In the aftermath of the 9/11 attacks, the Bush administration crafted a legal theory and detention policy to handle accused terrorists. Nowhere was the policy more conspicuously problematic than at Guantánamo, where a total of 779 detainees were held and where today 166 remain after over ten years. The Bush administration referred to these people as the most dangerous terrorists, as “the worst of the worst,” but that was simply a lie. Of the total captured, only a little over half were even determined by the U.S. government to have committed any belligerent acts against the United States or its allies. And of course, most of those people were just soldiers, many conscripted in the Taliban, fighting against an invading army. Captured enemy soldiers are traditionally treated as prisoners of war, not vicious criminals. Only about 8 percent were labeled al Qaeda fighters. What’s more, only five percent were even captured by U.S. forces—the bulk came from Northern Alliance and Pakistani warlords who rounded up as many people as they could to hand them over for a cash reward. In short, a huge number of these people were totally innocent—on pilgrimage to conduct business or charity work. Some were children.

By 2008, almost everyone who was the least bit reasonable realized this whole thing was a great stain upon the American character and wanted it ended. The Supreme Court ruled in Boumediene v. Bush that constitutional guarantees of common law habeas corpus extended to the prison. Bush’s Defense Secretary Robert Gates and Secretary of State Condoleezza Rice were among the voices calling for closure. Seven Guantánamo prosecutors had resigned, most citing the total mockery of justice. Obama won the presidency promising to close the prison camp.

Yet he didn’t simply vow to close it, release the many who should be released, and try the few whom the government had any evidence to try on terrorism charges. He instead proposed to create a Guantánamo-like prison camp within the United States. In May 2009, standing in front of the National Archives, Obama announced a policy of “prolonged detention” to continue indefinitely holding people without traditional just cause on the basis that nothing else easy could be done.

Under Bush and in the early Obama era, the executive and then the judiciary released prisoners. The administration put a freeze on these releases. Congress also obstructed releases by passing a law barring the release of prisoners to designated enemy states, but it also passed legislation allowing Obama to make individual exceptions of prisoners in the name of national security. He has not done so. What’s more, as commander in chief, he can easily move these prisoners around and order their release as Bush set the system up in the first place. As the head of the executive branch, he also can pardon people in the criminal justice system. Are we really to believe he’s powerless here? Even PBS recognizes that much is in his control.

The last three prisoners to leave Guantánamo have left dead. The last one, Adnan Latif, committed suicide after being told he was cleared for release. He had been stuck in the dungeon for ten years, another totally innocent victim of being in the wrong place at the wrong time. Even though the Supreme Court declared that habeas extended to Guantánamo, and a lower federal court ordered his release, the administration appealed, was backed up by a higher court, and the Supreme Court refused to come to his rescue.

Latif was on a hunger strike, and was force-fed, in violation of international standards of basic human decency. Now a majority of Guantánamo’s inmates are on hunger strike, the administration has responded with force-feeding and by cutting off their water, and Obama again reiterates his supposed goal to close down the prison.

Obama’s partisans attribute his waffling to political pressure and the Republicans, but congressional Democrats were the ones to first refuse to fund the prison closure in 2009. What’s more, Obama could have won points for standing firm on this, for standing up for justice for a change, and teaching the country the importance of human rights and constitutional law. Instead, he chose to spend his political capital on his domestic economic policy.

Here’s what I think the administration should do: simply release these people. If it thinks a few of them can be prosecuted, then it should be bound by all the basic rules of civil procedure. If it thinks that the case against some of them is tainted due to torture, then it should release those people. That is a risk that comes in torturing people, and a civilized society shouldn’t tolerate holding people because they’ve been abused. It should dispense with this “terrorist nation” designation and free these people. The Bush administration detained tens of thousands in Iraq, and let them go. Whatever risk comes in letting them go cannot justify holding onto them a second longer. If the Obama administration really has trouble finding a place for them, I’d recommend buying each of them a house on Pennsylvania Avenue. The money can come from liquidated government assets or from forcing Bush and Obama administration officials to pay restitution.

America’s post-9/11 detention policy will always be remembered as one of the greatest injustices in American history. The very least that must happen now is for the injustice to end. If any of America’s enemies were torturing over a hundred people in a dungeon for a decade and concocted a shameless legal theory to justify it as the Obama administration has, it would be cited as a major human rights abuse and some would call for military intervention to depose such a tyrannical regime. It’s time for all Americans to stop tolerating these profound, unspeakable atrocities carried out in our names. Free the prisoners. Close Guantánamo. And end the nonsensical Alice-in-Wonderland legal principles and military policies that have so thoroughly twisted the American system into a wannabe impersonator of communist dictatorships.

Why is the price of a knee replacement for a dog—involving the same technology and the same medical skills that are needed for humans—less than one-sixth the price a typical health insurance company pays for human operations? Why is it less than one-third of what hospitals tell Medicare their cost of doing the procedure is?

When you recover from your knee replacement surgery, let’s say you spend two nights in a hospital room. If you are like some patients, you may be enjoying all the comforts of a luxury hotel. Fido recovers in a cage, which presumably costs much less. But even with meals, two nights in a hotel should come in under $1,000. The price difference we are trying to explain is many times that amount.

Then, there is the difference in surgeons’ skills. Presumably, the surgeons who operate on humans are more talented and therefore more valuable. But an orthopedic surgeon in Dallas typically gets paid an amount equal to about 10 percent of the $32,500 an insurer pays to the hospital.

I suppose you (as a patient) would get more attention than Fido from nurses and support staff for the one or two days of recovery. Guess how much a nurse gets paid in Dallas? It’s about $30 per hour. That is nowhere near the explanation we are searching for.

Let’s take the actual cost hospitals tell Medicare they incur for this procedure. It’s about $15,000, not including surgeon’s fees. But if veterinarians can do it for a third of that amount, it’s hard to see why the human hospital cost isn’t at least half of what it actually is.

The only explanations I can come up with for why human knees cost so much more are (1) government regulations, (2) malpractice liability, and (3) the inefficiencies created by the third-party payment system. It looks like these three factors are doubling the cost of US healthcare.

Let’s take regulations first. In terms of rules, restrictions, and bureaucratic reporting requirements, the healthcare sector is one of the most regulated industries in our economy. Regulatory requirements intrude in a highly visible way on the activities of the hospital medical staff and affect virtually every aspect of medical practice. In Patient ­Power, Gerry Musgrave and I described the burdens faced by Scripps Memorial Hospital, a medium-sized (250-bed) acute care facility in San Diego, CA. Scripps had to answer to thirty-nine governmental bodies and seven nongovernmental bodies. It periodically filed sixty-five different reports, about one report for every four beds. In most cases, the reports were not simple forms that could be completed by a clerk. Often, they were lengthy and complicated, requiring the daily recording of information by highly trained hospital personnel.

Then there is the malpractice system. Estimates place the burden of the system at between 2 percent and 10 percent of the cost of US healthcare. But it’s hard to separate out the effects of malpractice from the effects of regulation. Remember, both institutions are trying to do the same thing: reduce the incidence of adverse medical events (no matter how imperfectly). If a hospital fails to follow a regulation and that failure leads to a patient death, the failure would undoubtedly be the basis for a malpractice lawsuit. So the existence of the malpractice system helps encourage compliance with regulations—making them more costly.

Finally, there are the inefficiencies produced by the third-party payment system. When providers do not compete for patients based on price, they typically do not compete on quality either. In the hospital sector, they tend to compete on amenities instead. The way you compete on amenities is to spend more on amenities. This adds to costs.

It’s amazing how often people cannot see the forest for the trees. Think how many volumes have been written trying (and failing) to explain why our healthcare costs are so high. Sometimes the answers to complex questions are more easily found by asking the simplest of questions. I will ask and answer more of such questions in my next blog post. Until then, please see my Independent Institute book, Priceless: Curing the Healthcare Crisis.

[Cross-posted at Psychology Today]

Complex systems, by definition, are systems that are too complex for any single individual (or group of individuals) to grasp and understand. What difference does that make? It makes a huge difference.

Most of us wouldn’t walk into a chemistry lab and start pouring solutions from one beaker into another—at least if we don’t know anything about chemistry. Similarly, we wouldn’t walk into a biology lab and start moving substances from one petri dish to another if we’re not trained biologists. And if we don’t know anything about nuclear power plants, most of us wouldn’t walk into one and start pushing buttons.

We wouldn’t do any of these things because most of us have common sense. We know intuitively that if we don’t know what we are doing in a complex environment, odds are great that anything we do will mess things up.

Not everyone has this common sense-based humility, however. The late Nobel laureate economist, Friedrich Hayek, called the hubris of people who want to tinker with systems they do not understand the “fatal conceit.” The term is apt. Just about everything that has gone wrong in health policy can be directly attributed to this very error.

For more than 200 years, economists have been studying the complex system we call the economy. How do they do it? They don’t try to understand the economy in all its complex detail. Instead, economists use highly simplified models to predict some general effects of parameter changes in ordinary markets. For example, we can say with some certainty that rent controls will cause housing shortages and price supports in agriculture will cause crop surpluses.

Unfortunately, there is no model of the healthcare system that allows us to make anything like these kinds of predictions. The Affordable Care Act will insure 32 million more people. In addition, most of the rest of us will have to convert to health plans that have more generous coverage than we now have. We know that when people have more insurance coverage they try to consume more care. But what happens when there is a system-wide increase in demand and no change in supply?

Will the excess demand drive thousands of people to hospital emergency rooms? Will clinics run by nurses start springing up to meet the demand that doctors cannot meet? If service is rationed by increasing the waiting time, will everyone who can afford it turn to concierge doctors, who will be paid extra fees for prompt service? As more doctors become concierge doctors, how will the system manage the even greater rationing problem faced by all those left behind? Will patients start going out of the country—seeking care in the international medical marketplace?

Unfortunately, there is no model that allows us to answer these questions with any confidence.

Why can’t we apply ordinary economic models to healthcare markets? As I explain in my book Priceless: Curing the Healthcare Crisis, one reason is that price doesn’t play the same role in healthcare as it does elsewhere in the economy. Although many would like to think that our system is very different from the national health insurance schemes of other countries, the truth is that Americans mainly pay for care the same way people all over the developed world pay for care at the time they receive it—with time, not money.

On the average, every time we spend a dollar at a physician’s office, only 10 cents comes out of our own pockets. As a result, for most people, the price of care in terms of the time (getting to and from the doctor’s office, waiting in the reception area, waiting in the exam room, etc.) tends to be greater—and probably much greater—than the money price of care.

In general, we have no reliable model to tell us who gets care and who doesn’t when the time price of care rises for everyone, as we expect to happen once the Affordable Care Act gets fully implemented.

[Cross-posted at Psychology Today]

It’s May Day—International Workers’ Day—a time for us to celebrate the workers of the world, who, as Marx told us, had nothing to lose but their chains and therefore would inevitably mount a worldwide revolution to throw off the hated capitalist system that had forged their chains. But something happened on the way to the workers’ socialist revolution—a great many things, in fact, including World War I, which proved that the workers’ devotion to their nation-states was much deeper than their devotion to their comrades in the working classes of other countries.

Moreover, in some industrial countries, especially the USA, the socialist workers’ movement never took deep root, and whatever impetus it had spilled over into other political causes and movements and was thereby dissipated and dispersed. Hence arose the question stated by a leading German sociologist (and very bad economist) Werner Sombart in the title (as translated into English) of his 1906 book Why Is There No Socialism in the United States? Sombart’s answer, at bottom, was “roast beef and apple pie.” That is, the hated capitalist system in the USA had delivered most workers such a comfortable standard of living that they considered socialist revolution a stupid idea and wanted nothing to do with it.

This, oddly enough, was basically the correct answer, although much more complex answers can also be (and have been) given, especially in the great work by Aileen Kraditor, The Radical Persuasion, 1890-1917. To put Sombart’s conclusion in modern American terms, I would not make reference to the well-fed workers’ roast beef and apple pie, or even to the sumptuous servings of cheap delights dished out by Wendy’s, McDonald’s, Burger King, and Taco Bell, but rather to monster pickups, big-screen TVs, and refrigerators full of Bud. American workers have a thousand times more interest in the Super Bowl game than they have in the overthrow of capitalism (if such we continue to call the fascist monstrosity that now sits astride our politico-economic order).

Happy May Day, comrades.

“Anthony Gregory reduces 400 years of Anglo-American legal and political history to a readable, thorough, compelling study of this natural and constitutional right. This book is so well researched and written that it will soon become the bible on all things habeas corpus for generations.” –Hon. Andrew P. Napolitano, Senior Judicial Analyst, Fox News Channel

To live under tyranny is to live in fear—especially the fear of being arrested and jailed at the whims of the rulers. This is why America’s Founders regarded the right not to be detained arbitrarily as a cornerstone of liberty, and why they cherished the legal device they believed had secured that right: the writ of habeas corpus. If we are to live as a free people and avoid the clutches of oppression, it is imperative that we learn the history of this Anglo-American right—a task made immensely easier with the publication of the landmark new book, The Power of Habeas Corpus in America: From the King’s Prerogative to the War on Terror, by Independent Institute Research Fellow Anthony Gregory.

Habeas corpus is often thought to have originated as an individual right against unjust detention. But Gregory shows that the truth is more complex—and far more dramatic—than the mistaken notion that habeas corpus as we know it emerged fully formed from the brows of the barons who forced King John to sign Magna Carta. The Great Writ, as scholars have called it, began as a court’s and a king’s prerogative to challenge the detainment of a particular person (hence the Latin meaning of habeas corpus: “have the body”). It evolved into a pillar of individual liberty over the course of centuries of power struggles.

The Power of Habeas Corpus in America tells the story of those struggles, offering insights on numerous pivot points of American history: how the American colonists overestimated the extent of the legal protections enjoyed by English citizens; why the Anti-Federalists criticized the U.S. Constitution’s Suspension Clause; how state writs of habeas corpus were used both to support slavery and to challenge it; how Lincoln planned to escape prosecution for suspending habeas corpus during the Civil War; how the states lost their authority to use habeas against federal detention; how the Great Writ freed many immigrants who’d been detained under the Chinese Exclusion Act; how the Supreme Court rationalized the internment of Japanese-Americans during World War II; why federal habeas review in the late 20th century expanded and contracted; and how the round-up of immigrants in the wake of the 9/11 terrorist attacks underscores the importance and limitations of habeas protections. (The book devotes five of its eight appendices to dissecting Supreme Court decisions regarding the detention of suspected terrorists during the Bush administration.)

Although Americans celebrate habeas corpus as a safeguard against tyrannical imprisonment, it has been an imperfect remedy. What would make it fully reliable? For habeas to live up to this ideal, Gregory argues, ultimately there is only one solution: legal thinkers—and the public—must champion an ethos that elevates the principle of individual liberty above government power. Readers who absorb Gregory’s nuanced and erudite book will be well equipped to articulate the value of a legal right that unfortunately remains vulnerable to the machinations of the state—and will be better able to defend liberty, too.

[This post appeared first in the April 30, 2013, issue of The Lighthouse. For a free subscription to this weekly newsletter and other bulletins of the Independent Institute, enter your email address here.]

In fields as diverse as cosmetic surgery and LASIK surgery, we are discovering that healthcare markets can give patients transparent package prices and that costs can be controlled—despite a huge increase in demand and enormous technological change (of the type we are told increases costs for healthcare generally). For services as diverse as walk-in clinics and mail-order drugs, we are seeing that price competition is possible and that price competition promotes quality competition as well. In the international market for medical tourism, we are discovering that almost every type of elective surgery can be subjected to the discipline of the marketplace; that discipline is increasingly evident within our borders in the emerging market for domestic medical tourism, where patients willing to travel to other cities can find cheaper, higher-quality care.

In each of these cases, new products and new services have cropped up to meet the needs of patients spending their own money. These are products and services that were made possible precisely because the third-party-payer bureaucracies were not standing in the way. If the private sector is left free to continue with such innovations, there is much more to come.

Among the current buzzwords in Washington policy circles are such terms as electronic medical records, medical homes, coordinated care, integrated care, and so on. To hear the policy wonks tell it, the Affordable Care Act is designed to bring all these new ideas to the practice of medicine—prodded by the guiding hand of government regulators.

But did you know that sensible, workable electronic records systems (including the ability to electronically prescribe drugs) have been in use for over a decade by walk-in clinics, by private telephone and email consultation services, and by concierge doctors (who give their patients more time, more services, and special attention) without any guidance from Washington or from any employer or insurance company? Did you know that sensible, workable medical homes—together with diverse doctors providing integrated, coordinated, low-cost, high-quality care—have been emerging in the private sector for some time, without any federally funded pilot program or any advice, encouragement, or harassment from any third-party payer?

I stress the words sensible and workable because in the hands of impersonal bureaucracies, shielded from marketplace competition and subject to pressures from every special interest group imaginable, we are likely to get systems that are neither sensible nor workable.

Liberated from the confinement of legal impediments and suffocating bureaucracies, doctors, patients, hospital personnel and profit-seeking entrepreneurs are perfectly capable of solving our most serious health policy problems. All they need is the freedom to be able to do so.

For more, please see my Independent Institute book, Priceless: Curing the Healthcare Crisis.

[Cross-posted at Psychology Today]

Everyone, it seems, has a hollow space in his makeup. Perhaps he has no faith, no hope, no charity; no sense that he is basically a lord or a priest or a peasant; no comfort in knowing his personal latitude and longitude in the great scheme of things; no ethical compass to give him his bearings and help him navigate between what is right and what is wrong, what is good and what is bad.

As religion’s hold on the Western man’s mind has diminished during the past several centuries, replaced by a cold scientific sense that, at bottom, everything is just a lot of lifeless particles and electrical currents or, in many cases, replaced by nothing at all, this empty space has dilated. Into the vacuum of ethical emptiness and absent personal identity has rushed nationalism. More and more people answered the question, “What are you?” by saying “I am a Frenchmen,” or a German, or an American, or whatever. State rulers, of course, actively strove to encourage such mass identification because it rendered the masses easier to exploit, plunder, and command. The culmination came in the world wars, when scores of millions submitted to kill and to die in the service of nationalism.

Americans, perhaps more than any others, are immersed in nationalism, drenched to the bone. It follows them everywhere — to school, to work, to their amusements and entertainments, even in many cases into their churches. They wallow in it, and they wallow happily. The merest village idiot takes pride that “We are #1,” whatever such a declaration might mean. Usually, sad to say, it means only that the idiot’s rulers in Washington have their hands on the levers and buttons that allow them to dish out violent death and effective intimidation on a global scale. Hooray for us, he proclaims; we’re the biggest, baddest bully in the history of mankind. Yet, this pathetic individual, and the hundreds of millions who resemble him more or less, are really nothing at all. Their inner selves are entirely ersatz; their moral core is devoid of real substance. They have effectively surrendered their souls, their minds, and their capacity for living a moral life to politician/rulers who shamelessly pull the strings of their identity.

Nationalism and its fruit — the powerful welfare/warfare nation-states that now infest virtually the entire planet — are the banes of the modern age. Their fundamental resources are violence and fraud, and their most indispensable fraud is the conviction they have inculcated in their subjects that the people’s very identity, the very essence of who they are, derives from and depends on the nation-state that dominates their lives.

President Obama’s policies have been criticized by some as harming the economy. The “stimulus” policies he has put into place are not working, according to critics. Indeed, the economic recovery has been unusually slow. Here and here are two of the many articles critical of the president’s economic policies. When I Googled “stimulus not working” I got more than 18 million hits!

The president’s policies have been very good for one industry, however: firearms. With the president embarking on a campaign to ban so-called assault weapons (this article calls them “modern sporting rifles”) and high-capacity magazines, demand has skyrocketed. That article quotes one manufacturer of AR-15′s as saying they have a one-year backlog of orders.

It’s not only guns. The president’s policies have stimulated ammunition sales too, to the point that there are widespread shortages. Here and here are two of the more than 2 million hits I got after Googling “ammunition shortage.”

The president’s strategy to stimulate the firearms industry is not new or untested. When the federal government required new toilets to limit the water they used per flush in the early 1990s, that increased the demand for high-capacity toilets. The president’s proposed firearms policies are merely taking a cue from policies that have been proven in the past to increase demand in a particular industry.

The next time you hear someone complain that the president’s policies have not been effective in stimulating the economy, you can cite the firearms industry as one place where they have.

A rancher* friend of ours—fancying himself a free man, self-sufficient, and disinclined to outsiders’ meddling—was stopped in airport security not too long ago, caught carrying a fancy pocketknife: the Mini Leatherman at right, in fact, a handy all-in-one tool just right for a working man. Not taking kindly to the suggestion that he give up his property, our friend John failed to cooperate meekly as we citizens of the former land of the free are now expected to. Fortunately, he was able to enlist the help of the local sheriff’s deputy, who took possession of the contraband (over the protests of the TSA agent: “You can’t transfer a dangerous weapon here!” Deputy: “Get serious!”), and saw that it was later returned to John.

One might think that would have been the end of it, but, no, the TSA doesn’t take kindly to “resistance.” John received a registered letter from the feds offering him a choice: appear in federal court, which could result in a $10,000 fine and/or one year in a federal pen, or pay a $1,000 fine.

Consequently, John is now the proud owner of this $1,022.95 Mini Leatherman.

Those like John who had subsequently celebrated TSA’s announcement last month that the ban on small pocketknives (with blades less than 2.36″—which the Leatherman’s 1 1/2″ would have easily met) would be lifted effective tomorrow instead face disappointment:

Facing a huge backlash from the public and the Flight Attendants Union, the US Transportation Security yesterday postponed its controversial plan to allow knives on US flights beginning on Thursday.

Reading further, however, we see the “backlash” wasn’t exactly from “the public:”

A group of 133 Congressmen had signed a letter urging TSA to withdraw the plan, and the Flight Attendants Union has been a vocal opponent.

A number of airline unions are working with Congressmen Ed Markey (D-MA) and Michael Grimm (R-NY), and Senators Charles Schumer (D-NY) and Lisa Murkowski (R-AK), to propose legislation to permanently keep knives off planes.

Providing yet further evidence—if any were needed—that the TSA is all about providing security theater while actually catering solely to the politically connected—with the costs and consequences of this arbitrary and officious agency carried by the voiceless traveling public.

And just in case the ticket-buyers actually footing the bills for airline travel remained under any illusion that their interests matter, the extensive delays imposed this week by furloughs of traffic controllers—ostensibly resulting from the “sequester”—must surely lay that to rest.

As the Wall Street Journal details, flyers directly fund two-thirds of the FAA’s budget through 17 airline taxes and fees—about 20% of the cost of a $300 domestic ticket, up from 7% in the 1970s—yet the FAA is using the 4% cut from the sequester to produce delays in 40% of flights.

Meanwhile, the Department of Transportation (FAA’s papa) seems to have all the money in the world, including funding a $474 million discretionary TIGER grant to “make communities more livable and sustainable,” as well as a “Women in Transportation History” online exhibit.

In case anyone had any doubts that these furloughs have been scheduled to produce maximum pain on travelers to produce maximum political gain for the pork barrel crowd, the FAA is making a handy tool available on its website to find out in real time just how delayed your flight will be:

The Federal Aviation Administration claims the sequester spending cuts are forcing it to delay some 6,700 flights a day, but rarely has a bureaucracy taken such joy in inconveniencing the public.

Though the FAA says it is strapped for cash, the air traffic control agency managed to find the dollars to update its interactive “command center” tool on its website so passengers can check if their airports are behind schedule due to what it calls sequester-related “staffing” problems. Oklahoma Senator Tom Coburn noticed this rare case of FAA technological entrepreneurship and fired off a letter Wednesday protesting what he called the agency’s “full blown media rollout” to hype the flight delays.

Confirming the senator’s charges, an FAA whistleblower emailed:

the FAA management has stated in meetings that they need to make the furloughs as hard as possible for the public so that they understand how serious it is.

Poor babies: how unfathomable to be asked to scale down one’s spending by 4%!

With median American household incomes 8% lower than they were in pre-crash 2007, perhaps it’s time for our pals in Washington and those who feed at their trough to understand how serious we really are.

—

*Full disclosure: John Baden is a rancher in addition to being founder and chairman of the Foundation for Research on Economics and the Environment (FREE).

The premise of my latest book, Priceless: Curing the Healthcare Crisis, is that most of our problems arise because we are trapped. We are caught up in a dysfunctional system in which perverse economic incentives cause all of us to do things that raise the cost of care, lower its quality, and make access to care more difficult. Perverse incentives are faced by everyone: patients, doctors, nurses, hospital administrators, employees, employers, and so on. As we interact with the system, most of us spot ways to solve problems. We see things we could individually do to avoid waste and make care less expensive, for example. But the system generally penalizes us for doing the right things and rewards us for doing the wrong things. Anything we do as individuals to eliminate waste generally benefits someone other than ourselves.

So what’s the answer? Let people out of the trap. Liberate them from the dysfunctionality that is causing us so much trouble.

This message is precisely the opposite of what you are likely to hear from other health policy experts—on the right and the left. The conventional view is that we have too much freedom, not too little. Doctors are said to have too much freedom to provide treatments that are not “best practice” or that are not “evidenced-based.” Patients are said to have too much freedom to patronize doctors and facilities with inferior performance records.

Hence, the conventional solution: put even more restrictions on what doctors can do and where patients can go for their care. Ultimately, the conventional answer to the country’s health policy problems is to have government tell doctors how to practice medicine and to tell patients what care they can have and where they can get it.

The biggest problem with this approach is that it would leave us even more trapped than we currently are. Incentives would be even more perverse. We would have a plan designed by folks in Washington. But 300 million potential patients, 800,000 doctors, almost 2.5 million registered nurses, and thousands of others working in the system would find it in their self-interest to undermine the plan. My answer is just the opposite. I want all those patients and all those doctors to discover it is in their self-interest to solve problems, not create them.

Under the conventional approach, every doctor, every nurse, every hospital administrator will get up every morning and ask, “How can I squeeze more money out of the payment formulas today?”

My answer is just the opposite. Under the approach detailed in my book, all these people will be encouraged to start each day by asking, “How can I make my service better, less costly, and more accessible to patients today?”

[Cross-posted at Psychology Today]