensationalistic “perceptions” would be useful here. I have some actual data on how available these arrangements were to ordinary workers, which I present briefly in the article — typically between 20% and 50% of workers in major urban areas in English-speaking countries were covered, and these numbers were rapidly rising in the 1900s, prior to the political campaigns to eradicate the associations and raise medical prices. If you want a fuller presentation of the data, I recommend David Beito’s excellent book, From Mutual Aid to the Welfare State, especially Ch. 6, “The ‘Lodge Practice Evil’ Reconsidered.” If you have actual countervailing data that tends to cut against the conclusion I draw, feel free to present it, but if what you’ve got is just ill-specified “perceptions,” well, so what?

2. If, on the other hand, you’re referring to the decades leading up to the passage of major government entitlement programs for the “poor and elderly” — programs like Social Security (1935) or Medicare (1965), then you need to keep in mind that these programs were introduced and rolled out decades after the non-corporate, grassroots, free-market alternatives that I discuss in the article had been deliberately dismantled by politically-driven campaigns — coordinated mainly by establishment medical guilds, using their power over government licensure of practitioners as their primary means of enforcement — to drive them out. (The blackballing campaigns against lodge-practice doctors in the U.S. ramped up in the mid-1910s and succeeded in forcing dramatic declines in lodge practice starting in the 1920s. See Beito, p. 124 et seq.) So, to the extent that government could point to a crisis of health care accessibility or affordability for the poor and elderly, just before the New Deal and Great Society transfer programs were created, it’s because government was pointing to a situation where the kind of grassroots, consensual social organizations that had made health care accessible to the poor and elderly had already been rubbed out by government in the decades prior. Once again, an example of government breaking your legs, then handing you crutches, and telling you, “See, without me you couldn’t even walk!”

John:

However I am not ready to drink the cool-aid …

I don’t want to be a dick about this, but can you not use that phrase when what you mean is I don’t accept your delusional beliefs? It’s an offhand jokey reference where the punchline is the murder of 276 children, and the senseless deaths of almost 1,000 people, just 30 years ago. Jokes like that suck.

John:

… and say that we need to rid ourselves of the FDA or of medical accreditation. Kevin Trudeau is a salesmen of alternative cures for a variety of ailments [etc., etc.]

The existence of quacks and dangerous drugs today, in spite of already-existing heavy government regulation, seems like an odd argument for relying on government regulation as a means of getting rid of quacks and dangerous drugs.

In any case, the free-market position is not that we need to get rid of drug testing or medical accreditation. The free-market position is that the state should not force any particular scheme for drug safety or efficacy testing, or for medical licensure, on you or me without our consent.

The important thing, from the standpoint of individualist principle, is that, if you want to pay for snake oil without any consideration of demonstrated effects, you should be free to do so. And if I want to spend money only on drugs that scientific research has demonstrated to be safe and effective, or on doctors who have garnered the recognition of their peers as honorable and competent professionals, then I should be free to patronize only those that consensual consumer-protection outfits and professional medical institutions have approved.

In a freed market, there will certainly be both drug testing and medical accreditation; it will simply be drug testing and medical accreditation that relies on informed choice, or education and persuasion, rather than on the force of the law. How do I know that such institutions will exist? Well, of course, because they already exist, or have existed in the past. Before the modern prescriptions system was created in 1951, the role of objective watchdog for drug safety and efficacy in the U.S. was handled by the American Medical Association (which maintained a private drug-testing laboratory and published annual guidebooks of drugs that received their seal of approval). They provided a system of voluntary, independent oversight that worked — until government “fixed” it.

Similarly, nobody that I know of is proposing that existing methods of accrediting doctors or other medical practitioners be abolished. Where would you get such a ludicrous notion? There’s already plenty of non-governmental means of accrediting doctors — among them, well, the doctoral degree in medicine, which is issued by medical schools and still would be issued by medical schools in a freed market, based on standards of training and mastery. Similarly for nursing degrees, certification by professional associations like the AMA, etc. What radical individualists oppose is not accreditation, but state licensure laws, which add an unnecessary layer of politically-directed licensing restrictions on top of already-existing, voluntary professional standards and certifications within the medical profesion. The problem with this is, first, that they are coercive, and hence violate the rights of patients and practitioners; and, second, that the standards for governmental licensure are imposed through political decision-making and legislative fiat, rather than being determined through open debate and consensus over best practices within the health care market.

As a result, they often use the force of the state to shut down debate and impose requirements that have nothing to do with medical fact and everything to do with political pull — as when state licensure laws were used to attack feminist women’s health centers, midwives, or other alternative medicine providers, even without any evidence that any identifiable patients had been harmed or were even dissatisfied with the service. Or, to return to our original topic, when state licensure laws were used to blackball doctors who were providing perfectly adequate care, but who were seen as “underselling” (that is, providing competent care at costs that were affordable by ordinary working people) during the political campaign against lodge practice in th 1910s and 1920s.

John:

The truth is that of all the industrialized countries, America is the only one with a private for profit system, …

Didn’t you read the article? “America” doesn’t have a private health care system. It has a government-imposed health care system. The market is dominated first, by direct government control, and, second, by the operations of a handful of corporate privateers who depend entirely on a combination of government subsidy and government-imposed barriers to entry for their day-to-day operations and long-term strategy.

A freed market in health care would look completely different from the “system” that you and I face today.

In a later comment, a different John — John de Laubenfels — writes:

Would you give companies that research and produce new drugs NO protection from competition,

You are correct that I do not believe that protectionism for pharmaceutical corporations is an adequate argument for imposing government-granted monopolies.

If you want to “protect” pharmaceutical companies’ existing business models, do so on your own dime by boycotting competitors and directing your money to first movers. (Hey, it worked for Tolkien.) But I’m not nearly so invested in protecting current business practices in the pharmaceutical industry, and I’d rather that you don’t use government monopoly to force your protections on my pocketbook.

John de Laubenfels:

starting the moment someone gets ahold of the new drug, analyzes it, and creates a knockoff? Nothing for all the money the original company has spent doing trials? I don't think that such a system would be either fair or likely to motivate companies to produce new, life-saving drugs.

On the cost of doing drug trials, of course, in the same sentence where I advocated the abolition of patents I also specifically stated that I supported the abolition of the FDA, which would dramatically reduce the compliance costs involved in developing new drugs and bringing them to market. So I don’t know what you’re referring to here. (Of course, if companies want to do internal testing they can do so, but in voluntary independent oversight systems, the costs of running trials are typically assumed by the independent watchdog organizations themselves, as part of their institutional charter.)

However, if it turns out that it’s no longer profitable for big, for-profit corporations to do medical research, then — horrors! — it may just turn out to be the case that medical research has to be carried on by non-corporate or not-for-profit institutions. But I hear we have some of those. And I’m not typically impressed by broken-window arguments that fail to take any account of the value of the unseen alternative uses to which money might be put, if not for the coercive government intervention.

To-day, in the online edition of The Freeman: Ideas on Liberty, you’ll find the following column — in which I find myself in the unusual position of saying that David Brooks did say one true thing in his New York Times column:

The Health Care Debate Has Been "Meaningful"? It Just Ain't So!

There’s no I in health care reform

Credit where credit is due: David Brooks does say one true thing in his New York Times column The Values Question (Nov. 24) on government health care reform: The system after reform will look as it does today, only bigger and more expensive.

Brooks is certainly right that no health care reform proposal with any chance in mainstream partisan politics promises any fundamental change to the status quo. What we have had is a system where pervasive government regulation, subsidy, and mandated captive markets corral workers into an industry driven by sky-high costs, managed by bureaucratic pencil-pushing and corporate economizing (often at the expense of innocent people's health or lives), and owned by a handful of uncompetitive, well-entrenched incumbent corporations. No mainstream reform proposal will change anything about that. The proposals mainly concerned themselves with introducing new government subsidies and new captive-market mandates to force yet more workers and money into the broken system.

But Brooks takes all this as a sign that the health care debate is about fundamental values. I think it's a sign that conventional political debate is a superficial squabble over meaningless details. The real debate is about grammar.

— Charles Johnson, The Freeman Online (2009-12-22): The Health Care Debate Has Been Meaningful? It Just Ain't So!

For more on why (although, if you’ve been here a while, you might be abe to guess), you can read the whole thing at the Freeman‘s website. The column will also be appearing in print in the March 2010 magazine.

See also:

• GT 2009-11-12: In which women's access to abortion becomes public-optional
• GT 2007-10-25: Radical healthcare reform

From Thomas Szasz The Freeman: Ideas on Liberty (May 2009): The Shame of Medicine: The Case of Alan Turing:

The persecution of homosexuals is paradigmatic of the history of psychiatry's monumental blunders and brutalities and of its policy of never acknowledging nor apologizing for them. Instead, organized psychiatry intensifies the celebration of its founding quack, Benjamin Rush (1746–1813). Declared Rush, I have selected those two symptoms [murder and theft] of this disease [crime] (for they are not vices) from its other morbid effects, in order to rescue persons affected with them from the arm of the law, and render them the subjects of the kind and lenient hand of medicine. What did Rush mean when he spoke of medical kindness and lenience? Lamenting the excess of the passion for liberty inflamed by the successful issue of the [Revolutionary] war, he explained, Were we to live our lives over again and engage in the same benevolent enterprise, our means should not be reasoning but bleeding, purging, low diet, and the tranquilizing chair. Psychiatry–glorifying the use of coercion as cure–is the shame of medicine.

From Bryan Caplan, EconLog (2009-04-24): Szasz on the Turing Tragedy:

In the last couple of decades, a lot of people have apologized for the past crimes of the groups with which they identify: the U.S. for Japanese internment, the Church for Galileo, Swiss bankers for Nazi money laundering, even the Japanese (kind of) for their war crimes. I’d like to see psychiatrists do the same — to admit that unusual preferences are not disease, affirm that it is wrong to treat people against their will, and turn their backs on the greats of their profession who believed in and practiced coercive therapy.

I’d like it, too. Psychiatrists expect to be taken seriously, both as scientific experts and as benevolent caretakers; I think at least a minimal requirement of being taken seriously on these claims would be for them to own up to the fact that within living memory, their discipline was rife with theories now universally regarded as the worst sort of politically-motivated pseudoscience and therapeutic practices now universally reviled as the worst sort of atrocities. They have been wrong about everything and they ruined life after life with the most appalling sorts of brain-damaging treatment on the basis of these pseudoscientific superstitions. If shrinks want to be taken seriously, they need to start by owning up to their record; because if they can’t do so much as that, the rest of us have every reason to expect that they’ve done nothing to correct the systematic vices that led to the ridiculous lies and sadistic horrors they were inflicting as recently as 30-40 years ago. But I don’t expect anything like it to happen this side of the revolution.^*. As Szasz says in The Freeman: Ideas On Liberty (July/August 2009): The Shame of Medicine: The Depravity of Psychiatry:

I am grateful to Caplan for calling attention to a problem most people prefer to ignore. His expectation will, however, not be fulfilled, and it is important to understand why. Claiming competence in astronomy and incarcerating heretics are not integral to the identity of the Catholic Church. In contrast, claiming competence in predicting dangerousness and incarcerating persons alleged to be so because of mental illness are integral to the psychiatric enterprise.

From GT 2008-06-24: Medicated madness

Of all the horrible things that institutional psychiatry routinely does, one of the most infuriating for me is its stupidly aggressive lack of anything approaching self-consciousness or critical reflection. In a field where, not half a century ago, patients were routinely locked away in filthy hellholes that would be hard to distinguish from a medieval dungeon, and, once confined, subjected, against their will, to restraints, tortures and mutilations that would have made Torquemada blush — camphor shock torture, repeated massive electric shocks to the brain, and, at the end of the road, an icepick jabbed through the eye socket and rotated so as to mutilate the brain and deliberately destroy centers of personality and higher cognition — in a field, I say, where all this was dignified as brain damaging therapeutics and regarded as best practices for a scientifically-informed helping profession — in a field where current practitioners now more or less universally agree that torture like this was based on little more than pseudoscience and quackery, and where almost no-one in their right mind would propose ever using practices like these on any patient today — in a field, that is to say, where within living memory thousands of people were subjected to the worst kinds of sadism and torture that the human mind can devise, and all of it based on what are now almost universally acknowledged follies, illusions and lies indulged in by the recognized experts of the field — in such a field, you might expect at least a little bit of humility, historical awareness, and decent caution, rather than sanctimonious self-righteousness and aggressive obliviousness to the idea that psychiatric practice itself might perhaps be part of the problem.

In point of fact, there are countless cases like this one, cases where a life crisis becomes the occasion of massive psychiatric intervention, and where the intervention itself spirals into years of institutionally- and chemically-manufactured madness; in which the stereotypical behavior of the psychiatric patient, invariably passed off as part of her disease, can in fact be traced quite directly to the physiological, behavioral and social effects of the forced drugging, the forced confinement in hospital psychoprisons, and other aspects of psychiatric therapy. Psychiatrists then have the gall to use those same symptoms, created by their own therapy, as proof of the need for even more of the same.

Under the present circumstances, there is no reason to believe that individual psychiatrists or psychiatric institutions will ever trouble themselves to acknowledge this possibility or to incorporate it into their practice in any way that matters. It’s not just the financial incentives — although those are certainly there, and those are certainly important. The problem that underlies the financial problem is that psychiatrists have no real reason to care whether they get things right or not. Why should they? They are backed by cultural prejudices in favor of doctors; they can dismiss any complaints by their patients as literally the ravings of lunatics, and almost no-one will bat an eye; they are backed up by the force of the law, which gives them the power to force their latest and greatest therapies on a literally captive market of unwilling patients. Unless and until psychiatrists no longer have the privilege of inflicting nonconsensual treatment, which is to say, unless and until they become directly accountable to the will and desires of the people for whose benefit they claim to be acting, cases just like Nikki’s are going to happen again, and again, and again.

Here’s the opening of a story published earlier today by Dan Ball at KVBC News 3 Las Vegas, entitled Few new City Hall obstacles remain

It looks like the city of Las Vegas may soon get a new City Hall.

No, we won’t.

Last I checked, the city government in Las Vegas will soon get a new City Hall.

The rest of us in the city of Las Vegas aren’t getting anything, except the $185,000,000 bill for Oscar Goodman’s new office.

For six years, chef John Simons has operated Firefly restaurant on Paradise and Flamingo. Four months ago he opened a second location inside the Plaza hotel downtown. Simmons says he supports a new City Hall.

I’m hoping that we can develop kind of a really cool, vital downtown scene, ya know?

Because nothing says really cool and vital in a downtown scene like municipal government office buildings.

Betsy Fretwell is the city manager for the city of Las Vegas.

If we can move the City Hall from its current location we will be able to create about $4 billion in private investment in the downtown area and create over 13,000 jobs over the period of time and over four projects.

Well, hell, why don’t we just move the City Hall every year? Why not build a new one every month? Just imagine how much private investment and how many jobs all that new construction could create.

The project is estimated at about $185 million. Fretwell says the city can afford to pay for it.

You do have to evaluate what you can afford. We’ve done that, we’ve done a full feasibility report for the City Council. …

Actually, what’s happening here is that she does the evaluating. We do the affording. Whether we want to or not.

Betsy Fretwell doesn’t have to afford a damned thing; she evaluates, and we’re forced to pay up whether we reckon we can afford it or not.

Hence, this massive screwjob against Las Vegas workers, in order to fund a ridiculous and obviously self-serving local government boondoggle.

See also:

• GT 2009-04-13: The grammar of war
• GT 2007-05-13: Cry havoc! and let slip the pronouns of war...
• GT 2006-12-21: In ten words or fewer (personal pronouns edition): George W. Bush on the next year of the Iraq War

I got this story by email from a private correspondent. Right now, most of the news stories on this terror-murder, and the homophobic victim-blaming by the government police’s investigator on the case, are printed in Spanish. So I’ve translated the story into English, below.

Jorge Steven L?@c3;b3;pez Mercado was an openly gay 19 year old, well known in the local gay community in Cayey, Puerto Rico. R.I.P.

Solicitan relevo de agente investigador en asesinato de joven homosexual en Cayey

Portavoces de Puerto Rico Para Tod@s y la Fundaci?@c3;b3;n de Derechos Humanos exigieron hoy una investigaci?@c3;b3;n libre de prejuicios por el asesinato de Jorge Steven L?@c3;b3;pez Mercado, un joven homosexual de 19 a?@c3;b1;os, que se presume fue víctima de un crimen de odio y cuyo cuerpo fue encontrado el viernes calcinado, decapitado y desmembrado de brazos y piernas en el área de Guavate, en Cayey.

El líder activista y portavoz de Puerto Rico Para Tod@s, Pedro Julio Serrano, denunci?@c3;b3; que el agente investigador del caso, Ángel Rodríguez Col?@c3;b3;n, realiz?@c3;b3; expresiones inconcebibles, inmorales y antiéticas, referentes al homicidio.

“Este tipo de personas cuando se meten a esto y salen a la calle saben que esto les puede pasar”, expres?@c3;b3; el agente Rodríguez a un noticiario televisivo (Univisi?@c3;b3;n).

“Es inconcebible que el agente investigador aduzca que la víctima bus?@c3;b3; ser asesinado. Es como el abusrdo y falaz argumento de que una mujer se busc?@c3;b3; ser violada por llevar falda corta. Exigimos la renuncia al caso de este agente investigador y que el Superintendente Figueroa Sancha ponga en su lugar a alguien capacitado que investigue este vil asesinato, por prejuicios de clase alguna”, manifest?@c3;b3; Serrano.

Por su parte, la licenciada Ada Conde, presidenta de la Fundaci?@c3;b3;n de Derechos Humanos, le solicit?@c3;b3; a Figueroa Sancha y al Secretario de Justicia, Antonio Sagardía, que cumplan con la ley y establezcan mecanismos para que se investiguen este tipo de casos y que se procesen como crímenes de odio.

— Bárbara J. Figueroa Rosa, Primera Hora (2009-11-15): Solicitan relevo de agente investigador en asesinato de joven homosexual en Cayey

Translated into English:

They call for relieving the agent investigating the murder of a homosexual youth in Cayey

Today, spokespeople from Puerto Rico Para Tod@s [Puerto Rico for Everyone] and Fundaci?@c3;b3;n de Derechos Humanos [the Foundation for Human Rights] demanded a prejudice-free investigation into the murder of Jorge Steven L?@c3;b3;pez Mercado, a homosexual youth of 19, who is presumed to have been the victim of a hate crime and whose body was discovered Friday burnt, decapitated, and dismembered of arms and legs in the area of Guavate, in Cayey.

The activist leader and spokesman for Puerto Rico Para Tod@s, Pedro Julio Serrano, denounced the fact that the investigating agent for the case, Ángel Rodríguez Col?@c3;b3;n, made unthinkable, immoral and unethical statements referring to the homicide.

When this type of people get involved in this and go out in the street they know this kind of thing can happen, Agent Rodriguez told a TV news program (Univisi?@c3;b3;n).

It’s unthinkable that the investigating agent would allege that the victim was looking to get murdered. It’s like the absurd and fallacious argument that a woman is looking to get raped by putting on a short skirt. We demand that this investigating agent get off the case and that Superintendent Figueroa Sancha replace him with someone capable of investigating this vile murder, without any kind of prejudice, said Serrano.

For her part, the lawyer Ada Conde, president of Fundaci?@c3;b3;n de Derechos Humanos, called on Figueroa Sancha and the Secretary of Justice, Antonio Sagardía, to comply with the law and establish mechanisms for investigating this type of case and processing them as hate crimes.

— Bárbara J. Figueroa Rosa, Primera Hora (2009-11-15): Solicitan relevo de agente investigador en asesinato de joven homosexual en Cayey