We’ve got mail – Boston physician desires “not for profit” health care

I guess I’m smarter than a 5th grader. Or at least I’m smarter than a professor emeritus of medicine and social medicine at Harvard Medical School and former editor in chief of the New England Journal of Medicine. Dr. Arnold Relman might know plenty about health care, but nothing about health care economics.

A Radio Vice Online reader sent us the following…

Take a break from spouting “free market” myths and read the following letter on your show.

Free market myths? We come up with facts – backed up by solid economic theory and history – and the best proponents of government-run universal health care can do is say the free market does not work? Hogwash. We do not have a free market system when it comes to health care.

Relman – in a letter to the editor – responds to Jeff Jacoby’s piece Healthcare: Do we need the Lexus? in the Boston Globe.

Jeff Jacoby believes it “should be left to the market’’ to decide what benefits are covered by health insurance. Medical care is not a commodity in trade to be selected by shoppers, like ordinary goods and services in a commercial market. If there is one lesson to be learned from the dismal failure of the private medical system in the United States, it is that market forces don’t care about medical needs. Anyone who has ever been seriously ill or injured knows that.

The “key to healthcare reform’’ is not “lively competition,’’ as he asserts, but a sensible government program that offers everyone the protection they need, and ensures that a properly organized, private, not-for-profit medical care delivery system is in place to provide services according to medical needs.

Jacoby seems to think medical care is a business, but it is not. It is an essential social service that requires collective (i.e., government) support and should be the primary responsibility of dedicated, not-for-profit medical professionals and not-for-profit medical care facilities.

There are multiple problems with Relman’s position and I will not stand for his ignorance and accept any of his premises since they are wrong.

I believe in the free market, and we don’t have one in health care now. There are so many state and federal programs out there (hundreds) to provide care via government-funded programs, the so-called private system is not private. Health insurance companies are pulling IT professionals off projects intended to improve quality and service levels for members and putting them on regulatory projects to ensure the company meets federal and state regulations so they are SOX compliant. (I’m serious.)

The free market would work. If there is a demand for a service and a reasonable profit to be made health care providers and insurance companies would provide the service at the lowest reasonable cost and the highest justifiable quality.

Relman and our reader clearly think health care should be provided by not-for-profit organizations and/or the government. Readers, tell me… how much profit is too excessive? If there is no profit involved, will people be willing to buy stock in pharmacutical companies and research organizations who create products and services to enrich people’s lives?

Hell no. They will put their investment dollars in Apple (APPL) with a net profit margin of 14.88 percent. You know it Dr. Relman. You can forget about advances in cancer treatments and heart disease – no funding will exist.

Good of the collective my ass.

We have fantastic health care here in the United States. The statement that the United States health care system has been a dismal failure is completely false. None of the government run plans are better than the so called private system.

Since he thinks health care is an “essential social service”, what about food production? Water production and delivery? Fuel oil for heating homes? Electricity to cool homes? I assume all of those services should be run by “not for profit” organizations?

Want to see food production dry up around the world? Make it a not-for-profit “essential social service.”

I know – it feels good and your emotions tell you everyone should be taken care of. It does not work that way and will never work that way. I’m trying to slap you all into reality here!

Then there is the little pesky problem of the United States Constitution – completely ignored by all pundits – which gives no authority for the federal government to do any of this in the first place.

But, as readers of my blog know, I have a solution to put on the table. Get the federal government completely out of the health care business and leave all responsibilities to the states.

Some states may choose to provide universal coverage, some states may choose to provide zero coverage but encourage health care providers and insurance companies to come in and provide the service. Some may provide a little of both.

States will compete to find the best solutionthe free market at work.

Why when I bring this up, do liberals walk away?

Posted in

Steve McGough

Steve's a part-time conservative blogger. Steve grew up in Connecticut and has lived in Washington, D.C. and the Bahamas. He resides in Connecticut, where he’s comfortable six months of the year.


  1. Dimsdale on August 4, 2009 at 7:23 pm

    Yeah, Relman lost me at "…dismal failure of the private medical system in the United States…" too.  Relman is a big pusher of "social medicine" and clearly is an ivory tower academic that clearly never had a job in the private sector.  Being in academia, I recognize his type.  Doubtless, he is one of the few that think Cuba is a worker's paradise and socialist utopia.  Of course, as John Stossel pointed out last week, in Canada, the government run, single payer human health care system runs a very poor second to the privately insured veterinary health care system.


    According to the Wikipedia entry for Healthcare reform, it purportedly attempts to do the following:

    Broaden the population that receives <a title="Health care" href="http://en.wikipedia.org/wiki/Health_care&quot; rel="nofollow">health care coverage through either <a title="Public sector" href="http://en.wikipedia.org/wiki/Public_sector&quot; rel="nofollow">public sector insurance programs or <a title="Private sector" href="http://en.wikipedia.org/wiki/Private_sector&quot; rel="nofollow">private sector <a title="Insurance companies" href="http://en.wikipedia.org/wiki/Insurance_companies&quot; rel="nofollow">insurance companies

    Expand the array of health care providers consumers may choose among

    Improve the access to health care specialists

    Improve the quality of health care

    Decrease the cost of health care


    Of all of those, the only item that socialized medicine even comes remotely close to is the first.  The rest, based on current socialized medicine around the world, have never been realized.  And never will, with bureaucrats running the show.   Maybe Relman should push for increased admissions at the Harvard Medical School, at grossly reduced tuition, to cover all doctors needed to address the "47 million" uninsured in the country.

    Relman makes me believe that the editor of the NEJM is as useless and self inflated a position as the President of the Harvard Law Review.

  2. sammy22 on August 5, 2009 at 2:50 am

    Can't quite get my head around the notion that substituting the states for the feds would change the equation and create a "free market" for healthcare. I read the words, but cannot believe in the conclusions. What would entice states to compete? Why would states provide different coverages? What's in it for them?

  3. Steve McGough on August 5, 2009 at 3:33 am

    Remember, "the states" are the people. Again, you've ignored my fact about the United States Constitution. Why do states compete now? Some have zero sales tax, some have zero income tax, some already offer health care (Massachusetts), some do not. It's all about encouraging people to live, work and play in their state, and for businesses to move into the state to provide jobs.

    Let's say you were offered two jobs with different companies, one provided full health benefits and the other provided no health care benefits. Of course, the company who provided no health benefits would be offering a higher salary. You have a choice, and that is where competition comes in.

    State legislatures (the people) would be putting their best foot forward to ensure people want to live, work and play in their state. Some might provide full health care coverage, some may provide none, some may fall somewhere in between.

    As a resident, I'd have a vested interest in doing what is best for my state, and again, if the residents of a state elect to provide health care to residents, I'm perfectly fine with that, but it is a clear violation of the US Constitution for the federal government to get involved with this.

    Sit down and read Mark Levin's recent book and you'll understand better. States would simply be great incubators of ideas if given the chance!

  4. sammy22 on August 5, 2009 at 6:36 am

    Fine, Steve I hear what you're saying, but….. I moved to CT for reasons that have nothing to do with your arguments, my daughter moved to OR for reasons that do not fit your scenario, and my wife moved to CA and 15 years later back here for reasons that again to not match your scenarios. These are facts too whether or not the feds are involved in health care.

  5. Steve McGough on August 5, 2009 at 7:05 am

    And I can name more than a dozen family members and friends who – when they moved – considered all of the following when doing so. School system, housing costs, energy costs, job opportunities and state tax rates among other reasons. Sure, they also considered weather and the location of friends and family. My point is that states compete when it comes to my factors listed above.

    Many – including yourself – also continue to ignore the 10th Amendment in this debate. It's quite rare for an amendment written to restate a principle outlined in the Constitution itself; I guess it was so important the founding fathers felt it necessary to drive the point home in the Bill of Rights.

    If you and others intend to devalue the 10th, what other Constitutional provisions will you be ignoring in the future?

    "The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people."

  6. Dimsdale on August 5, 2009 at 3:36 pm

    I have competition for you: now that the MA sales tax is more than the CT sales tax, guess where I will be purchasing goods?  Or course, CT would lose big if I lived closer to NH….

    Similarly, is a company going to locate in a high tax state or a low tax state?  Where would they be more willing to move to save money.  That is state competition.

    If one state had a sensible and affordable health care policy (not MA!), and an equally sensible tax policy (corporate and property at minimum) we would all be buying goods manufactured in that state.  And other states would be scrambling to copy or better them to attract that business.

    Let the states be little laboratories where different ideas can be tried and tested, not a massive mandated federal program nobody can escape from, where the politicians think they have the expertise to think of every eventuality.  I can't thing of a single time that ever happened!

  7. sammy22 on August 6, 2009 at 3:00 am

    I, for one, do not hear a stampede from people fleeing MA (I guess Dims… does not like the MA experiment on health care, so much for the little laboratory idea). Also, I don't think it's cost-effective for me to drive to MA to escape some sales taxes.

  8. Steve McGough on August 6, 2009 at 3:52 am

    Against my better judgment, I'm going to reply one more time. Sammy22, your premise is all wrong, Massachusetts did try an experiment with health care that is not working so well, but they had zero incentive succeed (it's the intentions that count with liberals, not results) when the federal government is angling to get involved, or is already involved (Medicare/regulations…). The goal of many state legislatures and governors – including Connecticut – is to position themselves (through legislation and regulation) to get as much cash from the federal government as possible.

    I live near the Connecticut/Massachusetts border. You think residents don't cross borders for better deals? When Massachusetts had no-tax weeks, how many Connecticut residents went to a Namco up north to buy that $699 patio set? Plenty. That's competition, and that's how you stimulate the economy. Continue to ignore the facts if you'd like.

    Readers – notice that Sammy22 completely ignores my main point about the United States Constitution. I called him out on that fact numerous times. Oh sure, he might step in again and bring it up since I'm calling him out, but honestly, he could not care less, remember that during this debate.

  9. sammy22 on August 6, 2009 at 6:24 am

    @ Steve- I'll concede your point on the Constitution. But then, we are doing a lot of things that are not spelled out in the Constitution. Should we try to repeal them all?

    Since the MA experiment is not doing as well as expected, how do we know it will get fixed?

    I am a bit more pragmatic than you, I think.

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