Как правительство "починило" медицину

Всяческий Бред - Идти на Главную Страницу >>>

Категории:

Полезные Сведенья
Кухонная Философия
Общество и его пороки
Новости
Еда и Питье
Техника
Разное
Личное
Природа
Фото/Видео
"Веселые" Картинки
Юмор


Пишите Письма



Реклама:

Реклама

July 1, 2017

Today, we are constantly being told, the United States faces a health care crisis. Medical costs are too high, and health insurance is out of reach of the poor. The cause of this crisis is never made very clear, but the cure is obvious to nearly everybody: government must step in to solve the problem.

Eighty years ago, Americans were also told that their nation was facing a health care crisis. Then, however, the complaint was that medical costs were too low, and that health insurance was too accessible. But in that era, too, government stepped forward to solve the problem. And boy, did it solve it!

In the late 19th and early 20th centuries, one of the primary sources of health care and health insurance for the working poor in Britain, Australia, and the United States was the fraternal society. Fraternal societies (called "friendly societies" in Britain and Australia) were voluntary mutual-aid associations. Their descendants survive among us today in the form of the Shriners, Elks, Masons, and similar organizations, but these no longer play the central role in American life they formerly did. As recently as 1920, over one-quarter of all adult Americans were members of fraternal societies. (The figure was still higher in Britain and Australia.) Fraternal societies were particularly popular among blacks and immigrants. (Indeed, Teddy Roosevelt's famous attack on "hyphenated Americans" was motivated in part by hostility to the immigrants' fraternal societies; he and other Progressives sought to "Americanize" immigrants by making them dependent for support on the democratic state, rather than on their own independent ethnic communities.)

The principle behind the fraternal societies was simple. A group of working-class people would form an association (or join a local branch, or "lodge," of an existing association) and pay monthly fees into the association's treasury; individual members would then be able to draw on the pooled resources in time of need. The fraternal societies thus operated as a form of self-help insurance company.

Turn-of-the-century America offered a dizzying array of fraternal societies to choose from. Some catered to a particular ethnic or religious group; others did not. Many offered entertainment and social life to their members, or engaged in community service. Some "fraternal" societies were run entirely by and for women. The kinds of services from which members could choose often varied as well, though the most commonly offered were life insurance, disability insurance, and "lodge practice."

"Lodge practice" refers to an arrangement, reminiscent of today's HMOs, whereby a particular society or lodge would contract with a doctor to provide medical care to its members. The doctor received a regular salary on a retainer basis, rather than charging per item; members would pay a yearly fee and then call on the doctor's services as needed. If medical services were found unsatisfactory, the doctor would be penalized, and the contract might not be renewed. Lodge members reportedly enjoyed the degree of customer control this system afforded them. And the tendency to overuse the physician's services was kept in check by the fraternal society's own "self-policing"; lodge members who wanted to avoid future increases in premiums were motivated to make sure that their fellow members were not abusing the system.

Most remarkable was the low cost at which these medical services were provided. At the turn of the century, the average cost of "lodge practice" to an individual member was between one and two dollars a year. A day's wage would pay for a year's worth of medical care. By contrast, the average cost of medical service on the regular market was between one and two dollars per visit. Yet licensed physicians, particularly those who did not come from "big name" medical schools, competed vigorously for lodge contracts, perhaps because of the security they offered; and this competition continued to keep costs low.

The response of the medical establishment, both in America and in Britain, was one of outrage; the institution of lodge practice was denounced in harsh language and apocalyptic tones. Such low fees, many doctors charged, were bankrupting the medical profession. Moreover, many saw it as a blow to the dignity of the profession that trained physicians should be eagerly bidding for the chance to serve as the hirelings of lower-class tradesmen. It was particularly detestable that such uneducated and socially inferior people should be permitted to set fees for the physicians' services, or to sit in judgment on professionals to determine whether their services had been satisfactory. The government, they demanded, must do something.

And so it did. In Britain, the state put an end to the "evil" of lodge practice by bringing health care under political control. Physicians' fees would now be determined by panels of trained professionals (i.e., the physicians themselves) rather than by ignorant patients. State-financed medical care edged out lodge practice; those who were being forced to pay taxes for "free" health care whether they wanted it or not had little incentive to pay extra for health care through the fraternal societies, rather than using the government care they had already paid for.

In America, it took longer for the nation's health care system to be socialized, so the medical establishment had to achieve its ends more indirectly; but the essential result was the same. Medical societies like the AMA imposed sanctions on doctors who dared to sign lodge practice contracts. This might have been less effective if such medical societies had not had access to government power; but in fact, thanks to governmental grants of privilege, they controlled the medical licensure procedure, thus ensuring that those in their disfavor would be denied the right to practice medicine.

Such licensure laws also offered the medical establishment a less overt way of combating lodge practice. It was during this period that the AMA made the requirements for medical licensure far more strict than they had previously been. Their reason, they claimed, was to raise the quality of medical care. But the result was that the number of physicians fell, competition dwindled, and medical fees rose; the vast pool of physicians bidding for lodge practice contracts had been abolished. As with any market good, artifical restrictions on supply created higher prices — a particular hardship for the working-class members of fraternal societies.

The final death blow to lodge practice was struck by the fraternal societies themselves. The National Fraternal Congress — attempting, like the AMA, to reap the benefits of cartelization — lobbied for laws decreeing a legal minimum on the rates fraternal societies could charge. Unfortunately for the lobbyists, the lobbying effort was successful; the unintended consequence was that the minimum rates laws made the services of fraternal societies no longer competitive. Thus the National Fraternal Congress' lobbying efforts, rather than creating a formidable mutual-aid cartel, simply destroyed the fraternal societies' market niche — and with it the opportunity for low-cost health care for the working poor.

Why do we have a crisis in health care costs today? Because government "solved" the last one. D

http://www.freenation.org/a/f12l3.html

В оригинале есть перечень литературы, на основе которой эта заметка написана. Переводить мне лень. Кратко суть в том, что до того, как государство вмешалось и начало регулировать медицину существовали (как в США так и в Европе) добровольные "общества взаимопомощи", когда люди скидывались в общак и при нужде брали оттуда на оплату медуслуг или другая форма, когда такое общество нанимало терапевта на постоянной основе. Взаимный контроль и конкуренция снизили цены настолько, что крупные медицинские конторы начали возмущаться и требовать от правительства зарегулировать. Ну оно и зарегулировало. Теперь вот все недовольны высокими ценами на медицину.



Тэги: Общество Полезные сведенья

Темы, имеющие некоторое отношение к этой (русскоязычный поиск в mysql все же очень не совершенен):
Внезапная мысль на тему медицинского страхования January 18, 2016
Интересное, хотя и тривиальное наблюдение April 9, 2016
"Потому" December 17, 2014
Фраза из фильма Кин-Дза-Дза заиграла новыми красками в текущих реалиях June 22, 2016
Два варианта April 22, 2010


posted by Rosewell at July 1, 2017 Свернуть
Свободные американцы хотят сильной руки? Рынка, здесь.

пользователь: пароль:
регистрироваться  Залогинится под OpenID


Архив:

Jun2023   May2023   Apr2023   Mar2023   Feb2023   Jan2023   Dec2022   Nov2022   Oct2022   Sep2022   Aug2022   Jul2022   Jun2022   May2022   Apr2022   Mar2022   Feb2022   Jan2022   Dec2021   Nov2021   Oct2021   Sep2021   Aug2021   Jul2021   Jun2021   May2021   Apr2021   Mar2021   Feb2021   Jan2021   Dec2020   Nov2020   Oct2020   Sep2020   Aug2020   Jul2020   Jun2020   May2020   Apr2020   Mar2020   Feb2020   Jan2020   Dec2019   Nov2019   Oct2019   Sep2019   Aug2019   Jul2019   Jun2019   May2019   Apr2019   Mar2019   Feb2019   Jan2019   Dec2018   Nov2018   Oct2018   Sep2018   Aug2018   Jul2018   Jun2018   May2018   Apr2018   Mar2018   Feb2018   Jan2018   Dec2017   Nov2017   Oct2017   Sep2017   Aug2017   Jul2017   Jun2017   May2017   Apr2017   Mar2017   Feb2017   Jan2017   Dec2016   Nov2016   Oct2016   Sep2016   Aug2016   Jul2016   Jun2016   May2016   Apr2016   Mar2016   Feb2016   Jan2016   Dec2015   Nov2015   Oct2015   Sep2015   Aug2015   Jul2015   Jun2015   May2015   Apr2015   Mar2015   Feb2015   Jan2015   Dec2014   Nov2014   Oct2014   Sep2014   Aug2014   Jul2014   Jun2014   May2014   Apr2014   Mar2014   Feb2014   Jan2014   Dec2013   Nov2013   Oct2013   Sep2013   Aug2013   Jul2013   Jun2013   May2013   Apr2013   Mar2013   Feb2013   Jan2013   Dec2012   Nov2012   Oct2012   Sep2012   Aug2012   Jul2012   Jun2012   May2012   Apr2012   Mar2012   Feb2012   Jan2012   Dec2011   Nov2011   Oct2011   Sep2011   Aug2011   Jul2011   Jun2011   May2011   Apr2011   Mar2011   Feb2011   Jan2011   Dec2010   Nov2010   Oct2010   Sep2010   Aug2010   Jul2010   Jun2010   May2010   Apr2010   Mar2010   Feb2010   Jan2010   Dec2009   Nov2009   Oct2009   Sep2009   Aug2009   Jul2009   Jun2009   May2009   Apr2009   Mar2009   Feb2009   Jan2009   Dec2008   Nov2008   Oct2008   Sep2008   Aug2008   Jul2008   Jun2008   May2008   Apr2008   Mar2008   Feb2008   Jan2008   Dec2007   Nov2007   Oct2007   Sep2007   Aug2007   Jul2007   Jun2007   May2007   Apr2007   Mar2007   Feb2007   Jan2007   Dec2006   Nov2006   Oct2006   Sep2006   Aug2006   Jul2006   Jun2006   May2006