For once, the most compelling thing I found today at National Review was a comment. Nothing against Jonah Goldberg, whose brief post was about insurers and the question of whether or not they would resist the edicts of ObamaCare. It’s just that the commenter, one devan95, exhibited real passion:
Will Obamacare be repealed or won’t it? Will Congress fund it or won’t it? Will the web site be fixed or not? Blah, blah, blah. We the people just need to do what we need to do and Congress be damned. Resist. Refuse. Revolt. EXEMPT OURSELVES! We did not comply with Prohibition and we simply should not comply with Obamacare. For religious reasons. For privacy reasons. For the cause of liberty and freedom and in protest of the idea that the federal government (under one party rule, no less), can force private citizens to purchase anything with our own money. Are we citizens or subjects? Mice or (wo)men? Just say NO to socialism and to the corrupt, unionized, far left IRS: the gestapo of America’s political class. After all, the federal government ignores millions of illegals who are breaking U.S. immigration law every day. Our Founders pledged their lives, their fortunes and their sacred honor. All we have to do is just say no to a scheme we all know is un-American and a violation of our most basic founding fundamentals of privacy, self reliance, limited government and individual freedom.
Which got me thinking. He’s not alone out there. Surely, there are plenty of people, mostly healthy people not coincidentally, who would go to extreme lengths to opt out of this massive income redistribution scheme. When prices are artificially inflated or access is artificially limited to any product or service, the inevitable economic by-product is a black market.
ObamaCare has already been compared to Prohibition as a colossal error of public policy which led eventually though inevitably to repeal. But perhaps the Prohibition analogy should also be instructive. It was the rise of the bootlegging industry and all its associated institutions which made it clear that the law was an unenforceable failure.
Let’s think about the shape and prospects of bootleg medical care.
Prohibition put a lot of distillers out of business. Today, thousands of doctors are threatening to retire early and shut down their practices. They are the new potential bootleggers. How might they continue to live up to the Hippocratic Oath, make a living, and help restore the integrity of their profession?
The answer is: lotsa ways. The market for their wares is there, and unlike with abortion, there is no shame about needing and wanting medical care that doesn’t cost as much as your home mortgage. Just as people in the twenties didn’t feel shame about wanting a drink. Which means lots of those in positions of authority will be willing to turn a blind eye. To what? The sudden establishment of thousands and thousands of health care speakeasies.
Yes, house calls will make a comeback as private citizens make private deals with doctors in their circle of acquaintance (compare with bathtub gin). But diagnostics requiring medical equipment, tests, and drug treatment will require facilities. Where might these be located without detection?
Well, how about bars and restaurants? You know, those back rooms and upstairs rooms that only insiders usually visit for clandestine poker games, et cetera. What is suspicious about going out to lunch or dinner or an evening drink? Costs can be considerably lower without impoverishing the doctor. No regulations, no need for malpractice insurance, no use for the markups of pharmacies (more on this later). The quality is controlled by reputation. A doctor who screws up loses customers by word of mouth, not hideously expensive lawsuits. A good doctor benefits the same way. There’s no advertising expense — no TV ads, no yellow page displays, only word of mouth.
In the event of a need for surgery or capital-intensive diagnostics (MRI, etc), there will still be emergency rooms, but that doesn’t have to be the only resort.
Who exists on the fringes of the healthcare industry, not yet fully ensnared in the forests of regulation and government funding and bureaucracy that so plagues contemporary medical practice? I give you dentists and veterinarians. More or less, they still operate as entrepreneurs, often doing cash deals in place of insurance minuets, and they have the ability to prescribe drugs. (I once knew a buccaneer vet who dispensed antibiotics and such to his intimates, because in many cases, they are the same drugs, just not so hard to come by.) Both vets and dentists also have surgical facilities OR the right to procure same. Both also have laboratory facilities or access to same.
Need an appendectomy? Call this number. An unmarked vehicle manned by a skilled driver will transport you to the back door of Doggies’R’Us, and a thoracic surgeon will do the job in the spotlessly sterile operating room you rely on for your cocker spaniel’s spaying operation.
But we haven’t gotten to the most colorful feature yet — moonshiners. Yes indeedy, if there’s one thing the world’s other black markets know how to do, it’s transport drugs anywhere and everywhere. What do you need? They can get it and fast. But in this case there’s a price they have to beat, meaning the going retail market price. Only they don’t have the same cost structure as a pharmacy. And they’ve got to stay within spitting distance of the price of veterinary equivalents.
All right. Enough of the road mapping. Black markets always find their own way. But I urge you to think about the possibilities. If people really do revolt, resist, opt out, whatever they call it, they have a chance to show everyone else how cheaply a free (if illegal) market can do things. People will be paying cash, whether they join groups or not, and they will think twice before they consult a doctor about a hangnail or a bout of indigestion. They will question what tests are needed. They will take responsibility for their own health, and doctors will have to replace paperwork with an old-fashioned bedside manner.
And moonshiners, er, medshiners, will become the new, glamorous pirates of America.