The Battle for Self-Ownership in Medical Care

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This is a transcription of the Alphonse Crespo’s talk at the ISIL 2013 World Conference.
Transcription edited by Kenli S.

Before I start, I just want to tell you how I enjoyed listening to the previous speaker speak about Georgia. Georgia is indeed one of the finest examples of what can be done and what was done very quickly. I remember I was invited to Georgia just when they started this privatization.

They thought well, Switzerland is a good example we can use to develop this fantastic project and they invited me to tell them something about how to do it. When I saw what they had already done in a year, I said, “Well you tell me how you did it because I’m going to go back to Switzerland and try to get at least a little bit of what you’ve done in such little time.” I was extremely impressed as a whole, to see and actually witness as a doctor what Market Medicine and Hippocratic Medicine looks like.

When I came to my first ISIL meeting; this was in London, in I think 1984. It wasn’t ISIL yet, it was Libertarian International. I remember it was Chris Tame, who has since passed away, who organized this meeting with the Libertarian Alliance, which was the name of his organization.

In 1984 the Iron Curtain was still there, very much there, and we were talking about privatizing. I did this small thing on privatizing healthcare, and at the time it seemed that well, we still had a really long way. Even to get liberty in a free society, while there’s still half of the whole world that has an even longer way to go. It seemed very far away. I didn’t think that in my lifetime I would see the Berlin Wall tumble and the Iron Curtain go up.

There was one person at that very first meeting that I attended in 1984, Lord Ralph Harris who was there and who encouraged us—we were a few, only a handful of young European Libertarians. I thought I was the only libertarian in Switzerland at the time, and I probably may have been in those days. So how were we going to achieve liberty? I remember Lord Harris said, “It takes a small number of committed people to change society and if you’re really committed and you have the right ideas, you will make a changes.”

I never expected that, and though I’m not saying I made a change in Switzerland (there hasn’t been much change here because things still look too good for people to demand change), but nonetheless things have really changed. It took a few people to change things, if you look at who tore down the Iron Curtain, it wasn’t the Cold War that tore it down. It was a fistful of dissidents who spread the word on the ground. Ultimately truth and reason triumphed, almost overnight when a critical number of people had been exposed to it, as Ralph Harris had predicted.

Then there is when I read “Morality of Capitalism” I said this is really great we’re going to head to that, but I had never in my mind expected that China would be a leading Capitalist country in those days. I said well okay we’re going to do it, it seems Eastern Europe is changing, but China, not China. It took one person to change China; this is what I love to think.

Professor Camille Castorina, a professor of Economics in the United States (who was previously a guest speaker I think at a Norway Libertarian International Conference) told me last year that she once was on a boat cruise with some Chinese graduates and young academics. China was opening up to the West, it was just the end of the so-called Cultural Revolution and she was talking to them and they were interested in what she was saying (she’s a free market libertarian). They said ‘well, what you’re saying is interesting, could you send us a few books for our library in Shanghai? She said yes, sure.

They said, ‘because you know all our English books were burnt we burnt during the Cultural Revolution and our library is empty.’ She said sure I can send you a few books. They said just as long as they don’t have the word politics in the title. So she sent them “Human Action” by Ludwig von Mises and other such non-political books on economics and they were the first books to feed Shanghai’s future free-market intellectuals. So I like to think that it took one person to change China.

In the same way I like to think that of how Ken Schoolland told me yesterday that Jonathan Gullible was translated into Arabic and about six months after that Spring Revolution came up. So we still have much to, but there are enough of us to do it, and we have time do it!

With these encouraging words I‘m going to start my talk on what I’m supposed to talk about, “The Battle for Self-Ownership in Medical Care”.

This, by the way, is a real person that allowed me to make a picture of her back. So I won’t say her name because I didn’t ask her for formal permission to, but I told her I’d be speaking about that. It reads: “I am the owner of my body. I am the captain of my soul.”

Self-Ownership

To begin, I am going to try to really quickly focus on what the threats to self-ownership are. We all know, all the people in this room know, that self-ownership is at the basis of liberty. There’s a very good definition here that was given to me by Carl Watner, who was actually quoting Murray Rothbard.

Carl Watner (who I met in the United States, in 1983 if I can remember correctly) was the one who told me about the London meeting in 1984, and that’s where I started on my libertarian career.

So this is the definition and what are the threats today and yesterday to self-ownership in medical care? Well, the biggest threat of course, is disease. If you’re sick, if you’re ill, your mind cannot command your body and sometimes your mind cannot command at all if you have a psychological illness. So the biggest threat is disease, we’re all going to get it, or have gotten it, we’re all going to find out about this or have found out about this that when you’re ill; you’re unable to do what you want because you’re ill.

So I would say the main enemy of self-ownership, one of the biggest, is indeed sickness.

So if you want to regain self-ownership when you’re sick or at least improve your self-ownership, you need allies. In some cases you can do it alone, you can do it with mild illnesses, you have the internet that now opens you to self-treatment, that’s one way to regain your ownership of your body when it’s struck by mild illness.

If it’s a little more severe, you need the help of professionals. You need health industries that produce drugs and therapeutic agents that enable you to regain the ownership over your own body. Finding the right professionals, making sure they are working in your own interests, and finding and having access to the appropriate tools and medicines. It does not really work as well in Western Europe, I would say because we have inherited healthcare systems that are obsolete today.

Thank goodness for that, because that will make the change come sooner or later, whether the bureaucrats want it or not. We are working in systems where third parties call the game. This was initiated by Bismarck way back, we still have Bismarckian model which is overbearing in most of Europe. Bismarck is dead now and I think this model will probably die as well. It’s dead in Georgia, and it will die elsewhere.

So the point is how can we make this euthanasia of Bismarkan systems come a little quicker? I think we have a certain number of tools and that’s what I’m going to mention briefly today. What tools do we actually have now that enable doctors to no longer to serve two entities? One is their patients as every doctor is trained to do. The other is his paymaster, the third party payer, or the regulator who regulates and tells him what he can do and how he can do it. This is one of the reasons I quit medicine surgery a little earlier than I should have, because I just couldn’t bear this regulatory environment that was making my work more and more difficult to do, even technically.

A doctor cannot serve two masters at the same time. He cannot serve his ethics, which is to be at the sole service of his patient, and serve the other ethical issue that if somebody is paying you, you have to be loyal to the person who’s employed you. So you’re torn between these two and the interest of the insurer, the third party that mandates, are not always the same as your patient and in fact, more and more they’re not the same as your patient’s.

How can you reestablish the direct contract between patients and doctors? That’s one of the keys of achieving self-ownership for patients in so far as they can choose their doctor and also autonomy for doctors who can concentrate their work on their patients without third parties telling them what to do. That’s one way, and there’s several means of doing it.

The Black Market

You can go to the Georgian President and make him make the radical changes. But that’s not always easy to bring the Georgian president here. What I try to push now is one relatively simple way for future patients to see you. If you’ve not been a patient all your life, you’re going to become one, one day. For future patients to regain control of their doctors, one way is through the black market, like with the under the table thing described in Georgia.

I’ve written a paper on how black market medicine is better than State medicine. In so far as doctors treated their patients’ best interests, which was not the case in the State system. I think black market medicine is essential, when it’s there that means the market is still alive. Of course it’s better for the black market to become white, as it happened in Georgia where it was legalized, which made it really expand. Black marketers were like Solonitsyn, you know the people who were keeping the right stuff, the direct contract to life, even though the environment did not call for that; the socialist environment.

Health Savings Accounts

The second option is a health savings account, which is a very simple thing. It means that you save when you’re fit, to pay for your healthcare expenses when you really need them. It cannot be the only way, you need also some form of insurance, but the health savings has the advantage that you have the ability to pay for your Doctor in cash without a third party. This works in Singapore even though the health savings account system may be the only good thing they have in Singapore. It works.

Once I was invited to the Beijing University in China—once again they were interested in the Swiss healthcare system—at one point because they were reforming and I gave them a soft sell of the Swiss system and the hard sell of health savings accounts and other really free market stuff. And to my surprise, after I gave them the hard sell of health savings accounts; they said well we’re experimenting on that in urban regions and it’s working. So China is becoming one of the places to look at where these health savings accounts work.

It’s worked in the United States for the last ten or twenty years, even though now with Obamacare it may slow things down. But in the United States what is interesting is the fact that people do pay cash for their treatments, or did, which means that the relationship between doctors and patients has still kept up.

Now one thing I want to mention is I have friends in the AAPS, the American Association of Physicians and Surgeons, that are very much involved in what they call Concierge Committees, which is where doctors get together and say well we as a matter of principle we are Hippocratic Doctors, we are at the sole service of our patients, and we refuse to deal with any third parties! They call for cash payment as the rule, and that does not stop some Concierge’s establishments to offer free services if a patient can’t afford the treatment. This goes very much with the true mission of the doctor.

It’s developing in the United States and will continue to develop despite of Obamacare. Maybe because of Obamacare people will realize what they’re going to be getting with mandatory Insurance and they will opt for other alternatives.

Dual-track Systems

Another key to self-ownership of course is for patients to have some autonomy on what’s going to be done to them. Patient empowerment is a very powerful word, it’s what needs to be done. You need a means to increase patient empowerment and one of the ways that I want to mention here is the dual tracking system. This is tied to something I think Mary will be talking about the FDA, so I won’t go very much into this. She’ll be giving you more interesting stuff on this.

In the United States, the FDA makes innovations take a lot more time to get drugs to the market than it would take if the process was not so regulated and bureaucratized.
I have a friend, Mark Madden, who has worked with Vernon Smith, whom I also got to meet in this project. He is working on a concept that is being developed, in academia at least, on a dual tracking process which would enable people to contract with the industries that are producing new potentially curative products not yet on the market, but that could be life saving to them, by direct shortcut. That shortcuts the exceptionally long phases of drug approval.

Another thing being developed is the TED, Trade-off Evaluation Database, where the companies will make a database where patients and doctors can see what’s going to come for some treatment of let’s say a deadly form of cancer and they can say ‘well it’s not been approved yet, but what are the risks and the advantages? Okay I’d rather take the risk, I’m going to die anyway in two or three months probably, if this will save my life, I’ll take the risk.’

That’s the principle of this dual tracking process and I’ve left some of the books, a few books for you and for those who are interested can get them in the hall.

Medical Tourism

The other interesting feature that I’d like to highlight here is that it also increases patient empowerment. If you can’t get it in your country, you go next door. If you can’t get it in Azerbaijan, you go to Georgia. So medical tourism is one very effective way, provided you know what is being provided elsewhere, to get treatment you may not get in your own country.

There’s this very interesting thing called medi-bits. It was started by a Canadian, who realized Canadians were not able to get the care they needed in a very sophisticated way. Canadian medicine is one of the best in the world from the point of view what they can offer, but not from the availability point of view, where it’s one of the worst in the world.

So people can get fantastic treatments, but they have to wait for long queues and they have the time to die before they get them. So what medi-bit does, it pools resources of let’s say, I want a hip replacement. I call into medi-bit over the internet. I say here is where I live, I need a hip replacement in Canada and I’m going to have to wait for five years to ten years, is there any place in the United States where I can get it quicker and how much will it cost me?

Then doctors will bid, they’ll say I know a hospital where you can get it for this much and that much and then the patient will make a choice according to the quality of the hospital and the price he is going to have to pay for it. I think that’s a very nice way, a practical way, and it works, and it is working for patients to shop for care elsewhere when they can’t get it in their own area.

Organ Transfers

Medical tourism is also, this is another topic and I am not sure medi-bit specializes in this, but Ken is going to talk about organ transfers and that’s also you can travel in Pakistan to buy a kidney. I think it’s still legal for people to sell kidneys in Pakistan if you need one. People say, oh, it’s horrible this man he has to sell his kidney, why isn’t it horrible that I give my kidney? In donations I’ll give it to someone that I know, but what’s wrong with giving?

Your kidney is your own private property; you can give it away to someone in your family, you sell it to feed your family, the effect on your anatomy is the same if you give or if you sell. So you’re not really punishing a guy who sells his kidney, you are in fact enabling him to feed his family and at the same time save another person’s life. So I think there’s nothing immoral about buying or selling kidneys, but I think Ken will be speaking a little more about that so I won’t elaborate too much on this very crucial topic. It’s crucial to self-ownership, if you own your body; you should be able to do what you want.

Genetics

Another topic that is a timely given that genetics is the future of medicine; actually not the future, it is already the present now. Great advances have been made in that field and now it is possible to read your DNA and you know, sort of predict what kind of diseases you may or you’re likely to have throughout your lifetime.

I was talking to one of our friends here who had his DNA read and apparently he could also find out where his ancestors came from. So the DNA gives a lot of medical information, but the information should be yours, nobody else’s. And you should be able to deal with it in the same way as you will deal with your bank account.

There’s a very interesting a new, a startup called Sophia Genetics. I am mentioning it because they’re working near this place; they’re near Lausanne in the Scientific Park at the Swiss Federal Institute of Technology (EPFL). Some graduates from this very prestigious school started a pipeline where the doctor sends his patient to get their DNA read, then Sophia’s Genetics encode it, put it in a safe where it can be accessed by any doctor who has the password and the patient also has the password. It’s a very simple and sophisticated way to remain the owner of your genetic property.

This can be important with the third eye that is watching everywhere. Your genetics can enable a Government to know whether you’re going to vote for them or vote against them. I am also more than convinced there is a liberty gene that all of us in this room have and that some people will never have. Unless we marry someone who doesn’t have it and then our kids may inherit it. So we should not marry amongst one another, we should maybe find people in the other field so as to transmit our genes.

Genetics is one issue that’s going to be frequently discussed in the near future, when governments become interested in your genes. Health Insurance Companies will be the first to want to know whether you’re worth insuring or not.

Assisted Suicide

The owner of my life and “The End” does not mean the end of me, but it means I want to talk about the end of your life. I think that you should be able to decide when you can if you want to do away with your life. Assisted suicide is one issue where things vary. In Switzerland there’s a society called Exit, where you can book with them to have you killed. You book them and you say I want to go away and they come and they surround you and they do this in a very soft way. If you’re terminally ill and you just don’t want to go through the fuss of what’s waiting for you and you’re going to lose the battle anyway. We’re all going to lose that battle one day. Then you can call for Exit and they will do it for you.

This has created some health tourism. People from other European countries where assisted suicide is forbidden, do come to Switzerland and have their ashes spread over the Swiss mountains. This has happened and people were complaining that they were getting ashes from foreigners. So this is true. So I think that it is one’s right to end one’s own life and if you contract with someone, you have the right to contract with anyone to help you do it.

In the same way, I think if you want to pay a lot of money to be alive for another ten days in an intensive care unit, you or your kids should be able to do so and it is not up to the system to decide it’s too expensive. Nobody in his right mind would do that, but I still think from a matter of principle the truth goes both ways.

Conclusion

So to end my dissertation on this topic, I want to as always end on a confident note and I am indeed confident for the reason that I have written up here: we have truth for us, we have reason for us and when truth and reason, they are together, liberty is the natural outcome. So truth and reason inevitably leads to liberty.

There are a few little things you need on top of that individually; one is consistency, you have to insist on truth and liberty, the other one is courage, we don’t need too much courage here; but Solonitsyn and others did need a lot of courage to keep telling the truth and spreading reason. And you need confidence and that’s what I hope you will end up having after this meeting, if you need it, but I don’t think you need anything; we’re all confident that the ultimate battle, the war, we’re going to win it, someday. I think it’ll happen sometime in the long-run, but I think, no it might not even take that long, as I’ve been proven wrong several times in the last fifty years.

So thank you for your attention.

See more videos from the Lausanne Conference
This is a transcription of the Alphonse Crespo’s talk at the ISIL 2013 World Conference.
Transcription edited by Kenli S.

Kenli Schoolland

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