If I were ever going to put a conference together to help physicians understand the applicability of free market ideas to health care delivery (I have no plans to do this but doing this has been suggested to me many times now) I would hope that Dr. John G. Harold, president-elect of the American College of Cardiology would attend.  He is quoted in an AP article by Marilynn Marchione as having said the following:  ”Patients are doing this with or without our permission, so it’s important to test.”  He is talking about chelation therapy for coronary artery disease.  

“Permission?”  I think he may need some remedial market training at our conference prior to hearing invited speakers from the von Mises Institute.  Dr. Harold’s view of the physician’s role in the market and in relation to the patient is a “permission granter.”  Then again, perhaps he misspoke.  Maybe he meant “blessing.”  That’s another thing altogether, but that’s not what he said.  I’m picking on him because I know that there are many other physicians that having belonged to the union/guild AMA for most of their careers, have no concept of the workings of a free, market economy.  

Rather than embrace the free market, most physicians, just like the academicians that teach us, endorse this paternalistic, gatekeeper model.   I maintain that patients resent the physician as “permission-giver” even more than physicians resent insurance companies that play this role for them and their practices.  ”If you want your patient with chronic sinus disease to have a CT scan, call this number and wait on hold for an hour to get permission and authorization.”  This drives doctors nuts.  It has led many physicians I know to stop working with insurance companies that act in this manner.  Think the patient in a waiting room feels any different?  ”I am here to get permission to refill my blood pressure medicine.”  It’s bad enough to pay for the medicine.  The patient also has to pay for permission to pay for the medicine!  

This is changing, however, as the model is coming apart.  Once again, it seems that the market simply won’t be denied.  More and more doctors (almost all of which are members of the free market Association of American Physicians and Surgeons) are opting out of Medicare, not refusing to see elderly patients, just refusing to deal with Medicare.  More and more doctors are moving to “cash-based” practices, charging set fees for office calls and minor procedures and leaving the insurance game altogether.  Face to face with their patients, with no intervening and distorting third party, these physicians are practicing in a free market arena, one where their value to the patient is their job security, not inclusion in some “network.”  

I’m thinking that with the free market at work, physicians seeing themselves as “permission granters” would have empty waiting rooms.  I hate to see people learn things the hard way.  Maybe an “Adopt Medical Free Markets Conference!”  makes sense.  We could even give CME (Continuing Market Education) credit!  Folks like Dr. Harold, who would benefit the most, probably wouldn’t attend, though.

G. Keith Smith, M.D.