Over the past few days, I’ve been having a conversation with Dr Rich over at the covertrationing blog. Now, Dr Rich is a libertarian, so suffice to say, we have vastly different perspectives. But he tends to be right a lot, too.

I highly recommend everyone read this post of his, because he’s right about a lot of it. He’s not spouting paranoid nonsense there about how soon, we’re all going to be “fair game” if some get their way. There really is a dominant theory on healthcare “cost control” that proclaims that the ultimate answer is to force doctors, to force patients, to act differently.

I realise this sounds nuts. I do. But it’s true. I can go into detail and prove it if anyone wants, but for now, I’ll just ask you to believe me on this. In defense of healthcare reform, it’s worth noting that insurance companies do all these bad things, too, already. So the problem of “lifestyle policing” is not unique to the healthcare reform debate.

Except…(now we get to the discussion between Dr Rich and myself) :

Let’s suppose you’re someone with a health problem that responds best to a treatment that is not the one recommended by the guidelines physicians are “supposed” to follow. (these guidelines are often really “rules” doctors are forced to follow, and enforced by mechanisms such as “pay for performance” measures.) And let’s suppose you do find a doc that understands your situation, but he’s one of those “retainer docs” and doesn’t take any sort of insurance. (a lot of good doctors have actually switched to this model, disgusted by insurance companies trying to dictate to them how they should practice medicine.) You have to pay him $100 an office visit  to see him, but most besides the mega-poor would be able to come up with a little extra cash to see a doc like this if they found themselves wanting or needing to.

The problem is that HR3200 is incredibly vague. It’s just a skeleton framework for reform; something that will be built upon at a later date into an actual functioning structure, and there is a chance (however remote some might think it is) that someone might later try to use some vague something it says to effectively “ban” private physicians who don’t accept insurance.

And that, if it happened, would be bad. Really, really bad.

In my discussion with him in the comments here, Dr Rich states that he thinks it’s plausible enough to where he opposes HR3200 for this reason. I (Jupe) told him I don’t think even the liberalest of the liberals would want to see a prohibition on “pay out of pocket” medicine. “Even we damn liberals” would freak out over that, right? I mean, even in the UK there’s a small, but thriving private industry operating alongside the NHS. If the NHS doesn’t offer a service, and someone wants to buy it with their own money, they’re perfectly free to.

Would American liberals allow the government to deny people that right here? Tell me I’m right, and that pretty much everyone in the US would go ballistic (for good reason) if some creepy control freaks tried to ban private medicine.

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