Milton Friedman on universal health care



I'm going to talk about the economics of medical care this is an area in which as we all know there has been a trend toward ever greater government involvement the spending for the provision of medical care inevitably leads to control over the fees that are charged for medical care and it should if government is going to spend money and ought to be concerned with what it pays for what it gets control over fees inevitably leads to control over the practices that are followed over the behavior of the medical personnel and if this trend continues and inevitably leads to completely socialized medicine I believe that this trend including many of the steps that have already been taken is very much against the interests of patients of physicians and of other health care personnel and in the brief time I have available today I want to explain why I believe the trend is is so much against their interest why it has occurred and what if anything can be done about it the trend toward increasing government involvement in healthcare is not an isolated phenomenon it is not restricted to help you it is part of a general trend in our society toward replacing voluntary free-market arrangements by government control and regulation it is a trend that is happening happening all over it has happened in one industry after another there is nothing special in this respect about the move to replacing private voluntary medical arrangements with compulsory governmental arrangements this movement in the medical care field is not special in another sense in industry after industry producers who protest most strongly their belief in free markets have fostered and helped produce government take over government regulation government control to begin with a greater involvement of government in medicine may seem to serve the interests of at least the purveyors of medical care by providing an additional source of finance this is a honey that has landed persons and industry after industry to support and promote governmental involvement which has reacted ultimately against I have been impressed again and again with how often businessman leaders in various areas who are very farsighted when it comes to their own activities into concerns within their enterprises are very short-sighted when it comes to the area of Public Policy and allow themselves to be led by small advantages to foster in favor policies which ultimately redound very much to their disadvantage in the medical case the initial inducement is that here is a new source of money and presumably this is why organized medicine has been schizophrenic about the trend toward government involvement it has on the one hand tended to protest against the move towards socialized medicine it has on the other hand engaged in activities which have promoted that development as the one the government is taking over any activity there is more money available but what typically happens is once the government has taken it over the situation changes there are no more votes to be gotten by taking it over some more you have to move on to new fields and take over new areas in order to get some new votes and the result of that is that those areas already taken over gets starved and instead of there being more resources available there are fewer in addition to the fact that the ultimate result of a government takeover is less resources you invariably get lower quality in a lower quantity of medical care I am going to cite from a study that was made by a British physician dr. max gammon who spent five years studying the British Health Service mr. Gannon in a rather amusing way developed what he called a theory of bureaucratic displacement he argued that whenever you have any organization taken over by a bureaucracy like a government what tends to happen is that input goes up and output goes down that useless work tends to displace useful work in a further extension of Parkinson's laws and he Illustrated it with hospital service in the United Kingdom he took the eight-year period from 1965 to 1973 in that eight-year period the hospital staff the number of people went up 28% incidentally administrative and clerical help went up 41% but what about output what about what they were producing input was up well he measured output by the average number of beds occupied daily it turned out that the average number of beds occupied daily went down by 11 percent and he hastened to go on to explain that the decline in the average number of beds occupied was not for a lot of patients that at all times there was a waiting list in the neighborhood of 600,000 people waiting for hospital beds I don't know how many of you know the scandals in Britain about the waiting period for what is regarded as optional or postponed Obul surgery including for example bypass operations for heart problems there are stories of people who waited three years to have a bypass operation because that could be postponed indeed some of them manage to die before the operation was performed but 600,000 people waiting on the waiting list and four rather more readily more obviously postponed able operations the wait may be much longer than three years let me turn to Sweden I quote from a report by dr. Guney ganar Bjork in Minnesota I should be able to pronounce the Swedish name but it takes more than physical connection he was he's a professor of medicine at the Karolinska Institute he's a head of the Department of Medicine at a major hospital in Stockholm he formerly was and maybe still is a physician to the king of Sweden he gave a repaper in 1976 at the University of Chicago on quote how to be a clinician in a socialist country and I quote from his papers it is obvious that the existence of a competing free-market constitutes a continuous threat to the operation of a socialist public service however heavily subsidized by taxpayers money the element of quality that derives from patients personal preference for and confidence in certain doctors cannot easily be done away with so long as people are willing to pay for a free choice of physicians to do away with such opportunities therefore has become a new goal of Swedish healthcare politicians the introduction of these various regulatory processes has resulted in a cancerous growth in the numbers of medical administrators at all levels of incompetence the board of welfare I go on quoting has recently issued a 60 page book trying to describe how to calculate the number of physicians needed to cover the necessary staff of any one clinical department the book is a fascinating monument over the total absurdity into which legislatures administrators and trade union referees have finally brought a previously simple and efficient machinery the setting in which medicine has been practiced during thousands of years has been one in which the patient has been the client and employer of the physician today the state in one manifestation or the other claims to be the employer and thus the one to prescribe the conditions under which the physician has to carry out his work these conditions may not and will eventually not be restricted to working hours salaries and certified drugs they may invade a whole territory of the patient's physician relationship if the battle of today is not fought and not won there will be no battle to fight you

47 comments

  1. The universal systems today are literally better and cheaper than the USA's broken private system. The developed world switched to socialized medicine, and none went back. Friedman was wrong.

  2. I am so tired of people saying socialized healthcare is great because it is better than the US system. The reason that healthcare is so messed up in the US is because of government control and regulation. So how in the world is more government control the solution if it is the problem in the first place? If we actually had a free market in healthcare, then people would be paying out of pocket for non-emergency treatment which would lead to consumers staying away from hospital overcharging them for every little thing. Insurance would take care of emergency treatment in which consumers have no say on how much they are charged. There is no reason that hospitals should be charging five-star hotel prices for rooms and exuberant prices for simple things like band-aids in a truly free market.

  3. Australia, UK, Canada, China, Germany, France, Belgium, Japan, Thailand, Vietnam, Korea, New Zealand, India, all have universal health care systems. All do better than the USA.

  4. health care is a commodity……… how come no one is calling for ' universal ( government)' car repair, dental, home repair..

  5. Patents and regulations raise the price of medical costs, and people in the comments blame the free market. Call for socialized healthcare and then wait until the government decides it would be cheaper for you to just die…

  6. One of the biggest drivers of health care costs is that technology now has gotten so advanced that it's extremely expensive to do this, particularly in a private system where you can have the benefit of pooling the greatest number of people to share the costs related to that technology. The horrific bureaucracy doesn't make it better either. I've often thought that one possible solution would be to keep things private for the most part, keep it as deregulated as possible, but have a public system in place to pay for emergency services. Emergency services could be done by private health insurance as well, but at least with a public system you could have a health care provider of last resort.

  7. I'm grateful for the universal healthcare in the country I live in- without it, my family would not be able to afford life-saving care for my mother when she needed it, or for my younger brother when he could have lost his eye.

    What a nightmare it would be to live in a country that doesn't offer it cough (America).

  8. The mixed model approach seems to be more effective, if you look at the countries with the best healthcare and overall cost. Germany, Singapore, NZ, France all do very well and have some from of public/private system. The Canadian and UK systems of only public needs to be adjusted. The US private system is by far the worst performer for costs, but in monetary sense and in societal costs.

  9. A critically ill patient has zero bargaining power. It is therefore inevitable that absolute power corrupts Doctors. The question therefore is, how can we ensure the medical profession acts in the Patient's interest? Doctors are human too. They get sick and tired of sick people. In this respect they are like the legal profession. Lawyers hold the greatest contempt of the Law.

  10. I'm a big fan, but this was weak. Maybe because universal care programs were still new in other first world countries. It is clear now that the US system is 2x as expensive as the next worst country and has worse average medical outcomes than many.

  11. He calls right off with control over the practices that are followed.

    Prime example: the war on pain patients as I refer to the opioid crisis. Flat out equating prescription pain meds with street drugs because they are both opioids. Pain patients rarely become addicted to their meds and where they do, it is combined with street drugs and/or alcohol.

    This has recently affected even my overly cautious use of hydrocodone. I take 5mg a day that controls both pain and my IBS and I skip that twice a week to avoid building up a tolerance. I don't want to need more and this amount is a recent increase from 30 pills lasting six months specifically because I'm paranoid about addiction. This amount is not addictive.

    My primary care not only had no problem when I went to him and said I have to discuss this because my degenerative and incurable bone disease is worsening and pain is increasing but was surprised I wasn't actually taking it every morning. But when I returned a couple of weeks ago, he filled it reluctantly even after I informed him I skip it twice a week and intimated that I should be put on Prozac instead.

    First of all, why? If it's not broke, why fix it? The hydrocodone is working and I have been freer on the 5mg every morning than I have been for years.

    2nd, I find the push to put me on antidepressants when I don't need antidepressants a most alarming attempt to control my mind. Not going to happen and I am stressed and worried because he implied that he will not continue to prescribe me hydrocodone.

    This means looking for a new primary care because, frankly, calling such abuse of a patient, making her suffer needlessly by taking away a working medicine for one that may or may not work and has scarier side effects for a patient that seems to have the horrid luck of side effects happening (which is why hydrocodone controls my IBS), incompetent is being kind. This makes me run the risk of being labelled doctor shopping and drug seeking which is a ludricious accusation on such a close to nothing dosage unless you consider it drug seeking to seek out the medicine that actually works for you without side affects that land you in the hospital (as every other prescription pain med tried for me has).

    Oh, yes, the government is definitely controlling – inefficiently as always – our medical care. At least if you're a chronic pain sufferer and I suspect probably other conditions as well that I don't deal with but right now it's the "opioid crisis/epidemic" that is the political football and the government is waging war on pain patients.

  12. The US uses the exact opposite system to every other industrialised country in the world and pays twice as much to do it and allows tens of thousand of Americans to die every year because of it.   In the US the government has allowed the insurance companies to run the US health sytem and take as much money from Americans as they can.

  13. Socialized medicine is a good thing for the poor and a bad thing for the taxpayers that will foot the bill. France and England have it along with Canada. I suspect they pay for it by cutting in other areas like military spending.

  14. You will not have your blood drawn or urine tested in the doctors office. They will send you to a lab and you will wait there to get your blood tests and then make another appointment with your doctor for the results. Sometimes 3 weeks. Its not a big deal if your not in a hurry.

  15. The USA politicians can't manage money. Look at the mess with the electronic records, so rediculous. In stead of putting one out themselves they left it to the free market the costs were staggering. Single Payer is doable in the USA. Patience and understanding is necessary.

  16. So… It's bad for the government, whom THE AMERICAN PEOPLE ELECT, to control health care, but its good for the insurance companies, whom THEY HAVE ABSOLUTELY NO CONTROL OVER, to control health care…. BRILLIANT!!! American are just too stupid to have good things. They get tricked into going against their own interests time after time… Those fucking retards deserve to live in poverty. They smash unions, free health care, free college, fixing the infrastructure (like having bullet trains to take them to work quickly instead of having to commute through traffic), then put more of their own people in jail than anywhere else… Americans, seriously, I believe something in your food and/or water supply is draining your IQ. You're completely retarded!! You get what you pay for. If you dont pay for anything, you dont get anything. Enjoy your "freedom", lol. You are free to let corporations fuck you in the ass, and you're PROUD of it! lololololololo

  17. It looks like he is speaking at the Mayo Clinic, to doctors, which is why he doesn't criticize the monopoly on health care that MDs/allopathic medicine have enjoyed for almost a century now by law.

  18. In economically standpoint of view, he is right, but if we look at life expectancy it has increased alot since the implementation of social security.

  19. WE THE REAL AMERICANS NEVER WANT GOVERNMENT RUN HEALTH CARE SINCE THAT IS ANTI AMERICAN SOCIALIZED MEDICINE AND NOT GOOD FOR ANY AMERICANS!!!!!

  20. Civics people….we can have debate without getting into name calling, slander, or libel. If you disagree with the argument made, offer the counter argument and if no compromise can be made, just agree to disagree! Its fine! Life does not revolve around debate. More classes in civic discussion is needed in our universities and education system. My belief is that we can start learning and practicing this form of discussion right here on youtube.

  21. HE WAS WRONG YOU IDIOT. You're all fucking spastics. Donald Trump's plan is going to put 26 million Americans off insurance. Well done on the "privatizing health care" strategy. America comes dead last in the world with health treatment.

  22. Obviously the cameraman didn't like the tops of heads. But microphones and the bottoms of ties are really interesting.
    Milton should have done a sideline in ventriloquism.

  23. Friedman says in this video he based his whole idea of socialized healthcare being bad based off of what he said was a "trend" of government involvement in the care between a doctor and a patient because the funds for that care came from "the government". This then supports his total libertarian view to cut ALL entanglement. This "trend" he spoke of in NO WAY reflects the present day situation. How are there so many laws restricting free access to abortions in the states and yet here in Canada with my socialized care I have NO such restrictions? I hear a bill for one Advil in a hospital is off the charts in the US, not so here.

    Friedman's theories of trends (which were per-evidence based economics) should be reevaluated within our current time frame for accuracy. I've read Friedman's "free to choose" and shook my head at almost all his assertions. He tried to fit all things into a "one-solution" capitalist framework of Governance when really it was trying to fit square pages into round holes.

    Bottom line: Health care is about caring. Capitalist solutions are best in situations where a duty of care is not involved because the duty of care is overridden to caring about a shareholder, not the person purchasing services – in this case a patient who gravely needs them. I love the US but would never go into it without SOME form of vacation health care.

  24. oh ! now I understand !
    the provision would of public healthcare has been a disaster in Europe ?
    whereas the private, profiteering, exploitative system in the Us of A is the only system that could possibly work ?
    it's sad how Europeans laugh so scornfully at that obvious truth. they must be so deluded !

  25. Although he was a very intelligent man, in reality he just called it as it was and didn't play party-politics regarding these issues…….He knew, as any intelligent person would, just what socialism is and what it does. He's the textbook example of the old saying that "speaking the truth becomes a revolutionary act". I laugh at people who dote on their "free Healthcare" yet forget to mention their $10 a gallon gasoline at the pump……nothing is free, if you don't work you don't eat, it's a pretty simple philosophy.

  26. Friedman is brilliant once again. If only the idiots in Washington D.C. had listened to him 8 years ago we wouldn't have the disaster today known as Obamacare. Thank God Trump is repealing and replacing it with something sensible.

  27. Health care ran by a bad bloated bureaucracy will result in bad health care. Health care where there are too many administrators and upper executives who have bloated salaries sucking dry the American people results in bad health care which is what we have today. Too many people at the top, who are not necessary nor contribute to the actual process of providing health care to patients, making too much profit off the American people out of shear greed. Deregulation and a government controlled by the super wealthy and corporations has allowed this to happen. There is no free market when government is controlled by the super wealthy and corporations. Those who already have wealth or corporations who are already successful keep the playing field tipped in their favor by controlling the government to squash and real competition a true free market would bring.

  28. Friedman has forgotten one thing. The ER IS a monopoly. Why? Due to you might not have time to shop around before you die!

  29. Public healthcare does not cause the demise of private healthcare. Any country should have a basic healthcare system available to all citizens for preventive care, accidents, and any other diseases. Private enterprise can offer even better healthcare, better hospitals, doctors, etc. I am from Portugal, we have free universal healthcare AND private health care institutions. Every citizen knows they can see a doctor and get medicine, go to a hospital and get treatment. If they want a higher end experience in their health care there are many other options. The quality of those options is much higher since the private enterprises need to offer much more than the free health care in order to be attractive to the citizens who are able to pay for them.

  30. This is the one place I disagree with Friedman. Health is an inelastic good and thus private business will charge whatever they can because people will pay no matter what.

  31. Still never saw any comment thread or anything that answered the question: is this channel at all related to 1791L?

  32. i do not believe simply removing the government out of the free market is enough for corporate to exploit there worker. You can exploit ur worker and destroy competition in many other way.

  33. This man is not concerned about the statistics he quotes. I do not trust him. He's a brilliant economic scientist, I will allow, but I can not trust that smug little smile as he delivers these awful pronouncements.

  34. I like the idea of preventative medicine. If you consent to giving insurance more information about your diet and life style you can get bonuses on your insurance. It wouldn't be an invasion of privacy unless the government was involved. Where there is government, there isnt consent. Where there is capitalism there can only be consent. People should be allowed to choose their preferred coverage and suffer the consequences. No one should be extorted by the government to pay for someones tragedies. In a free market, insurance companies have to compete to offer everyone a specific plan that works for them. They are not self sustaining entities. Our dollars always matter.

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