"[T]here are, at bottom, basically two ways to order social affairs, Coercively, through the mechanisms of the state -- what we can call political society. And voluntarily, through the private interaction of individuals and associations -- what we can call civil society. ... In a civil society, you make the decision. In a political society, someone else does. ... Civil society is based on reason, eloquence, and persuasion, which is to say voluntarism. Political society, on the other hand, is based on force." ~ Ed Crane
Why We Need Libertarian Journalists
Column by Don Stacy.
Exclusive to STR
A December 15, 2012 article in The ASCO Post entitled "The Ethics of Rationing Cancer Care" is a distressing illustration of a healthcare journalist missing several opportunities to deliver not only interesting information to readers, but also genuine knowledge. I shall not name the offending columnist in this critique, for the mistakes of this person’s misguided mind are duplicated by thousands of non-libertarian commentators daily. In addition, I will restrict this analysis to five unfortunate examples to limit reader disgust.
The author’s purpose for this 20-paragraph column in The ASCO Post is to inform the curious that “soaring health-care costs have medical experts wondering whether modest benefits achieved from many new cancer drugs are worth the cost.” The journalist ultimately achieves that stated goal by providing relevant facts (the interesting information portion of the equation). However, a nominal inquiry divulges, at minimum, the following five instances where the columnist fails to deliver libertarian insights (the genuine knowledge portion of the equation):
In the first through fourth paragraphs, the author describes two expensive anti-cancer drug regimens that provide relatively small progression-free and overall survival benefits for certain patients with melanoma or breast cancer.
The author does not reference the vast libertarian literature (see Stephan Kinsella’s Against Intellectual Property) identifying the State-imposed intellectual property system as a root cause of the exorbitant cost of pharmaceuticals.
In the fifth paragraph, the author interviews David Howard, PhD, Associate Professor in the Department of Health Policy and Management at Emory University, who asserts that cancer drugs “very starkly raise the issue of trading off health and money in a way that you don’t find in other areas of medicine.”
The author neglects to explain the subjective theory of value (the value of a good is not based on an inherent property of the good) and its applicability to voluntary exchanges in all areas of medicine.
In the sixth through ninth paragraphs, the author initiates a discussion of healthcare rationing by stating that many "industrialized countries already consider a treatment's cost when deciding whether to pay for it.” The journalist also interviews Howard Brody, MD, PhD, Director of the Institute for Medical Humanities at the University of Texas Medical Branch of Galveston, who makes several misstatements about rationing, exemplified by the following quote: “The fact is we already ration care. We ration care based on an individual’s ability to pay and what kind of insurance someone has, which determines ability to pay.”
The author does not explicate that rationing is, by definition, a mechanism of State (criminal) central planning which has not, does not, and cannot occur in a private (non-criminal) healthcare market process.
In sections named “Shared Decision-Making” (paragraphs ten through twelve) and “Making Tradeoffs” (paragraphs 13 through 15), the author claims that "shared decision-making does not solve the ethical dilemma of how to equitably allocate limited health-care resources so everyone benefits, not just those with the ability to pay for costly therapy." The journalist also rhetorically inquires about the best way healthcare resources should “be equitably distributed.”
The author does not inform readers that a free market process is the only ethical way to apportion scarce resources justly.
In the final section of the article, titled "Reining in Costs" (paragraphs 16 through 20), the author lists a variety of cost-cutting measures associated with the Patient Protection and Affordable Care Act, which, if successful, "may avert the need for severe mandatory restrictions on health care in the future."
The author does not question the ethics of mandatory State (criminal) restrictions on private (non-criminal) healthcare spending.
In the final analysis, the author of “The Ethics of Rationing Cancer Care” ignores a slew of opportunities to inform readers about elementary libertarian solutions to current healthcare problems. Five examples of this phenomenon are given in this brief critique, but comprehensive study of the column reveals additional anomalies. It is evident the journalist who penned this article is not a libertarian. Are you a libertarian? Are you a libertarian with interviewing skills? Are you a libertarian with interviewing and writing skills? If so, journalism urgently needs your high-quality services.