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Mutualist Blog: Free Market Anti-Capitalism

To dissolve, submerge, and cause to disappear the political or governmental system in the economic system by reducing, simplifying, decentralizing and suppressing, one after another, all the wheels of this great machine, which is called the Government or the State. --Proudhon, General Idea of the Revolution

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Location: Northwest Arkansas, United States

Tuesday, September 27, 2005

Nulab's Economic Fascism

Via Dr. Chris Tame of the Libertarian Alliance yahoogroup. "Private firms to take over NHS staff"

Tony Blair was accused of planning the privatisation of the health service yesterday after it was revealed that some NHS buildings and staff will be transferred to the private sector.

Firms applying for contracts worth a total of £3 billion to run a new generation of treatment centres have been told that in some cases they may take over NHS facilities and employ NHS staff.

Patricia Hewitt, the Health Secretary, said there was "no question" of the NHS being privatised and that it was "nonsense".

But union leaders and doctors claimed that private healthcare firms were gaining unprecedented control over the NHS.

Three years ago the Department for Health announced that it was expanding NHS capacity by paying for operations to be carried out in privately run treatment centres....

The Government is now inviting bids for a second wave of treatment centres and, according to details of the tender documents leaked to a newspaper, some contractors will be allowed to take over NHS facilities.

In Birmingham and the New Forest, private firms will be allowed to take over state-of-the-art operating theatres built for the NHS.

The Adam Smith Institute should be all over this, since it's just the kind of "privatization" they like. I've noted before (most of the links are here) that what passes for "privatization" is usually just crony capitalism: sharing taxpayer-funded loot with politically connected corporatists in the nominally "private sector." As Nigel Meek said in response to the National Health story:

"Privatising" only in the sense that directors and shareholders of certain companies may well benefit financially. The state will still ultimately direct the whole show. This is an example of the corporatism typical of New Labour. They've moved the not very great difference from socialism to that "socialism for grown-ups" otherwise known as fascism. The instincts and ultimate state direction remain the same but it incorporates sufficient elements of "business" - e.g. personal incentives and rewards - to make the whole thing work after a fashion.

Remember: "business" and a genuine "free market" as libertarians understand it - i.e. the "economic" element of a social system of reciprocal individual liberty - need have little connection. Auschwitz was a commercial enterprise involving the Nazi government, big business and the luckless slaves working (to death) in the complex. We need to keep repeating this and indeed opposing such "privatisation" and making clear the thoroughgoing libertarian alternatives.

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Blogger Charles Pooter said...

Healthcare can only be truly liberated when the medical closed-shop is abolished. We must remember that healthcare is kept expensive by the artificial restriction of the supply of healthcare expertise. Only "doctors" may practise medicine and you may only become a doctor by going to medical school. The medical profession has always restricted the numbers of people graduating from medical school. This to maintain the scarcity of doctors and so inflate the income and prestige of that profession. Good labour organisation in action? Hardly, as it is backed up by the power of the state.

September 30, 2005 11:25 AM  
Anonymous Wild Pegasus said...

The hard question is: how does a country move from a state system of healthcare to a free market? Bringing in private contractors to perform state services isn't it, although it will probably improve some aspects.

My thought has always been to turn over ownership of hospitals and clinics to the doctors and nurses who work there. The hospital would be spun off as a private company with shares held by the doctors and nurses. The government would then cut off all funding to the hospital and refuse to pick up any of its bills.

- Josh

September 30, 2005 2:39 PM  
Blogger Sergio Méndez said...

To Charles Pooter:

But will your liberalization of the market allow to "anybody" to practize the medicine? Where do you draw the line between being a profesional and not being one? It cannot be argued that human health can be managed like any market comodity. Indeed, when the consumers buy something that does not satisfy them, they buy it somewhere else or from some other company or person. With health you cannot do that, since you are putting at risk your own life...you may not live to switch to a good doctor. How do you hold accuntable people who practize medicine in a pure free market system?

September 30, 2005 4:38 PM  
Blogger colorless green ideas said...


for starters, how about less strict licensing for lesser responsibilities? for example, many nurse practitioner effectively do the job of a family practice doctor, they just can't prescribe medicine. many registered nurses are really qualified enough to act as a family practice doctor, but of course, licensing prohibits this. family practice is 90% diagnosis, should it really require advanced study of medicine?

so 2 ideas:

1. increase the supply of "doctors" by allowing a lower tier of certification, for limited duties. thus your local clinic could have 5 practitioners and 1 doctor, instead of 6 doctors.

2. make it easier to become a doctor. the primary obstacles are financial, and limited number of accredited schools. i'm not really sure how to fix this part, actually...

September 30, 2005 7:12 PM  
Blogger Charles Pooter said...


But how are Doctors held accountable now? In the UK they are supposed to be held accountable by a QUANGO called the General Medical Council, which is a an organisation recognised by law but not accountable to voters. The GMC has the power to decide who is and is not allowed to practise medicine. It also has the power to strike off Doctors from the approved list. The catch is that the GMC is an organisation *run by doctors*, its hearings are held in private and there have been innumerable cases of Doctors guilty of the most heinous mal-practice being allowed back into the profession.

I propose a true free market in healthcare with the public (as individuals or collectives such as labour unions or friendly societies, as in Britian's past) able to purchase healthcare from whovever they wish. They will choose Doctors (and hospitals) on reputation, qualifications and membership of well-regarded professional organisations. Health insurance would still be an option but I suggest that in a true free market, collective purchasing would be a more attractive option. Doctors could organise in anyway they pleased, but their guild would not be recognised by the state as it is now.

October 01, 2005 2:27 AM  
Blogger Kevin Carson said...


That's pretty much my idea, too. Either that, or transform them into consumer co-ops owned by the people who use them--or maybe stakeholder co-ops based on a combination of the two principles.

Sergio, colorless, and Charles:

I think it may be possible to combine colorless' and Charles' ideas here. Multiple tiers of training and service (a free market version of the Chinese barefoot doctors, maybe) would work well within a system of free market credentialling. It works great with kosher foods. Depending on the dietary rules of your sect of Judaism, you look on your food for the seal of approval of the relevant inspection agency--all done by voluntary organizations.

As for "professionalism," I'd like to do away with the idea altogether and resurrect the medieval idea of the skilled trade. I view MDs the same way I view a plumber or electrician. I hire them for their expert advice, take it under advisement, and then make the final decision myself.

October 02, 2005 8:12 AM  
Anonymous Wild Pegasus said...

The qualm I have with stakeholder ideas is that I can't see how I get any right of ownership in the local university hospital because I went there during two kidney stone attacks. I spend a lot more time at the grocery store, and no one takes seriously the idea that I ought to own a piece of it because I choose to shop there.

(I'm also a part of a local food co-op, but that's a different situation. I bought into it.)

- Josh

October 05, 2005 11:27 AM  

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