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In this Fox article, Edward K. Glassman, my long ago Harvard classmate, author of Dow 36,000 (predicting Dow at that level by 2005), and current director of the George W. Bush Institute, extolls our free market medical system. The first reader to comment agrees that we have a “ free market” system, but thinks that “ profit based healthcare” should be “outlawed.” Another reader thinks that we actually have “socialized medicine.”

So what do we have? I think the most apt description would be crony capitalist medicine, one in which powerful special interests conspire with government officials to create legally mandated monopolies, with the specific goal of thwarting free market competition.

Here is how it actually works:

 1. Most people wonder why there are no visible prices in medicine. You only find out what the charge has been after the service has been delivered. There actually are prices, controlled prices, but you aren’t supposed to know what they are. Each year a committee of the American Medical Association recommends a set of prices to Medicare. The committee is dominated by medical specialists, so specialists tend to do particularly well. Medicare is actually run, not by government, but by private insurance companies, and these companies adopt these prices for private insurance purposes as well.

Congress further sweetened this price controlled system for hospitals by requiring Medicare to pay  more for the same service if provided by  hospital employees. This has inevitably led to local hospitals buying out most of the surrounding private medical practices, which has in turn created local medical service monopolies that feed patients to the hospital for its more costly services.

2. These monopolies are further sweetened for doctors by legally barring nurses, chiropractors, four year trained naturopathic doctors, and other health professionals from using the full extent of their medical training. In this way, the supply of medical services is constrained, which further raises prices.

3. Notwithstanding all the preceding, it is not the American Medical Association, which is itself financed by a monopoly in medical coding granted by the US government department of Health and Human Services, nor the hospitals, nor the medical doctors as a group that actually run the medical system. The top spot is reserved for the drug companies, which in turn share their largesse with the AMA, doctors, medical journals, media companies, and especially with politicians. In return, drug companies are granted a series of powerful monopolies, monopolies that are drive up the cost of medicine and, given the employer role in healthcare, destroy jobs, raises, and economic opportunity as well.

First, drug companies claim a legal monopoly when they patent a drug. The drug research may have been done by the government or by a university using government money but it doesn’t matter. The grant of monopoly stands.

Then the drug company takes the patented medication through the FDA approval process ( average cost of $3 billion over what can easily be a decade). Drug companies do not object to this ordeal, because the stiff price both eliminates any competition from unpatentable treatments and also flows into the salaries of FDA employees, who consequently tend to take a friendly view of drug companies and zealously guard the legal exclusivity of their products.

FDA enforcement includes armed raids and threats of a lifetime in jail for any producer who makes medical claims without permission. Even cherry and walnut growers have been threatened. The agency takes the position that for producers to make health claims for these heavily researched and very healthy “ superfoods,” they must first turn them into drugs through the drug approval process.

The end result is a narrow supply of licensed drug treatments that are often highly toxic and rarely cure anyone, both because curing the patient would end the gravy train, and also because drug side effects inevitably lead to the prescription of more drugs. If a treatment is safe, effective, and cheap, it is immediately purged from the medical system as “unapproved,” not “ standard of care,” when in effect its real defect is that drug companies cannot make billions from it.

For example, people who have acid reflux are more often than not suffering from a lack of stomach acid, not too much of it. The resulting incomplete digestion is the source of the problem.  They could cure it with acid supplements costing pennies, but nobody will ever tell them about this or suggest testing their acid production. Similarly, patients with frightening heartbeat irregularities are rarely told that they need more magnesium, a very cheap mineral,  although they may need it in IV or transdermal form for the same reason ( lack of stomach acid is interfering with absorption of the mineral). Instead,  reflux patients are given expensive prescription acid blocking drugs that pose a risk to the entire immune system, and have been linked to pneumonia, other infections,  bone loss, and many other medical calamities, while heart patients are put on prescription blood thinners that can themselves cause life threatening internal bleeding as well as bone loss and other problems.

No, this is not a free market system nor anything remotely close to one. In a genuine free market  system, prices reflect the decisions of consumers. Producers who solve significant problems are rewarded with high prices and profits. High prices and profits in turn attract lots of competition. The competition not only prevents monopoly. It also improves quality and very importantly increases supply, which is the only sustainable way to reduce prices. Consumers then get better medicine and ever lower prices. Producers dislike competition, and therefore try to buy government help in manipulating or fixing prices. This is more easily accomplished in medicine, because it can all be done under the guise of government “ protecting” consumers when actually the consumers are being fleeced and impoverished.

There are many honest and dedicated medical professionals sincerely devoted to the healing arts. But they are trapped in a system that can more accurately be described as a crony capitalist nightmare.

From LRC, here.

According to official history, the 104th Congress doomed itself when it shut down the government to force its budget priorities on the president. People got up in arms and demanded that government be reopened. This taught the people and their representatives a valuable lesson. As much as we may complain, we truly need big government. Today, we all agree with the White House vow to never allow the government to shut down again.

Of course, everything about this story is nonsense. Shutting down the government was this Congress’s most noble act. Though the freshmen, who forced the closing against the leadership’s wishes, didn’t properly prepare for the inevitable response from the media and the bureaucracy, they were on the right track. It may have been the only principled act in two years of political compromise.

Moreover, nobody has produced a shred of evidence that the government shutdown was as unpopular as the media claimed it was. It was asserted daily, but never proven. Oh sure, we heard about how people couldn’t get passports, couldn’t get into Yellowstone, couldn’t see the Vermeer art exhibit at the National Gallery of Art. But what’s most startling is that the central government—which consumes 40 percent of the national wealth—wasn’t missed much at all.

There was a fiscal illusion at work. At issue was a budget authorization that entitled government to spend money before it was there to spend. But government could have reopened, and run based on present receipts. That way the budget would be immediately balanced. Everyone claims to want pay-as-you-go government, but nobody suggested this as an option. They acted as if debt finance is part of the natural law.

There is still more to learn about government during shutdowns. Consider what is known as the “Washington Monument Ploy.” When budget cuts are threatened, visiting hours at popular monuments are cut back. A budget cut is voted by Congress, or an insufficient increase, and moments later an official-looking official asks the assembled tourists to please disperse. Thanks to those greedy Congressmen, we’ve been denied essential funds.

The media are there to record every word, and conduct interviews to be broadcast on national television. Average people tell the reporter, “my family and I came all the way from Sacramento, but because of political bickering, our vacation has been ruined,” etc. The lesson is clear: Congress had better vote every dime the president demands or the People will strike back on prime time news. Sadly, this ploy works time and again.

Behind the scenes, the whole scenario has been orchestrated. There are very few things the federal government does that people directly benefit from. Among them are issuing passports, delivering the mail, running monuments and museums, and maintaining national parks. That’s precisely why they take the hardest hit.

Now, in running the Washington Monument Ploy, the White House has to be careful not to cause it to backfire. For example, if the mail stopped being delivered, the public might revolt against the Post Office itself, and fuel demands that it be privatized. The trick is to shut down services that affect a minority conspicuously, in ways the media can dramatize, but not generate anger against government itself.

What’s behind it all, of course, is the desire to keep the largess flowing, not to serve the public. If the feds wanted to serve the public, and Congress wasn’t authorizing new spending, they could divert money from services people don’t need (“Social Services for Refugees and Cuban/Haitian Entrants”) to those they do need (passports). Even better, a truly beneficent leader would simply give away control of monuments and passport offices to private entities to run for profit.

Here’s the irony. The services that people need most from government are the very ones that could easily be run privately. This follows by definition: if people want something, an entrepreneur is glad to make a profit providing it. On the other hand, the services people don’t need shouldn’t exist at all.

From a strategic standpoint, the government has the incentive to hold onto privatizable services like national parks because they are useful in times of government shutdown. It monopolizes some services just to keep the public from thinking they could get along without the government.

This is more than just a budget trick; it goes to the heart of nearly everything government does. Even at the local level, when budgets are cut, the first thing to get the axe are extended hours at the public library. Then the most popular periodicals themselves are canceled. Government, in its malice, gains more benefit from withholding useful services than providing them.

This is the very opposite of how private business operates. When a business has to cut costs, it looks for waste and inefficiencies, but it is loathe to cut consumer services. In fact, it might improve them if doing so is likely to bring in more revenue. Sticking it to the consumer would only create more losses and drive the company toward lower profitability.

With government sabotaging any attempt to cut its budget by cutting services people want, how can government budgets be successfully cut? There’s no easy answer—ideally the person doing the cutting would have massive power over the bureaucracy—but here’s the first step. All so-called essential government services should be privatized. That way government would no longer be seen as economically or socially essential.

Let’s start with the Washington Monument. There’s no excuse for not handing it over to a private company or association to run, just as Mount Vernon is run privately. Those who say it can’t be done haven’t noticed how many people visit that political temple every year.

But isn’t this monument a public good that people should have full access to? Granted. That’s why we need private enterprise, which always focuses on the public, to provide it. The same is true of the mails, national parks, passport offices, the Smithsonian, or any other good or service the government provides that people regard as necessary to their well being.

The advantage would be obvious. During the next government shut down—let’s hope it comes soon and stays long—the bureaucracy would have fewer means of demonstrating that we really need them. They will be reduced to showing how awful it is that the Indian and Native American Employment and Training Program has been shut down.

All of this presumes that government has no other means to fund itself during emergencies. Unfortunately, that is not true. During the 1995 shutdown, Treasury head Robert Rubin conspired with other government-financial elites to run the government on money looted from civil-service pension accounts, although this is illegal.

Then the bureaucracy gave Congress a sock in the chops by forwarding unearned back pay to the entire government workforce. The whole shutdown ended up as a paid vacation for the most despised class in the country. If anything about the shutdown inspired public anger, it was this above all. Sadly, the opposition party took the blame, and then let bygones be bygones.

The lesson of the government shutdown is not that people want it to stay open, always and forever, but that the world doesn’t fall apart when Uncle Sam takes the day off. Let’s give him the next century or so, see how the people on their own can restore prosperity and liberty. With no taxes to pay, there’d be plenty left over to pay even exorbitant admission fees to the Washington Monument.

From LRC, here.