Sometimes The Market Works

April 13, 2010

 

I can't resist this news item. A Virginia pharmacy -- that went by the name Divine Mercy Care Pharmacy -- that refused to sell birth control has closed its doors due to insufficient business. I don't want to take glee in others' distress, but maybe, just maybe, the proprietors of this drugstore will have learned that a pharmacy is not an appropriate vehicle for imposing one's religious views on others.

As I have noted previously , the notion that religious beliefs should exempt a health care professional from providing certain services is suspect. Claims that the professional's freedom of conscience would be violated are unfounded because no one is under any compulsion to become a nurse or pharmacist, nor is the health care worker being forced to use the objectionable drug or service herself. All that is required is respect for the patient's choice. If someone is not comfortable providing health care services based on the patient's decision, that person can pursue another line of work.

Allowing health care workers to pick and choose among the services they will provide may not only set a dangerous precedent (can a truck driver refuse to deliver goods that are considered ungodly?), but it also could result in denial of access to needed health care. In the instance of the Virginia pharmacy, there were obviously competing pharmacies available to provide the services patients desired. That may not be true in rural, isolated communities.

"Divine Mercy Care" should not become a synonym for "Care Unavailable."

 

Comments:

#1 Matt Miller on Tuesday April 13, 2010 at 2:08pm

Yes, of course, a truck driver can refuse to deliver a certain category of freight/product. If s/he is an independent contractor, it might be an issue in getting work. If s/he’s not an independent contractor, s/he may be fired. Either way, that’s just the market at work. The problem in the case of pharmacists and physicians isn’t that some of them might refuse to provide specific products or services, it’s that there’s a government imposed monopoly on those products and services. If the market was allowed to operate freely, “patients” would have plenty of options (not all of them all that great, of course, but we all need to be savvy consumers regardless of what we’re buying).

BTW, I realize the thrust of this comment is a bit more appropriate to your previous post on this topic, but comments there are now closed

#2 SimonSays on Tuesday April 13, 2010 at 2:58pm

To Ron’s point, I would argue that this behavior may well be considered discriminatory against women (to my knowledge the main beneficiaries of birth-control), no different than businesses under Jim Crow that denied service to blacks. Only this may be considered worse, since we are talking about medicine again. This is shameful and ridiculous. The state should have revoked this joker’s pharmacist license long ago.

I entirely disagree with behaviordoc’s view that market forces should dictate the availability of medication in a civilized society.

Selling medicine is a vital public service which private companies can engage in-provided they follow laws deemed to be in the public interest. When you are selling substances that are protected by patents and that people need in order to survive or treat illnesses, as a citizen I demand that whoever does this follows some basic rules and regulations.

Without these regulations -given the inelastic demand for these drugs- could engage in all sorts of shenanigans and really mess with people’s health. Do YOU really think people should be expected to “shop around” like “savvy consumers” for life saving medication in the case of an emergency?

That’s why pharmacists are licensed by the states and correctly so. That is also why most places don’t charge sales tax on drugs, and the list goes on.

#3 Michigan_Man on Tuesday April 13, 2010 at 3:41pm

Like the article, dislike the title.

I agree with behaviordoc.  The market doesn’t “sometimes” work, it pretty much always works and works so much better than any alternative that to say it works “sometimes” is akin to saying that evolution works “sometimes.”  Any libertarian or professional economist could have told you ahead of time that businesses that discriminate for irrelevant reasons impose upon themselves extra costs which will eventually force them out of business.

Other objections; the notion that a healthcare professional can refuse to provide you with something isn’t “suspect”, it’s philosophically backwards.  This mentality is reinforced in the next paragraph when talking about “allowing health care workers to pick and choose.”  Whether you exist or not is irrelevant to the situation.  You do not “allow” anybody to do anything.  They exist apart from yourself and can do whatever they want with or without your permission or in spite of your condemnation.

A moral issue can no more be somebody “not” doing something than can a person be called upon to prove a negative (like prove that there is no God).  This person is not your slave, they are not your property, you cannot tell them that in order to interact with other people on terms they mutually set they must first meet the arbitrary rules of a third party because they could do whatever they wanted if that third party never existed.  Therefore the proposition cannot be whether or not a health care professional is “allowed” to do something.

Since the burden of proof lies on those that make the proposition it is up to the person who intervenes and forces the health care professional to provide a good or service to make a moral argument and practical case for action.  Regardless of what a voluntary and consentual behavior might be in whatever culture or context - not selling birth control pills, uncovering your hair in public, walking by a homeless man with a gold watch on, renouncing religion, protesting the government - pick the behavior and put it on one hand.  On the other hand put the initiation of force, of violence, of coercion.  I think that if you think the situation through you will find that in both practical and moral cases any argument for intervention will be found wanting.

What is needed in this world is a little bit more understanding of economics, of science, of philosophy, and tolerance.  I may not like religion, but I have no right to tell them what they can or cannot do or dictate to them what they must do.

http://www.youtube.com/watch?v=ZOck_bDb0JA

#4 Michael Labeit (Guest) on Tuesday April 13, 2010 at 4:03pm

I think that healthcare professionals have a right to refuse to engage in commerce with certain people just as tailors or carpenters do. They possess the right to do what they wish with their own goods, including refraining from exchanging them with certain people. To force religious pharmacists to engage in commerce they deem as immoral *is* compulsion. I don’t agree that a patient has a right to be serviced by someone who refuses (unless the serviceman has signed a contract promising to servive all, in which case he would breach his contract).

Now religious pharmacists who refuse to sell birth control because of their religious convictions act irrationally and the market works to punish irrationality by penalizing it with reduced profits. If the religious pharmacists refuses to sell birth control, then the secular pharmacists will pick up the slack and benefit from his irrationality. So, as we see, the market offers disincentives to discriminatory business decisions.

#5 SimonSays on Tuesday April 13, 2010 at 4:57pm

Predictably, the high-minded (capitalist) libertarians have come to Ron’s post to tell us about the evils of government coercion and regulation.

With regards to Michigan_Man, I would point out that being a libertarian economist does not automatically make one also a *good* or even a “professional” economist. Libertarian assertions are subject to the same scrutiny as anybody else.

Discriminatory behavior does not necessarily lead to a drop in business, especially when the consumer is a minority and/or poor. This is a documented fact and I can provide numerous examples. During Jim Crow, how many white barber-shops went out of business for refusing to serve black customers? How many restaurants? etc. During that backward time of racial segregation this very discrimination was often a *selling point* and arguably may have led to an *increase* in business by the dominant white group. The venerable “free market” of the time did absolutely nothing to help the disenfranchised minority. That is why civil rights legislation was enacted by congress that forbade this type of discrimination, and with good reason. By the libertarian capitalist standard, this would also be unacceptable “coercion” of the business class, no matter how civilizing the effect on society. So even the carpenter example you bring up is not really valid today. If the carpenter is racist and he doesn’t like your skin color, you can sue him if that’s why he/she refuses to provide you service.

Michael Labeit, can you explain how “rationality” works when we are talking about medicine that needs to be taken immediately for an emergency affliction? When the sh*t hits the fan and you need your meds and there is only one provider in your town/neighborhood or its 4 AM or whatever and they don’t have it…that is the difference between life or death as far as you’re concerned. Market be damned at that point.

#6 Michigan_Man on Tuesday April 13, 2010 at 5:30pm

Simon,

Of course being a libertarian doesn’t make you a professional economist which is why I used the word “or”.

Jim Crow Laws, were they a product of the market or a product of government?  Clearly a trick question; the fact that they were laws shows they stemmed from the government.

“The venerable “free market” of the time did absolutely nothing to help the disenfranchised minority.”

Very much to the contrary.  When looking at businesses during the period which sufferred under Jim Crow Laws which mandated segregation there are clear patterns of employment which show often that while whites were hired to work the counter, nearly everybody behind the scenes were black.  The free market did everything it could to fight racism and segregation while it was going on by hiring black people in disproportionately high numbers wherever they could.  Look at another case of segregation in South Africa.  In South Africa (why we are talking about racial segregation I don’t know, I thought this was about wanting to pass Jim Crow Laws of religious segregation, which you don’t seem to realize that you are arguing for in principle), under laws of apartheid what was found was that businesses had to be fined and raided over and over again for hiring too many blacks.  Often times white people would be hired to be a figurehead in charge of work operations in case a government official showed up, but these laws were constantly being violated because paying whites more than blacks (which is what happens when you force businesses to hire whites instead of blacks) is costly.  Those costs are translated into higher prices which mean lower business.

Your point about the carpenter not being able to discriminate was a legal point.  I believe he was talking philosophically.  You misunderstood.  The carpenter doesn’t have to do anything, he can sit on his rear all day and not make anything.  He doesn’t have to provide anything to anybody in reality.  A third party, in this case the law, can intervene but that invention is the action in question, not the carpenters refusal to act or interact.  That action needs to be judged on its merits.  Such an action, even if undertaken to punish racism, is immoral.  The least sympathetic among us are always the first victims of tyranny.

You have a false knowledge of history and economics.

http://www.youtube.com/watch?v=n0MaY33LJZ0

As for your attack on rationality and the extrapolation of life boat ethics to all aspects of life; I think they speak for themselves.

As for your economic error which leads you to (in true caveman fashion) say “markets be damned” which I guess means “slavery, robbery, and violence come forth” I shall include this video for the innocent bistander, which is much shorter than the previous video in this post:

http://www.youtube.com/watch?v=E74itK6yLJY

#7 Michael Labeit (Guest) on Tuesday April 13, 2010 at 6:07pm

Simon,

Within a free market economy, producers would have the right to discriminate on any basis, including race. That is, racists have the right to be racist, religionists have the right to be religious, etc. However, one cannot simply abolish racism by passing laws against it, any more than one can abolish the law of gravity. Racism is abolished by a change in culture, by intellectuals, and by education, not the legal system.

Furthermore, “during Jim Crow” segregation was *mandated* by the government. Owners of transportation firms lobbied against Jim Crow laws which coerced enterprises into conforming with segregationist laws. Thomas Sowell has written much on this topic.

Moreover, discriminatory behaviour, almost by definition, means reduced profit margins. Discriminating producers alienate a segment of potential consumers. A race-discriminating firm may not go out of business, but it certainly pays for its dicrimination. This is but one way the market discourages racial discrimination - by making it costly in monetary terms.

“Well, what if the white consumers prefer racist businesses.” In this case, the consumers have a disincentive to possess such a preference. Firms that attract the most money will possess the most financial capital. Those with the most financial capital can purchase the most and/or best productive factors with which to produce goods more efficiently and on a greater scale. This translates into better quality consumer goods on a greater scale. I gather these whites are opposed to being served by black employees too. Well, then they will have to cope with lower quality service, if better performing blacks are to be replaced with lesser white employees. The “one provider in the neighborhood” has every incentive to provide for blacks. If he is the single provider, then he will earn extra by doing so, after all, he is the single provider. Where will the racist white consumers go? Abroad? If they can, why can’t blacks if the provider refuses to stop discriminating?

My carpenter reference is as valid as any. I argued that carpenters have the right to refuse to offer their goods to whomever they feel, just as I have the right to refuse to allow anyone to enter my home. The issue is individual rights. That the government does not recognize that right is a whole other issue. Do carpenters have a right to control the use of their own labour? If you say they must produce for others against their will, then by implication you deny their right to control their labour. The necessity of the good is irrelevant in this case since need is not a coercive claim to the goods of another person. Don’t put coercion in quotation marks. Thats precisely what is entailed when the government goes about criminalizing discrimination.

In addition, the civil rights legilsation that you allude to did not manifest itself without producing serious social and economic mal-effects. The welfare state it created has made swathes of black Americans dependent upon it. It subsidizes poor decision making by extending free money to those who engage in it, thereby encouraging such conduct and wasting scarce resources that could have been used to finance profitable undertakings elsewhere. Its also has given many black Americans the impression that they are entitled to material goods from taxpayers.

#8 SimonSays on Tuesday April 13, 2010 at 7:02pm

Michigan_Man, I’m not extrapolating to all aspects of life with my pharmacy example. I am referring specifically to medicine, which is the topic of Ron’s post. I stand by my asssertion that where there is a legitimate interest in public health-such as the sale of medicine, the government ought to intervene and regulate the rules of sale.

With regard to Jim Crow I am not referring to legally enforced segregation which arguably was not good either. I’m referring to most most local private businesses (ie not schools, buses, etc) of the time in the south that were practicing segregation on their own without any legislative assistance. Most white business owners did not suffer much because of this since blacks were the minority and were much poorer.

I agree that in the grand scheme of things this was the time that the south was left behind economically to a more prosperous north-due in large part to such obtuseness, but tell that to the poor black sharecroppers of the time.

I am also not saying people do not have a say on their own and leave everything to the government. Indeed free speech is a vital part of democracy and society depends on people being able to freely voice their opinions. With segregation, had it not been for popular movements and demonstrations to display a popular will, the government probably would not have done as much as they did.

So in summary, positive changes require both good laws and good attitudes (broadly speaking). It’s not one or the other.

#9 Michigan_Man on Tuesday April 13, 2010 at 7:29pm

Well in regards to private individuals discriminating here you are just misinformed about the facts.  When you review the data it is clear that private schools are far more racially mixed than public schools because they had to be.  You see, public schools bore no cost for discriminating because they could just raise their money through taxes, so they could indulge their prejudice.  Private schools however bore a cost because their funding was tied to the wishes of the parents.  Parents likewise had to make a choice between their racism and the education of their children and children were more frequently chosen as the priority.  Feel free to go over the economic journals, this data is quite clear.

http://www.youtube.com/watch?v=e2Nuy_gbMtc

http://www.youtube.com/watch?v=hsIpQ7YguGE

In regards to public health I disagree there both in opinion on the notion that this topic was about healthcare.  This topic was celebrating religious demagogues going out of business because they discriminated for irrelevant reasons.  He also added a veiled shot at markets and false premises which is why I also made a note of it.  We should be celebrating our agreement here.

#10 SimonSays on Tuesday April 13, 2010 at 8:21pm

Michigan_Man, I’m not an expert on education and diversity, though I do know that this depends vastly on locale, so I’ll pass on commenting.

With regards to the topic of the post, are you saying that the availability of one of the most widely prescribed medications for women is somehow not a public health issue? Especially if more places decide to follow his lead? Let me be clear, if the pharmacist had some peculiar aversion to selling say… laundry detergent or potato chips I agree that would be out of place for the government to intervene.

#11 Michigan_Man on Tuesday April 13, 2010 at 9:14pm

What’s a public health issue?  Like an airborne infectous disease?

Again, the burden of proof lies on those that make the proposition.  Nobody is ever called upon to prove a negative.  If you make the claim that something is a “public health issue” then you have to first, define what a “public health issue” is and what that entails (apparently the initiation of force), and second why birth control pills would fall into that category.  You choose to have sex and as far as I know birth control pills don’t prevent any disease that might affect the public.  If you mean it is a “public health issue” because the “public” (presumably you mean the state) chooses to involve itself in the individuals behavior by offerring state subsidy for medical care or whatever (and therefore it can claim jurisdiction over individual behavior since it has financial ‘skin in the game’) then “public health issue” encompasses everything and nothing.  It is just a meaningless catch phrase meant to elicit emotion which will entice people to hand over individual liberty in exchange for promises of tempering those emotional outbursts.

As for others following his lead, did you read the article?  He went bankrupt.

#12 SimonSays on Wednesday April 14, 2010 at 9:20am

Michigan_Man, preventing unwanted pregnancy is a public health issue in a multitude of ways that are elementary to the hundreds of millions of women who take birth control in the developed world. This is one of the most commonly prescribed medications for good reason. We can agree to disagree, but I don’t have the time to explain further I’m afraid.

What if you were asthmatic and they ran out of inhalers, or worse-they simply didn’t sell them? Or you had a migraine and the pharmacist had some “deeply held sincere belief” that headaches should be slept off? This is no different.

As I mentioned previously, this pharmacist is not only a bad businessperson but also arguably in breach of the ethical standards he has taken an oath to uphold:

From APhA Code of Ethics: http://www.pharmacist.com/AM/Template.cfm?Section=Search1&template;=/CM/HTMLDisplay.cfm&ContentID=2903

III. A pharmacist respects the autonomy and dignity of each patient.

A pharmacist promotes the right of self-determination and recognizes individual self-worth by encouraging patients to participate in decisions about their health. A pharmacist communicates with patients in terms that are understandable. In all cases, a pharmacist respects personal and cultural differences among patients.

From the pharmacist’s oath: https://www.pharmacist.com/AM/AMTemplate.cfm?Section=Home2&CONTENTID=18306&TEMPLATE;=/CM/HTMLDisplay.cfm

I take these vows voluntarily with the full realization of the responsibility with which I am entrusted by the public.

Shame on Virginia for allowing him to stay open as long as he did.


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#13 Michigan_Man on Wednesday April 14, 2010 at 10:15am

Simon,

You skipped the first question.  What is a “public health issue” and what does that entail?  How are the ethics changed?  Why would the State of Virginia have the moral right to initiate force against a person who has committed no offense against another person?  How does “not” doing something qualify as unethical?  The owner clearly made it known that he did not sell birth control pills and if you didn’t like the fact that the owner didn’t sell the pills then you were and are perfectly free to frequent another establishment.  In a world where the state holds coercive monopoly and not only can never be competed away, but can actually use physical force to shut down competitors (as they did for many years with the mail), what self correcting mechanism is there?  If a single shop owner decides that selling birth control pills is wrong then he can only grow so long as business continues to come in and has no power to shut down competing phamacies which do sell the pill.  In that senario, the free market, there is a self correcting mechanism of profits and losses which tells producers and sellers to eitehr make more of something or make less of it.  In this case the market said to make less of religious stupidity and put his ass out of business.  What self correcting mechanism like that exists in government?

Where do inhailers come from?  If you think you have a right to an inhailer then go pick it off the tree you think it grows on.  Inhailers, like all things, have to be produced.  A man who doesn’t wish to sell you his inhailer is no more immoral than you are for not allowing any passing homeless man to break into your home and sleep in your bed.  After all, you are both “not” providing something, the only difference is that the shopkeeper offers what he has to others more frequently than you do.

The original question still stands though, what is a “public health issue” and what does that entail?  What does it mean to be a “public health issue?”  Are the ethics of using force against others somehow different for “public health issues?”  Why would those ethics be different?  Why do you think application of those ethics would be more productive?

#14 SimonSays on Wednesday April 14, 2010 at 11:16am

You are asking how “not filling a prescription” could be unethical and a public health hazard? I’ve already stated a few situations where this leads to risk of death or serious injury, especially when there is a lack of an alternative provider.

Luckily this guy was in Chantilly, VA which is a populated and prosperous area. However, as the WaPo article states:

A half-dozen similar pharmacies in such places as Louisiana, Florida and Indiana are faring just fine, said Karen Brauer, president of Pharmacists for Life International, a coalition of pharmacists who also have moral issues with the full array of services that their profession entails.

Were is the powerful self-correcting market in those places?

As for the inhaler example, the patient is not asking to get it for free, so not sure what you mean.

I also reject the notion that being asked to uphold a set of ethical guidelines which <u>you signed up for as a pharmacist</u> is somehow “coercive”.

#15 Michigan_Man on Wednesday April 14, 2010 at 12:12pm

Simon,

No, I asked you what a “public health issue” is and what it entails.

As a point of correction I should also critique your statement about how not filling a prescription can lead to risk or death (neither of which is the case for birth control and is another case of you extrapolating life-boat ethics to everything).  Somebody not giving you something doesn’t cause whatever illness or injury you have sufferred because whether they existed or not your illness or injury would still exist.  They exist separate from you and your situation.  Simply developing knowledge in a profession (such as phamacology) does not automatically contract that person to serve whoever should come knocking on their door.  They do not become your property or slave just by learning how to do things (as was implied when you said that since others with similar knowledge laid out rules governing their behavior that this somehow affects the nature of the situation, again confusing principle and reality with laws and group standards).  Your need is not a moral claim on their existence.  I do not have access to future discoveries in regards to medicine, could I claim they are killing or injuring me for not providing those things?  Of course not, clearly this is ridiculous, yet in principle it is no different from your claim that you have have a right to the knowledge and resources of others who have developed that knowledge and those resources.  The only difference is that one currently exists for you to loot and the other is out of your grasp, but in principle they are no different because you are claiming that you have a right to knowledge and resources that you have not developed yourself.

As for the market working elsewhere, it is working.  This place was put out of business and if people in Louisiana and other places want birth control pills then they will frequent those places that provide them.  The fact that places like this exist elsewhere doesn’t make any rational point because you are not saying that birth control pills are not available in those places, you are just saying that there are places not selling birth control pills.  Who cares if they don’t sell birth control pills?  Bell Tire doesn’t sell birth control pills either!  If you want birth control pills then go and buy them where they are sold, but a pharmacy that doesn’t sell the pills not selling them is no more guilty of immorality than Bell Tire not selling ice cream.  If you think a pharmacy should sell birth control pills then buy a pharmacy and sell birth control pills or only buy your birth control pills from pharmacies.

Just to repeat because you’ve done a good job of avoiding the question up to this point:

What is a “public health issue” and what does that entail?

#16 Simon (Guest) on Thursday April 15, 2010 at 6:25am

Imagine all pharmacies refused to serve Libertarians. Now the Libertarians would regard this as fine, since it is their free right to refuse, and would die happy.

The duty is in part due to restrictions, pharmacies sell stuff you can’t get elsewhere, but all markets can have restrictions for reasons economic or otherwise.

But I think more crucially markets are imperfect in the real world, if none of the pharmacies you can reach are prepared to sell you what you need, that the “market” has arranged to have another one you can’t reach be willing to sell you the same goods is irrelevant.

And yes I’ve seen economics professors who really don’t understand that markets are imperfect, or what this means in the real world.

Those who believe the market is perfect, or even generally right (as claimed above) have to prove this is the case. They are in the same position as the anarchists. Anarchy (political) sounds great in theory, but if it was so great how did we get here from there.

If free markets were so great why do you think we regulated pharmacies?

Markets generally don’t operate, or don’t operate well without regulation. As can be seen from the huge economic successes of those countries without effective regulation (we call most of them the 3rd world).

#17 Matt Miller on Thursday April 15, 2010 at 11:13am

@Simon - I tried to imagine such a scenario, but I had to presuppose a government mandate and some heavy-handed enforcement to get even a large portion of pharmacies to do it

#18 Ronald A. Lindsay on Thursday April 15, 2010 at 3:55pm

Sorry that I have been absent from this post, but another blog post (arising out of a dispute between PZ Myers and Mike DeDora) has occupied my free time the last couple of days.

One key point of clarification: when talking about whether health care workers should be “allowed” to refuse to provide services, I principally had in mind employees who want to retain their jobs while at the same time refusing to provide services. (Yes, most pharmacists are actually employees.) In some states, there are laws that provide this protection to “conscientious objectors” and there is an effort to get similar legislation passed in other states. I oppose such legislation for the reasons outlined in my post. A truck driver who is an employee does not have the privilege of refusing to deliver goods he objects to on religious grounds while also retaining his job; there is no reason to give this privilege to health care workers.

The situation is a little different with respect to the minority of pharmacists who own their own business. In the abstract, it seems a person should be able to run her business the way she sees fit. However, pharmacists are licensed by the state, agree to abide by a code of ethics that requires them to respect patients, and, most importantly, they’re granted special rights over the dispensing of prescription medications. A patient cannot get prescription drugs she needs except by going through a pharmacist. On balance, I believe independent pharmacists should be required to provide any drug for which a physician has given the patient a prescription.

Nonprescription drugs and devices probably should be in the discretion of the pharmacist, especially since most such drugs can be purchased via the Internet.

#19 Michigan_Man on Thursday April 15, 2010 at 4:40pm

Simon,

What is a “public health issue” and what does it entail?

P.S.  On market failures:

http://www.youtube.com/watch?v=VHFIbfUi5rw

The reason we have regulations is because power hungry and economically ignorant people came together to impose force on free individuals interacting voluntarily because they think they can intelligently design the economy from the top down.

Also, third world countries do not have free markets.  They do not have property rights, they do not have free trade, they do not have courts of law, etc.  Name your country (India, Zimbabway, Ghana, etc.) that you think doesn’t have regulation and I will discuss it.

#20 Michigan_Man on Sunday April 18, 2010 at 12:58pm

“However, pharmacists are licensed by the state, agree to abide by a code of ethics that requires them to respect patients, and, most importantly, they’re granted special rights over the dispensing of prescription medications. A patient cannot get prescription drugs she needs except by going through a pharmacist.”

Ah, you see the fallacy with this, do you not?  You are accepting that since pharmacists are licensed by the state, the state can therefore do with them as they please.  What is the ethical case for state licensing though?  After all, if we are arguing from first principles rather than making legal arguments about the status quo then clearly licensing cannot be assumed as people can buy and sell things (including drugs) with or without anybody’s permission or in spite of their condemnation.  What comes into question is not their action which they can take independently of any third party, but the action of the third party which is being taken is that which must be considered.

Is it moral to take action against individuals for buying and selling things on mutual terms (which do not take away from third parties, we shall set externalities aside as they are a special case)?  This action may be prohibition or it may be the “kiss our ass” law which says that in order to do business and not be harassed by state officials you must first kiss the ass of the state.  This may come in the form of taking tests of competency designed by people who know nothing about the profession and therefore do not guarantee competency, in which case the license is useless.  This may come in the form of entrenched actors who are already established in which case the license process serves to preserve the status quo, keep the poor out of the profession, elevate costs, and keep the poor out of the store (which in medicine means keep them out of the clinic).  This may come in the form of arbitrary fees like in the case of dog licenses in which case the license serves no purpose except to run a protection racket.

In any case the license does not exempt any professional from being sued for improper performance, it does not guarantee competence, it often requires over-qualification (a paramedic need not be a doctor, but the AMA for years opposed the use of paramedics and in their early years actually used the license system to limit the number of doctors so that prices would be raised), the license system raises costs, limits producers, limits buyers, even if you get a license you are still subject to the same forces of supply and demand, and there is still the moral question of the initiation of force.  Transferring the question of shutting down a business through something like a Bill of Attainder to a system of licensing changing only the manner in which you shut down businesses and does not address the principle.

You’ve started me on a topic for which I could go a long time, but I hope it is clear that you avoided the question rather than answer it (except for your second paragraph which is spot on correct).  “If they are granted special privileges then…” is not dealing with the principles because you skip over the question, “why are they granted special privileges?”  The answer is, they shouldn’t be, and if you do grant them such privileges then it doesn’t take much of a thought experiment to carry to subsequent logical steps the next moves by government.  Once you establish in principle that the government can tell you what you can and cannot do so long as it gets its hooks into you then the government has the incentive (if it wishes to expand its power) to become more and more involved.  It is the same with people who say that “if you take welfare, then we have the right to mandate drug tests” and it is the same as “if you accept bailout money then we have a right to decide how much CEO’s get paid.”  The correct thing to do is to not get government involved in these matters at all except for courts of law for people to take action against private citizens who have done to them what the government should not; initiate force.

#21 SimonSays on Sunday April 18, 2010 at 6:34pm

Michigan_Man:

Ah, you see the fallacy with this, do you not?  You are accepting that since pharmacists are licensed by the state, the state can therefore do with them as they please.

No I am saying the state should hold them accountable to the principles they sign up for voluntarily. Do you not believe the state should be enforcing the contracts it has signed?

Also, to clarify, are you questioning why pharmacists should be granted special privileges? I don’t know about you but I want someone who is professional and accountable dispensing my meds, not just any random person. Just like I want a doctor who is certified prescribing them. We can quibble about the *amount* of regulation that is appropriate and the licensing etc. but if you don’t agree that at least some regulation is appropriate in the licensing of pharmacists and pharmacies then I’m afraid we’re not going to be able to get any further in this discussion.

Medical services and medicine are not the same as selling laundry detergent. These are very price inelastic products/services where the potential for abuse is very great due to the sensitive nature and high demand.

#22 Michigan_Man on Sunday April 18, 2010 at 8:05pm

“No I am saying the state should hold them accountable to the principles they sign up for voluntarily. Do you not believe the state should be enforcing the contracts it has signed?”

Here is the fallacy.  You are saying here is the contract and here is a gun.  You will sign the contract and if you don’t, fine, but if you try to do business without signing my contract then you will deal with my gun.  You cannot claim that you are holding people accountable to principles that they “sign up for” (where are these signed contracts I ask you) when you say that pharmacists shall do business on your terms or you shall do them harm.  What moral right do you claim to extort people to these terms and what moral right do you claim to use force against those who don’t comply?

Am I questioning that these pharmacists should have special privileges?  This question assumes implicitly that pharmacists having special privileges is the default situation and when arguing form first principles this is just not the case.  It operates on the same principle as assuming that God exists and then shifting the burden of proof not on those that make the proposition, but to those who challenge the proposition.  This is no way to argue.

If you don’t want just anybody dispensing your meds then there is a very simple solution to that; don’t go to just anybody to fill your meds.  Every drug, every medical technique, every part of the doctors training which you claim you have a right to all came into existence in the absence of state secured monopoly or ‘lick our boots if you want to live’ “regulation”.  Indeed, those advances came in a time period and in a country that for the first time in 100,000 years of human existence a society put in a Constitution written restrictions upon the power of the state place such limits upon people.  Business, labor, or any other special interest group was denied the use force directly or by proxy through government to deny entry, go after competition, or keep them financially alive.  Those groups could now only advance by living up to their deals, by appealing to consumers, by offering medicines that work, because if they did not then there would be courts of law they could be made to live up in, if they didn’t appeal to consumers then they would sell no products, if they sold no products then they would spend money without taking it in eventually going bankrupt, and if their medicines didn’t work then all those rules would apply from the courts to supply and demand.

When you put these “rules” into place what you do is change the rules of the game and instead of businesses being promoted, grown, and copied by producing and adapting to the market, businesses are instead promoted, grown, and copied by adapting to regulations and using them to their advantage.

I got my degree in economics and I have to say that your usage of price inelasticity isn’t clear (nor is it stated why that would warrant state intervention or why such intervention would be a better alternative within your argument).  How would you test for that?  Compared to what?

“if you don’t agree that at least some regulation is appropriate in the licensing of pharmacists and pharmacies then I’m afraid we’re not going to be able to get any further in this discussion.”

Strange.  You are unwilling to consider a position different from your own because it is different from your own?

Now, what is a “public health issue” and what does it entail?

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