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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“Socialism,” the Tea Partiers, and Slate’s Political Gabfest

Anti-Statism, Libertarian Theory, Statism, The Left, The Right
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On today’s Slate Political Gabfest the hosts criticized Tea Partiers for misusing the word “socialism.” David Plotz said it’s “stunning” that Tea Partiers would say Obama is leading the country into socialism. After all, the Obamacare legislation benefited corporations such as insurance companies. The hosts accuse the Tea Partiers of basically engaging in equivocation: using the pejorative potency of “socialism” because of its traditional technical meaning but using the word in a looser sense to refer to “big government.”

But of course the Tea Partiers have a point. It is true that socialism in a technical sense has been used to denote economic or political systems in which the means of production are publicly owned–basically, the state owns land and factories, as under communism. But fascism and corporatism can be seen as variants of this basic idea: instead of directly and explicitly owning the means of production, the state indirectly controls such resources by its control and regulation of corporations, who nominally own capital. This was done under fascism in Hitler’s Germany, for example, which was of course socialistic–the word Nazi means “national socialist”. Thus, the Slate Political Gabfest pundits, while a bit condescendingly chastising the Tea Partiers for their naivety, are themselves a bit naive in contrasting fascism from socialism, as if they are totally distinct or opposed.

As I noted in What Libertarianism Is, Austrian economist and libertarian philosopher Hans-Hermann Hoppe, in his treatise A Theory of Socialism and Capitalism (chapters 3–6), provides a systematic analysis of various forms of socialism: Socialism Russian-Style, Socialism Social-Democratic Style, the Socialism of Conservatism, and the Socialism of Social Engineering. In fact, recognizing the common elements of various forms of socialism and their distinction from libertarianism (capitalism), Hoppe incisively defines socialism as “an institutionalized interference with or aggression against private property and private property claims.” Ibid., p. 2 (emphasis added). He goes on:

If … an action is performed that uninvitedly invades or changes the physical integrity of another person’s body and puts this body to a use that is not to this very person’s own liking, this action … is called aggression … Next to the concept of action, property is the most basic category in the social sciences. As a matter of fact, all other concepts to be introduced in this chapter — aggression, contract, capitalism and socialism — are definable in terms of property: aggression being aggression against property, contract being a nonaggressive relationship between property owners, socialism being an institutionalized policy of aggression against property, and capitalism being an institutionalized policy of the recognition of property and contractualism. [pp. 12, 7]

In other words, although the term socialism is usually narrowly restricted to public ownership of the means of production, from a political or ethical standpoint there is nothing special about “capital”; what is important about it is that it is a type of private property. Thus the essence of socialism is simply institutionalized aggression against private property. In this broader sense, any state action that infringes on property rights is socialistic. The Tea Partiers are right to sense the socialism of Obamacare, for it most certainly involves institutionalized, massive, and widespread interference with private property rights–e.g., the taxes that fund it are theft of private property; the economic regulations imposed on businesses and individuals are trespass. Where the Tea Partiers go wrong is in not realizing that Republican and conservative polices are also socialistic in this broader sense–from the drug war to the war in Iraq. (See also Friedman and Socialism.)

Yet again, we have an illustration of the fact that only libertarians oppose the state, aggression, slavery, and socialism in a principled, consistent way.

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