The Coming Obamacare Healthcare Inequality: Concierge Medical Services

Health Care
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My wife and I have a great doctor. She has a small clinic nearby with a few other doctors, who are also all very good. Our doctor has a waiting list for people who want to be her patient. We have over the years recommended several people, even some who live 20 miles away, to her. She is very nagging–in a good way. She makes you promise to get a physical, eye exam, etc., intervenes to get you an appointment with a specialist if you need one, etc. Follows up by phone, and so on. She is great.

She recently announced to us that she is moving to some kind of “concierge” service–she figures she basically provides that kind of above-average service already, and this is a way to reduce her patient load (from about 4000 to about 400), and escape some of the regulatory burden that Obamacare is going to impose. So she’s picking a select group of her current patients–about 10% of them–and they will be allowed to remain her patients–for $1600/year each. Now, we love our doctor, so will probably do this. And 3600 of her patients will now lose their favorite doctor. Thanks, in part, to Obamacare.

So, you can see what’s coming. The affluent will have to pay more–in our case, $3200 a year more–but for even better service than we already get. And others will have increasingly slim pickings. Case in point, I mentioned this to some friends, and my TLS co-blogger Brian Martinez noted: “This is what my wife’s doc did, too. Went to a concierge system. Unfortunately we couldn’t justify the extra expense and pay for health insurance for the rest of the family. So my wife had to leave her doctor of 10 years and find a new one, and she hates to switch doctors.”

Expect to see more of this. I had never heard of it before and am still waiting to hear the details from our doctor (some information will be mailed later), but a google search revealed that this is indeed a growing trend; see Health care reform laws prompt surge in ‘concierge medicine’, Are Concierge Medical Services on the Upswing?, and Royal Pains: Can Concierge Medicine Coexist With Obama’s Healthcare Plan?

So, Obamacare will only exacerbate healthcare “inequalities,” and diminish the quality of care of many people. The government will then use this as an excuse to bash “greed” and “inequality,” and clamp down further, driving us closer to outright socialized medicine. As one of the articles above noted, “Critics say boutique medicine will only exaggerate the health insurance crisis. Many doctors may leave traditional family practices — widening the gap between the affluent and the poor.” As Martinez noted to me, “You know all the good doctors with wealthy patients will follow this route and as you say it will prompt the regime to crack down on this ‘greedy’ practice. [expletive deleted] Obama.”

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Libertarian Themes in Prince of Persia: The Sands of Time

Fiction Reviews (Movies), Imperialism, IP Law, Pop Culture, Taxation, War
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SPOILER ALERT: I try my best not to “spoil” the movie, but some plot elements are revealed.

Prince of Persia

There are lots of things to like about the movie Prince of Persia: Jake Gyllenhaal‘s abs, the parkour, Gemma Arterton‘s attitude and beauty, or Ben Kingsley’s well-proven ability to portray the bad guy. But I like the libertarian themes.

The movie is inspired from the video game franchise of the same name. All of the important elements of the movie are directly from the video game: the parkour, the street rat, the princess, the dagger of time. The fact that videogames are perhaps becoming in our age the leading form of art for the young is well explained in the lecture series Commerce and Culture by Paul Cantor. Many libertarians have underscored this essential link between market and art, and especially the way that copying is at the heart of artistic development.

The plot itself has libertarian themes. The antagonist, seeking political power, lies the Persians into a war of conquest on the false report of weapons manufacturing and collusion with a known enemy. After the invasion is over and won, there is a scene where the king admonishes one of his sons for his act of invasion, which could be interpreted as an unintended allusion to the foreign policy fiasco perpetrated by George W. Bush over the counsel of his father George Bush, among others.

But the overt libertarianism in the movie is a running gag throughout the movie delivered by Alfred Molina‘s character Sheik Amar, whose role in Raiders of the Lost Ark we cannot forget. The gag is that Amar is the proprietor of a community whose reputation is crafted to prevent tax collection, reminding me of Ralph Raico’s point (I believe he raises it in this lecture) that the Arab stories of caves full of wealth were likely based on the reality of businessmen hiding their wealth from the tax man. Molina/Amar makes many anti-tax comments throughout the movie, which were cheered in the theater where I saw it. As another homage, Molina’s famous scene in Raiders of the Lost Ark is replayed in Prince of Persia between the male and female leads.

Not only for its libertarian themes, but also for its action, characters, plot, and overall impact, I highly recommend the movie. Great summer movie for the family, rivaling the likes of Pirates of the Caribbean.

For my family it had an additional appeal, since the setting was the Persian Empire, and we’re preparing to leave for Turkey in a few days. PFS meeting, here we come!

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Article: What’s Really Wrong with the Healthcare Industry

(Austrian) Economics, Articles, Health Care
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The real problem with the American healthcare system is that prices are continually rising, making healthcare unaffordable to an ever-increasing fraction of the population. And recent healthcare legislation has addressed none of the causes of high prices.

Read the Full Article by Vijay Boyapati

Afterwards, discuss the article below.

[The article is also available at Mises.org]

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If you don’t like it, leave — for a price

Immigration, Libertarian Theory, Taxation, The Basics
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A common retort that libertarians, even minarchists, hear when criticizing ‘their’ government is “If you don’t like it, then just leave.”1 Indeed, residency is perceived to be one piece of evidence (among others, like voting, paying taxes, etc.) for one’s implicit consent to the state and its rules. Just leave. As if there are better alternatives. Or, as if ‘their’ country being the least bad option somehow justifies its government. Just leave. They make it sound so simple, don’t they? If only it were. Unfortunately, states are not so keen on letting their slaves get away so easily, free and clear.


  1. Thanks to Stephan Kinsella for reminding me of the especially vulgar “AMERICA: LOVE IT OR LEAVE IT!!!” He tells me he typically responds with “No, if you don’t like it that I get to stay here and bitch about it, then you leave.” This works in the United States, but not in every country. 

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Private Discrimination, Rand Paul, and the Civil Rights Act of 1964

Political Correctness, Racism, Statism
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I’m no fan of electoral politics, and never did think Rand Paul was a consistent libertarian or even as libertarian as his father, Ron Paul–though his recent remarks on the Civil Rights Act of 1964 make me think he may be more libertarian than he feels he can admit publicly. I don’t agree with many of his stated positions, but of late he’s being attacked for what is most libertarian: his view that private businesses have a right to discriminate on their own property (see, e.g., attacks by the monstrous Paul Krugman and an editorial from the New York Times).

Libertarians can debate whether the portions of the CRA64 that prohibit states and municipalities from discriminating on the basis of race, gender, etc., are libertarian or constitutional. As for the latter, the Fourteenth Amendment was illegally ratified, making legislation enacted pursuant thereto, such as the CRA64, unconstitutional (for more on the ratification issue, see Gene Healy’s The Squalid 14th Amendment). As for the former: libertarian centralists naively favor the federal government having broad powers to supervise the states, while libertarian decentralists and anarchists fear the central state and favor decentralization (see my posts Libertarian Centralists; The Libertarian Case Against the Fourteenth Amendment; Healy on States’ Rights and Libertarian Centralists; The Heroic Gene Healy on the 14th Amendment: “If this be heresy—then make the most of it!”; see also the insightful comments of J.H. Huebert quoted here).

But there can be no doubt that the provisions of the law that prohibit racial and other discrimination by private businesses in employment or accommodation (such as hotels and restaurants) are manifestly unlibertarian and unjust. Sadly, however, some libertarians actually endorse the state’s infringement on property rights as embodied in this law. Most of the prominent libertarian defenders of the unlibertarian aspects of the CRA64 seem to be associated with the Cato Institute, and include Brink Lindsey (see Cato Scholar Scolds Rand Paul, Gives OK to Soup Nazi; Lindsay’s stance is perhaps not surprising given his pro-war views), David Bernstein, Richard Epstein, and Roger Pilon (see my post Libertarian Centralists–Pilon’s stance is not too surprising, given his defense of the Police America Act). (Julian Sanchez, in a somewhat maundering article, seems to weakly defend Paul, but I’m not sure.) I don’t know if such a major deviation from libertarianism arises from shaky foundations (such as utilitarianism), naivety about the ability of the central state to do justice, or fear of a politically-correct backlash, but it’s pretty sad that a leftist is better on this issue than some libertarians–I have in mind Robert Scheer, who gave a surprisingly good and quasi-libertarian defense of Rand Paul on KCRW’s Left, Right and Center last week–he tears apart the Rand-bashing of his co-hosts Ariana Huffington (who drops the PC racism junk) and Tony Blankley (who says he agrees “intellectually” with Paul but still calls him a kook); see also Scheer’s article Who’s Afraid of Rand Paul? (Even John Fund and Aayan Hirsi Ali, both who seem libertarianish, gave a decent defense of Paul on the latest Bill Maher show, if memory serves). See also the partial transcription of Scheer’s remarks here:

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