Tuesday, April 27, 2010

What is "Panarchy" ??

Somebody sent me a message on Facebook today (feel free to look me up and friend me) asking what "Panarchy" was. Panarchy is an idea that I've become very interested in because it is a concept that provides for open competition between systems of government and taxation. As we all know, when there is no competition for a product that service may be lousy and the price can be high, where else are you going to go?

In the case of government, that is exactly how it is too, "Where else are you going to go?". There also seems to be a lot of confusion, mostly due to misuse of the word, in the media over what "anarchy" is. Below is a slightly edited copy of my very brief and hastily typed response to the Panarchy question and their concern they had about anything that sounds anarchistic.

Anarchy is just a state where each person lives free to interact voluntarily with all others. All things would be private including police and legal systems with open competition and mediation and private third party intermediaries and other mechanisms between them to ensure justice and the protection of each person's natural rights. Anarchy should NOT be confused with "chaos" or "violence" even though those in the media who do not understand the nuance in word selection may try to substitute one for the other. While anarchy may mean no government, it does not mean those functions are not performed or handled in other ways.

Panarchy is an idea that basically allows for open competition between government systems and you would voluntarily align yourself, perhaps contractually, with the one that suits your needs, preferences and values.

Most government systems are basically nothing more than a monopoly on violence, force and theft within the imaginary lines drawn on maps by men. Imagine if a government system you belonged to started charging too much for the services they provide, or started providing services you don't need so you voluntarily de-affiliate and become a citizen of a different system without having to relocate geographically. That way socialists can be (broke) socialists, communists can be communists and free market capitalists can be just that and the different groups need not bother each other with their polices. So long as basic natural and contractual rights and obligations are enforced each system could operate under a very small legal framework with each sub-system augmenting as necessary for their needs.

The overlying mechanism that would make this work and one that I think still makes me prefer panarchy or minarchy instead of anarchy is the idea of that basic legal framework for the protection of individual natural rights. Nobody, not even elected officials or their minions, would be allowed to steal or oppress people without them first having agreed to such by their voluntary association.

Hope this helps. It's an idea that needs more attention and the advent of technology probably makes it more plausible today. There are a lot of potential complications, for example, a company might have to be authorized to do business with citizens of each or any particular system and might be subject to different kinds of restrictions within each population group; but, this is no different than companies doing business in different countries or jurisdictions. Even state laws and regulations vary.
Even if not at the individual level, which is preferable, different cities or towns might opt-in to a specific system of governance. There are lots of things that would need to be examined, and certainly the idea of people or groups of people having those kinds of options scares the heck out of big government apologists of the status quo variety who lack imagination; but, otherwise, you're stuck unless you want to pick up and move, emigrate to another country, potentially lose your voting rights, unseat your family or your career.
Basically, getting rid of government having a monopoly. Competition, like in everything else, would ensure better service and lower prices (taxes are the price way for our government - we know what happens when there is no competition). I've not really considered this idea fully from a practical perspective; but, I think it warrants some thought. But, I caution that when coming up with roadblocks, objections or complications to stop and really think through whatever the issue is and ask, "hmmmm... how might that work in this kind of environment?", "what kind of cooperation between groups would be needed?" and "could it be any worse than what we have now?"

Monday, April 12, 2010

Health Care Bill Restrictions Kill 60 Hospital Projects

The recent so-called "health care reform" bill, which in reality didn't so much reform "health care" as to addressing the high cost of care but in reality was a big government shuffling of the health care "insurance" and "pre-paid care" business is already working to limit the supply of hospitals.

Here are some excerpts from an article at CNSNEWS.com today whose site was most unavailable after The Drudge Report posted a link:

The new health care overhaul law, which promised increased access and efficiency in health care, will prevent doctor-owned hospitals from adding more rooms and more beds, says a group that advocates physician involvement in every aspect of health care delivery.

Physician-owned hospitals are advertised as less bureaucratic and more focused on doctor-patient decision making. However, larger corporate hospitals say doctor-owned facilities discriminate in favor of high-income patients and refer business to themselves.

The new health care rules single out such hospitals, making new physician-owned projects ineligible to receive payments for Medicare and Medicaid patients.

Existing doctor-owned hospitals will be grandfathered in to get government funds for patients but must seek permission from the Department of Health and Human Services to expand.

To get the department’s permission, a doctor-owned hospital must be in a county where population growth is 150 percent of the population growth of the state in the last five years; inpatient admissions must be equal to all hospitals located in the county; the bed-occupancy rate must not be greater than the state average, and the hospital must be located in a state where hospital bed capacity is less than the national average.

The rules fall under Title VI, Section 6001 of the Patient Protection and Affordable Care Act. The provision is titled “Physician Ownership and Other Transparency – Limitations on Medicare Exceptions to the Prohibition on Certain Physician Referral for Hospitals.”

More than 60 doctor-owned hospitals across the country that were in the development stage will be canceled, said Molly Sandvig, executive director of Physician Hospitals of America (PHA).

The article goes on to talk about nurse to patient ratios, the employment impact of doctor-owned hospitals and how corporatist interests have been working to limit the suppy of them:

The organization says physician-owned hospitals have higher patient satisfaction, greater control over medical decisions for patients and doctor, better quality care and lower costs. Further, physician-owned hospitals have an average 4-1 patient-to-nurse ratio, compared to the national average of 8-1 for general hospitals.

Further, these 260 doctor-owned hospitals in 38 states provide 55,000 jobs, $2.4 billion in payroll and pay $509 million in federal taxes, according to the PHA.

In one ironic aspect, President Barack Obama’s two largest legislative achievements clashed. The Hammond Community Hospital in North Hammond, Ind., got $7 million in bond money from the federal stimulus act in 2009. It will likely be scrapped because of the new rules on physician-owned hospitals, according to the Post-Tribune newspaper in Merrillville, Ind.

Doctor-owned hospitals have long been a target of the American Hospital Association, which represents corporate-owned hospitals as well as non-profit hospitals.
This is the kind of action on the part of government that limits competition and innovation rather than encouraging it. At the same time, if patients took more control of their health care dollars and decisions they might be more apt to shop around. Historically, people have just submitted themselves to the doctor's directions rather than asking if there are any less expensive options. We also have an issue where doctors are limited in which hospitals they may provide services at, this further limits patient choices in ways that may or may not be appropriate but might be understandable from a hospital administration perspective. The problem is that often the doctors can't tell you what the full price will be for any kind of procedure ... hardly anyone ever asks apparently.

In short, the whole health care delivery system needs to overhauled; but, massive government regulation and red tape stand in the way. Instead of getting less red tape, Congress just gave us a bunch more. Once again, taking the country in the wrong direction.