Thom Hartmann talks with Dr. Jay Richards, 26 June 2009: should the free market place decide all things health care?
[Thom Hartmann]: Right now Jay Richards is with us. He is a senior fellow at the Discovery Institute. And Jay, let me just get this right. First of all, welcome to our show.
[Jay Richards]: Great to be with you, Thom.
[Thom Hartmann]: Thank you. Let me just get it right about, this is the Discovery Institute that was funded by Howard Ahmanson and Bruce Chapman is the president of the board, the one that principally is out there promoting creationism?
[Jay Richards]: Well not exactly, no, not quite, but the Discovery Institute is the institution that's sort of directly identified with funding work on Intelligent Design by scientists and philosophers, so yes, there's distinctions between Intelligent Design and creationism which we could spend 20 minutes on.
[Thom Hartmann]: Sure, well, let's just say Intelligent Design, then.
[Jay Richards]: Yeah, exactly, that's the thing the Discovery Institute, you've got that right.
[Thom Hartmann]: You know, it kind of rather surprised me that somebody who appears to be a good Libertarian like you would be associated with an organization that's basically got a religious agenda. But I'll leave that to you to comment on or not. I want to get, what we want to discuss is the medical market place, here.
[Jay Richards]: Sure.
[Thom Hartmann]: You have been, you're also the author of "The Privileged Planet".
[Jay Richards]: That's right.
[Thom Hartmann]: Discovery.org the web site. And, as well as "Money, Greed and God: Why Capitalism is the Solution and not the Problem".
[Jay Richards]: That's right.
[Thom Hartmann]: And Jay, your pitch on this whole thing is that we should allow the so-called free market place to decide all things health care. Do I have that right?
[Jay Richards]: Not exactly right, but I would say that health care, unlike a lot of parts of our economy, doesn't actually have any of the disciplinary forces that a market has, you know, in the United States, of clothing or home repair stuff or food or almost anything else we buy. You've got direct market forces, and we've got those, you've got a free exchange to get better service for less money. Now, in the health care industry, unfortunately, you might think, well, the market's broken down here, but, you know, just a little common sense, think about the way you make your medical decisions, you rarely compare prices between doctors, you might have heard that one doctor's better than another but you don't do the same kind of calculations you do in health care that you do with other regular sort of market exchanges. And that indicates that in fact health care in the United States is quite different from most parts of the economy. And I would argue that it's the ways in which it's different that are primarily causing the problems which are real, but I think we're diagnosing the problem incorrectly and that the solution that a lot of people are proposing, which is greater centralization and control of this part of the economy will actually create more problems rather than create the solutions we're looking for.
[Thom Hartmann]: Here's why I think that your take on this is, no offence, nonsense. And I don't mean that as a personal slur, or anything.
[Jay Richards]: Nonsense in the best possible way.
[Thom Hartmann]: Right. A free market, even by Libertarian definitions, is a market in which sellers and buyers, with no undue pressure to sell, no coercion on either side, are free to make decisions to buy or sell. Right? Are we in agreement on that?
[Jay Richards]: No, that's right. Yeah, that's right, or that people, or any particular exchange if it is free then both the buyer and the seller are not being coerced into decisions so that both perceive themselves, at least, as better off as a result of the exchange, even if they don't end up equally well off.
[Thom Hartmann]: Right, right, but the seller has no undue pressure to sell, and the goods and services are entirely under the seller's control. The buyer has no undue pressure to buy, and the goods and services are known to the buyer. I would say that that that definition of a free market with regard to health care is plain old flat out impossible, never was, never will be. And here's why. On the seller's side we've got government regulation which I think even you would want. I am guessing that you would rather not go to a doctor who got his degree by going to a mail order school from the back of a matchbook for 6 months.
[Jay Richards]: Oh sure, yeah.
[Thom Hartmann]: And has now set up in brain surgery.
[Jay Richards]: That's right, I'm not arguing, I'm not a, you know, simple Libertarian that says markets solve everything and I certainly don't, you know, people talk about the unregulated banking industry which of course has got thousands of pages of regulations. So of course I believe in certain things, the rule of law itself is essential.
[Thom Hartmann]: Right, and so on the seller's side you've got, we don't have a free market for two reasons. The first being that the supply of doctors and the nature of doctors, and not just doctors, medical devices, medical drugs, the whole thing, all of that is tightly regulated by we the people and even Libertarians agree that that's a necessary thing.
[Jay Richards]: No, but that's no different from almost everything else. There's lots of regulations for any particular profession. You know, people have to get degrees for all sorts of things. That doesn't mean that ...
[Thom Hartmann]: I don't need a degree to be a talk show host.
[Jay Richards]: No, well there are some things, or to be a talking head, actually, either.
[Thom Hartmann]: Right. You don't need a degree to do what you do. But we're talking about medical services here and it just makes me crazy when people say free market, because number one.
[Jay Richards]: I don't, no, but...
[Thom Hartmann]: Let me just finish this line.
[Jay Richards]: Sure. go ahead.
[Thom Hartmann]: And then you can take it apart if you can. I dare you. Number one, on the seller's side you've got, as I said, we've got regulation of physicians, but there's another part of that and that is that the AMA, which probably you and I will agree shouldn't be doing this, is limiting the supply of doctors in the United States.
[Jay Richards]: That's exactly right. That's one of the serious problems that we have.
[Thom Hartmann]: Right, one of the areas where we can agree.
[Jay Richards]: Yeah.
[Thom Hartmann]: There is no AMA in Cuba, for example. Anybody can become a doctor. They've got so many that they've exported over 30,000 doctors to Central and South America over the last 5 years.
On the buyer's side there's no free market because if somebody is sick, that by definition is coercion. In other words, I...
[Jay Richards]: Oh, no, no, no. This is a terrible argument, you could use this for everything. I need gasoline to get to school. I need clean water in order to be able to drink. I need food.
[Thom Hartmann]: But those are bio...
[Jay Richards]: No, we have...
[Thom Hartmann]: Well, with water, yes, and that's an argument for water being part of the commons.
[Jay Richards]: No, but, no but, yeah, the commons, any time that we actually have clean water there's going to be some kind of market forces in which we pay for it, the same way with food. I need food to survive. That's no argument about centralization of food prices. I mean, your argument, if it were correct, would entail socialism for everything. This is exactly the problem. You're not being principled. Market forces can be brought to bear even on things that are essential. Coercion, the fact that you have a need, a personal need for something, even maybe a need for life, is not the same as coercion in which the person selling you is forcing to buy it. That's the whole point.
Yeah, health care is a need, so what we want is competition between providers so that we get more of the need met, that is, better services, at less price. I find this argument, Thom, quite strange, actually, and I thought you were going to give me something powerful. But the argument, if correct, basically means that anything that we need, the government has to control the price for, which I find utterly fatuous.
[Thom Hartmann]: Well, it's not, Jay Richards, what I'm suggesting is...
[Jay Richards]: No, what you want to do, contradict my point, though...
[Thom Hartmann]: Let me finish the sentence.
[Jay Richards]: Should they fix prices on food? That would be the counter example. Fix prices on food because we need it.
[Thom Hartmann]: What I am saying is that there are things that are part of the commons. They are the things that we collectively cannot have 'life, liberty and the pursuit of happiness' without. Whether it's our roads, our police, our fire department, we have now decided to include our education system in the commons, and, frankly, more than half of all people in the United States get water and power from commons-based systems, publicly owned utilities. And it works just fine. In most cases it's actually cheaper than corporate-owned water and power systems. And I would submit to you that in order to have life, liberty and the pursuit of happiness, in order to have life, that health care should be part of the commons.
[Jay Richards]: But why is food not part of the commons? Food is more important than health care, surely, for life? Why is food not part of the commons?
[Thom Hartmann]: Because food is something that a person can produce for themselves.
[Jay Richards]: No, but no-one...
[Thom Hartmann]: I can grow food in my own back yard.
[Jay Richards]: Most people in cities cannot grow enough food to survive, unless you are on a farm. Even people that are on farms, unless the climate is correct, can't do subsistence farming.
[Thom Hartmann]: But, no.
[Jay Richards]: I mean. your argument, if correct, would instill socialism for basically anything other than pure luxury goods. You want to be a soc...
[Thom Hartmann]: No, it doesn't.
[Jay Richards]: Yeah it does. Because food is vastly more important to my needs.
[Thom Hartmann]: Food is vastly more important, it's vastly more available. Anybody can grow food. You don't need a degree to grow food, you don't have an AMA regulating food...
[Jay Richards]: No, but your arguments, all of your arguments can be an argument for a greater market, the solution being greater market forces in health care rather than worse.
[Thom Hartmann]: No.
[Jay Richards]: I completely agree that cartel systems for doctors are a bad thing, they ought to be reformed. I think lots of things need to be reformed. I think health care should be portable for people as opposed to attached to their employer, which is an unfortunate sort of artifact from World War II. Again...
[Thom Hartmann]: No, this is, what you're saying, Jay, is ...
[Jay Richards]: ... market forces would give us more life, liberty and the pursuit of happiness, better health care for less money, no one...
[Thom Hartmann]: What you're asserting is the classic Libertarian notion that there is no commons and there is no free ...?
[Jay Richards]: No I'm not, I'm saying that health care needs to be treated as a market and not as the commons and that would create less cost, good health care and more ...
[Thom Hartmann]: No, it would create more billionaires in the health care industry...
[Jay Richards]: No one believes that the government controlling health care is going to make it cheaper or better. And I doubt ... either.
[Thom Hartmann]: All right. Jay Richards, discovery.org.
Transcribed by Sue Nethercott.