The dilemma faced by doctors, nurses and others in the health care team are just as you describe. Rationing and budget blowouts in New Zealand’s public hospitals are a direct result of the inability of the health market to set realistic prices for the services they offer (and thus match supply with demand).

There are even price controls in so-called “private” medical practice here in New Zealand. Family practitioners are denied the right to raise their charges by more than a certain percentage, and have to justify any “excessive” increases before a kangaroo court of accountants, which can disallow their fee rise without reference to things such as the economic viability of the business in question.

The corollary of this is that medical practices in New Zealand are now struggling to find doctors to cope with rising demand, as they cannot afford to pay them high wages. Our graduate doctors are heading overseas in large numbers to better-paying jobs. The doctors that remain here are struggling to cope with an almost endless demand encouraged by the subsidisation of medical fees.

The only solution to the problems faced by doctors worldwide is to allow a free market in the practice of medicine. Let doctors set their own prices; allow lesser tiers of qualification, such as medical assistants, nurse practitioners and others, and stop government interference in the training and oversight of practitioners. Let doctors, nurses, and allied professionals administer themselves. Let private ratings agencies and consumer watchdogs exert pressure on poorly performing hospitals and health services. Allow free passage across borders so that under-resourced areas can more easily attract the necessary manpower, from abroad if necessary.

In my own country, despite the badly-needed economic reforms of the late 1980s, there are now no mainstream political parties remotely interested in establishing a free market in anything. Thus was set up in 1993 a pro-free market minarchist political party: Libertarianz – the Libertarian Party of New Zealand, which I am proud to say I currently lead. I was very pleased to see that at long last there is a Libertarian Party in the United Kingdom, and that one of its major policy platforms is deregulation and gradual privatisation of the NHS.

The Daily Mail website contains numerous stories about the inevitable results of nationalising health servies in Britain – long queues, interminable waiting times and people taking matters into their own hands – even performing home dentistry, with a Gulf War veteran removing thirteen of his own teeth with a pair of pliers because he could not get an appointment with an NHS dentist. Horror stories like this abound, but no-one seems to want to strike at the root of the problem: an unwillingness to decouple the state from the provision of health care.

Thanks again for writing this, Aeon; it gives people like me at the coalface some hope. It’s heartening to see that there are like-minded individuals out there possessing the courage to challenge the accepted “wisdom”. I liked your appropriate use of the North Korean flag!

This post was mentioned on Twitter by TorrentX: RT @davidrand: Why mainstream political parties are so ineffective at taking on the BNP http://bit.ly/48UF9P #tcot…

My comments are directed to David S.

I am a native of Houston, Texas, which hosts the world’s top medical center and is the fourth largest city in the US. In addition, Houston has a huge immigrant population and a high number of uninsured citizens. No one is dying in the streets. If people are dying in the streets of America, the ratings-hungry press would’ve been all over that!

I did see on the news where hospitals would occasionally go on “drive by” status, which simply meant their ER was full and they could handle no more. Ambulances would be asked to take patients to other facilities, which isn’t very difficult in such a large city with such a huge medical community. I do not recall hearing a single news story about anyone dying as a result of the “drive by” status at hospitals.

The “drive by” status wouldn’t be necessary if medical providers were free to operate in their (and their patients’) best interest and for profit (thus creating a motive to provide good care to as many as possible.) Under capitalism, supply and demand drive businesses, not government regulations set up by bureaucrats who know nothing about running a business or health care. The problems in American health care are caused by government and only free markets can solve the problem.

Since you brought up affordability, I would also like to point out that most bankruptcies in the US are caused by medical bills. That sounds awful on the surface, and I know it’s hard on the patients and their dependents, because my parents filed for bankruptcy after my mother’s unexpected hysterectomy in the 80s. But here’s something to ponder, my mother is alive and healthy. She and my dad came out of bankruptcy about 7 years later and are doing fine! We all made it through. I’m very glad she got the quality medical care she needed and it was well worth 7 years of bad credit to have her alive, healthy and able to rebuild her nest egg.

I shudder to think how long the NHS would’ve made her wait in pain for her surgery. Probably until her condition was far worse and required even more suffering and surgery. (Assuming she wasn’t “too old” for treatment.)

Firstly, under EMTALA it is illegal for hospitals in America to refuse emergency treatment to anyone who cannot pay.

Secondly, anecdotes are not arguments. I’m sure there are frightful cases of avoidable deaths in the United States (see “How American Health Care Killed My Father” above) but that’s true of all healthcare systems. It doesn’t illuminate the essential issue of what makes a system better or worse.

Thirdly, Michael Moore is a very entertaining comedian but his movies are hardly examples of journalistic objectivity. If I were you I wouldn’t take his claims too seriously.

Finally, I don’t regard myself as “right-wing”. I share some of my views with those on the right and some with those on the left but I generally see it as a false choice. I believe the real issue is freedom versus slavery and I’m frequently forced to fight against both wings for the cause of individual rights.

And according to Michael Moore’s movie Sicko – under the American private enterprise system, they ARE left to die! You can mouth all the right – wing talking points you want, but I doubt you can refute the facts of the cases he put forward in the movie — unless you can prove the people he said died did not actually die.

I believe it does. Altruism begs the question of who is to be sacrificed and to whom. The second part does not necessitate collectivism: it can be sacrifice in the name of a collectivist abstraction, such as a social class or “society”, but it could also be for a single person, such as a dictator.

However, the question of who is to be sacrificed, from a political context, demands one form or another of collectivism. There must be some sort of identifier to link a person to an object of sacrifice. This could be race (as in Nazi Germany), class (as in Soviet Russia), political opinion (as in both of the former examples) or any other identifier. There is always some arbitrary connection between the identifier and the sacrificed, which is to state that a particular collective A) exists and B) exists for a specific purpose.

For example, the middle classes exist to provide jobs for the working classes, the Jewish race exists as a scapegoat for the Nazi party.

All of these examples are from the far end of the spectrum, but it is easy to point out their analogies in “moderate” politics. The example of all-women shortlists operates on the presumption that there are two tribalist collectives, men and women, with definite interests that must be balanced.

One could campaign for the sacrifice of an individual: a “requisition the wealth of Mr Smith” party could be formed, yet this would not be an example of individualistic altruism in politics, for the ideological method used by its political supporters would still be collectivist (in this example, it is Mr Smith’s belonging to the collective of wealthy people that puts him in the cross-hairs.)

The same relationship can also be discovered with the opposite ideologies: individualist politics is impossible without egoism. Ayn Rand frequently discusses this relationship in detail in Capitalism: The Unknown Ideal