I got this book because I heard one of the author’s speak on one of the podcasts I listen to…not sure which one. Maybe I should keep track of that! These are just notes about the book, not a whole lot of deep thinking or rewriting here. Skip to the end to read what I really got out of the book!
Chapter 1 – How We Got here
“Alarmed by the proliferation of unregulated rivals, the university-trained physicians organized into country and state medical societies and lobbied to enact licensure legislation,”
See. That’s what happens. Why, as a user of medical advice, ask the person I’m going to where they were educated, look at reviews, make up my own mind about whether I believe they are capable? Do I really trust a third party (government) to tell me?
“the stricter standards just as surely harmed patients of modest means who would have preferred to hire the services of a cheaper provider, an option that was now illegal.” And I’d say I poor doctor is better than no doctor at all. It goes for “organic” food too. Pesticide sprayed food is WAY better than no food. You cannot take options away from people “for their own good” and kill them.
“a government intervention into medicine leads to a problem, but rather than repeal the initial measure, the government simply slaps on further interventions.” Yes. That goes for intervention into anything. Food, shelter, health care, education.
My note from the margin, How pervasive was the problem of poor doctors giving bad treatment to warrant laws that made the unintended consequence of fewer doctors all around?
“many influential doctors welcomed the restrictions because they gave them a relative advantage over their competitors.” And I’m sure they had the hubris to believe that they knew what was best for everyone. I mean, you should be going to us and paying X, not that guy and paying less. He’s a lesser doctor! Well, yes, but I can’t afford your X fee and now I have no doctor.
Here’s one you’ll like…”there’s nothing magic about health insurance” and “you don’t use your car insurance to pay for a routine oil change”
And here’s the problem, “In order to provide this much coverage and still keep premiums affordable, the doctors and hospitals sought the help of the government.” It’s a ‘public good’ right?!
“the government never gives out a favor without strings attached.” and taxes.
“Moral hazard refers to the fact that people take on greater risks when they are personally shielded from the negative consequences.”
A note from the margin, when people ask me ‘what about the poor?’ because they think they poor didn’t get medical service before insurance, I’d like to ask ‘are they getting it now?!’
“the doctor-patient bond had been a fiduciary relationship that was mutually beneficial.” and thanks to third party insurance that relationship is dead. Think about it. Why would a doctor not do his best to keep you healthy and happy? Is he going to keep getting paid if he doesn’t? Now he really doesn’t care. You don’t pay him, the insurance company does and thanks to the lovely regulations, there are so few doctors now that if you leave, they are happy to see one less patient.
1942 Stabilization Act (look into that)
“The E&M coding system allows for levels of billing from the most simple to the most complex. In order to bill at higher levels, you have to rack up more elements in each segment of the medical record.” That’s part of why I have to endure so many tests to get birth control. It has nothing to do with good health care.
Some doctors have to hire an extra person do the recording on the computer while they treat a patient. A computer person needs to translate what the doctor is doing into legalese for the insurance and government. Crazy. What if they end up doing something like this in education? Maybe they already have!
HIPAA violations…and “potential” ones! The cost of health care isn’t going up because of greed it’s because of government.
Chapter 2 – The Deadly FDA
A note in the margin…so the answer to “our system works” is to revamp it and make it different?
“According to one estimate for the 1950s and early 1960s, it then cost about half a million dollars and took about twenty-five months to develop a new drug and bring it to market…By 1978, ‘it was costing $54 million and about eight years of effort to bring a drug to market’” The introduction of the FDA has raised the cost of creating new drugs so high that companies can only afford to work on drugs with a large market, or rely on federal funding (taxes) to keep them in business.
A note in the margin…why not have FDA approved drugs and non-FDA approved drugs and let people choose?
“on one occasion US marshals seized and destroyed 12,000 gallons of P&G’s orange juice because it was labeled “Citrus Hill Fresh Choice” (for what it’s worth, the juice had the disclaimer “Made from Concentrate” on the packaging, but FDA officials said the print was too small)” Yay! Saved from the horrors of mislabeled orange juice!
A note in the margin…Why? What benefit is it to the FDA to have a bad drug out? Do they do it on purpose or is their system so screwed up they really aren’t helping anyone? It’s just as likely that a bad drug would be on the market after the FDA as before.
“in the real world, most patients are on multiple medications for which their side effects are additive” like vaccines, tested individually but never in bulk the way they give them to children.
“we are pointing out that the current system – with the FDA sitting atop a pyramid of control by the power of law – suffers from institutional biases that would be weeded out in a more competitive arena with multiple “authorities” providing expert product review.” I think most people would agree that the system doesn’t work as well as a thinking and reasoning population of humans. But most people don’t believe that actually exists. They think that most people will kill themselves if left to make important decisions on their own when in actuality some will but most will not. A larger portion will not if they are allowed to take care of themselves.
“What you should now be starting to see is a particular pattern that develops when the government is given the power to regulate. There is an immediate alliance that develops between the government and the dominant players in the industry to be regulated. A naïve observer might expect all private companies to adamantly resist government interference with their business. However, the biggest companies in an industry often recognize the advantages of costly new regulations.” This is perfect. I wish everyone could understand that this is what happens when government regulates anything and it is what has caused so many of our problems the past 100 years. Capitalism and liberty do not create it, government does. And giving all the power to the government as in socialism will only create bigger problems.
My note in the margin…people think that if there were no regulations/FDA, companies would kill more people with bad drugs and procedures, but it’s just not true especially with today’s communication. One bad drug and the trust is gone…if we were thinking for ourselves instead of trusting the monopoly on approval and usage, the FDA.
Chapter 3 – The Medicare Ponzi Scheme
“the government taxes current workers in order to pay current retirees” Ponzi Scheme. And you are forced to buy into this one.
“the bulk of those painful projected budget cuts conveniently occur in the future, when other people will be in office”, who will then amend the law to remove those cuts or postpone them to the future again.
“the original “investors” are paid not with the genuine earnings created from the wise investment of their initial contributions, but instead with money flowing in from the next wave of “investors”” Why is this ok when the government does this at the point of gun? Because previous generations voted it to be a good thing to do to their children and grandchildren? Why is it wrong for me to do it by convincing people to “invest” but ok for the government to force you to do it?
Chapter 4 – The Perverse Economics of US Medicine
“the ACA won’t solve the festering problems in the US health care system, but rather, will exacerbate them and hasten the degradation of the private sector.” I think this is the intended idea.
Confusing “care” with “insurance”. It’s not really insurance. And it’s tied to an existing employer.
“Some readers might be tempted to say, “Annual testing – money is no object when it comes to my daughter’s health!” but that ignores reality. If cost really is irrelevant, then why not weekly or daily testing? At some point it is obvious that more frequent testing “isn’t worth it.”” People say this because they aren’t paying for it and most don’t believe they should pay for it. They honestly believe that the rest of the country owes them health care, among other things.
What if we stopped saying “government” owes us and say what it really means, “the people of this country”?
“The public can’t have it both ways. If they want a government strong enough to take care of them, they must be willing to endure a government with the power to kill them.” But I don’t think that’s right. They believe that there is such a thing as a government that can take care of them and there isn’t. No one is more interested in your well-being than you.
Chapter 5 – The Inner “Logic” of the Affordable Care Act
“there is nothing qualitatively different about the ACA; it is simply an extension of trends that have been in motion for many decades.”
“each intervention spawns further problems, which are then cited as the rationale for further encroachment.” How can people not see this? Does everyone think that all the laws that exist now have always existed? That this has been the way things have always been and will always be unless we make one more law?
Chapter 6 – The Fatal Flaws of the ACA
Bastiat “The State is the great fictitious entity by which everyone seeks to live a the expense of everyone else.” We will eventually run out of other people’s money because we cannot force them to make more.
“the government doesn’t have any resources” Yes! Few people seem to understand that the only money the government has was taken from someone else. Each year you take from the “rich” there will be less to take and they will take from more and more of what you call “middle class” and then the poor.
If you operate a health insurance like you do any other insurance it’s a viable business, but if you force them to pay for regular care and keep their prices low, they will go out of business. But people think that if the government runs it they will never run out of money. Why? Because they can print it? Or steal it from someone else?
“CBO estimates that the ACA will reduce the total number of hours worked, on net, by about 1.5% to 2% during the period from 2017 to 2024, almost entirely because workers will choose to supply less labor – given the new taxes and other incentives they will face and the financial benefits some will receive…The largest declines in labor supply will probably occur among lower-wage workers…”
And that’s good for us all because the un-employment numbers will go down! And people will have more time with their families. That’s actually what people are saying. And this will happen way after the people that made the new law will be leaving office and the people will blame the lower productivity and less jobs on something else, make a new law, etc. This is just nuts.
“But if the employer reduces (or eliminates altogether) spending on the employee’s insurance, and increases monetary compensation instead, then the extra wages are taxable income.” And that is effectively raising taxes on everyone, not just the rich.
Chapter 7 – Paving the way for “Single Payer”
“…eventually it will become clear to the pundits and political officials that the “free market system” is still broken and the government “needs” to intervene yet again.” This is exactly what I said when they passed this dumb thing. It was created to forcibly break the system even more, not fix it, and then the people will be clamoring for the government masters to take over.
Chapter 10 – Choosing Your Doctor
Thinking of a doctor as a sherpa. “Despite his superior knowledge, conditioning, and familiarity with the environment, the sherpa knows he is your servant. His authority is always delivered in a subservient fashion, because he knows you are the one paying him. He lets you set the goals and agenda and tired to accomplish them within the constraints of reality.” I really don’t think this type of doctor exists, especially out here. It sure sounds nice though.
“You do not need a doctor to be well.” And they insist that you do!
“When testing is done just for the appearance of thoroughness in order to decrease malpractice risk, you face a greater chance of false positives.”
“Alternative Providers” People like nutritionists and homeopaths are “wellness care”.
Chapter 11 – Getting off your meds
This part really hit home. When my sons were young I went to the doctor about anxiety. She gave me a heavy dose of anti-anxiety meds. It helped a lot, but I could never find the real help I needed. The meds healed a symptom, not the disease, and it took me 8 years to get off of them and find real help elsewhere. I never really did. I read and thought and discovered on my own to try and get off the meds. It might not have taken so long if I had found help.
Chapter 12 – Surviving the hospital
“Have an advocate” That’s what I took from this chapter. You are too sick to question and search for answers. Have someone there all the time that knows what you want and is willing to work for it.
Chapter 13 – Medical Screening & Elective Procedures: Worth the Risk?
“…find yourself at risk for type II diabetes and Alzheimer’s dementia. What should you do?” Eat better, get exercise, and stay fit, but it won’t stop it from happening, it just reduces your risk of becoming ill. You can do that anyway, without the tests and worry.
“What seems like a matter of necessity is really a matter of our unwillingness to endure the pain and suffering for the period of time it takes Mother Nature to heal the injury.” So many times I’ve wondered if I should go to the doctor for something, put it off, and found that the problem corrected itself.
Chapter 15 – Living Health and Free
I just like that title. And here’s the real take away from this book, “…it’s about reducing stress and embracing independence as a way of life. Benefits will spill over into other areas of life, including your career and personal relationships.” and “there are always going to true experts in every walk of life who know more than you, but you must develop the ability and confidence to identify sincerity and reject charlatans.” Yep. This is something I found by leaving the education system completely behind. Greatness is still achieved and at a much higher rate without trying to conform myself and my family to their standard of living and learning. And it spilled over into my relationship with Jesus when I left the idea of the church as authority and gave it back to Him. It’s spilled into my relationship with family and friends. And now…into health care. If only I had this information from my youth, where would I be now? Raising my children to be confident and independent thinkers gives me some hope that there will be change in the future.