John: If it was so that medical care and mutual aid was so easy to come by, then why was their a perception that the poor and elderly were dying sick in the streets?

It depends on what period this “perception” is supposed to apply to.

1. If you’re referring to the heyday of the mutual aid societies in the late 19th century through the 1910s, the answer is simply that this “perception” exists because statists often promote bogus perceptions of crisis without much supporting data, in order to put over the need for their desired programs with the politicized public. Some actual data on the circumstances faced by the poor and elderly, rather than impressionistic and sensationalistic “perceptions” would be useful here. I have some actual data on how available these arrangements were to ordinary workers, which I present briefly in the article — typically between 20% and 50% of workers in major urban areas in English-speaking countries were covered, and these numbers were rapidly rising in the 1900s, prior to the political campaigns to eradicate the associations and raise medical prices. If you want a fuller presentation of the data, I recommend David Beito’s excellent book, From Mutual Aid to the Welfare State, especially Ch. 6, “The ‘Lodge Practice Evil’ Reconsidered.” If you have actual countervailing data that tends to cut against the conclusion I draw, feel free to present it, but if what you’ve got is just ill-specified “perceptions,” well, so what?

2. If, on the other hand, you’re referring to the decades leading up to the passage of major government entitlement programs for the “poor and elderly” — programs like Social Security (1935) or Medicare (1965), then you need to keep in mind that these programs were introduced and rolled out decades after the non-corporate, grassroots, free-market alternatives that I discuss in the article had been deliberately dismantled by politically-driven campaigns — coordinated mainly by establishment medical guilds, using their power over government licensure of practitioners as their primary means of enforcement — to drive them out. (The blackballing campaigns against lodge-practice doctors in the U.S. ramped up in the mid-1910s and succeeded in forcing dramatic declines in lodge practice starting in the 1920s. See Beito, p. 124 et seq.) So, to the extent that government could point to a crisis of health care accessibility or affordability for the poor and elderly, just before the New Deal and Great Society transfer programs were created, it’s because government was pointing to a situation where the kind of grassroots, consensual social organizations that had made health care accessible to the poor and elderly had already been rubbed out by government in the decades prior. Once again, an example of government breaking your legs, then handing you crutches, and telling you, “See, without me you couldn’t even walk!”

Also, secondarily, because, insofar as there was a genuine crisis, it was, in no small part, the direct result of the non-corporate, grassroots, free-market alternatives that I discuss in the article having been deliberately dismantled in the decades prior. The grassroots voluntary mutual aid associations that I discuss in the article flourished in the late 19th century up until the 1910s; in the 1920s,

By the time that government programs such as Social Security (1935) and Medicare (1965) were being proposed and rolled out, the “lodge practice” arrangements and similar mutual aid associations had already

John: However I am not ready to drink the cool-aid …

I don’t want to be a dick about this, but can you not use that phrase when what you mean is “I don’t accept your delusional beliefs?” It’s an offhand jokey reference where the “punchline” is the murder of 276 children, and the senseless deaths of almost 1,000 people, just 30 years ago. Jokes like that suck.

John: … and say that we need to rid ourselves of the FDA or of medical accreditation. Kevin Trudeau is a salesmen of alternative cures for a variety of ailments [etc., etc.]

The existence of quacks and dangerous drugs today, in spite of already-existing heavy government regulation, seems like an odd argument for relying on government regulation as a means of getting rid of quacks and dangerous drugs.

In any case, the free-market position is not that we need to get rid of drug testing or medical accreditation. The free-market position is that the state should not force any particular scheme for drug safety or efficacy testing, or for medical licensure, on you or me without our consent.

The important thing, from the standpoint of individualist principle, is that, if you want to pay for snake oil without any consideration of demonstrated effects, you should be free to do so. And if I want to spend money only on drugs that scientific research has demonstrated to be safe and effective, or on doctors who have garnered the recognition of their peers as honorable and competent professionals, then I should be free to patronize only those that consensual consumer-protection outfits and professional medical institutions have approved.

In a freed market, there will certainly be both drug testing and medical accreditation; it will simply be drug testing and medical accreditation that relies on informed choice, or education and persuasion, rather than on the force of the law. How do I know that such institutions will exist? Well, of course, because they already exist, or have existed in the past. Before the modern prescriptions system was created in 1951, the role of objective watchdog for drug safety and efficacy in the U.S. was handled by the American Medical Association (which maintained a private drug-testing laboratory and published annual guidebooks of drugs that received their seal of approval). They provided a system of voluntary, independent oversight that worked — until government “fixed” it.

Similarly, nobody that I know of is proposing that existing methods of accrediting doctors or other medical practitioners be abolished. Where would you get such a ludicrous notion? There’s already plenty of non-governmental means of accrediting doctors — among them, well, the doctoral degree in medicine, which is issued by medical schools and still would be issued by medical schools in a freed market, based on standards of training and mastery. Similarly for nursing degrees, certification by professional associations like the AMA, etc. What radical individualists oppose is not accreditation, but state licensure laws, which add an unnecessary layer of politically-directed licensing restrictions on top of already-existing, voluntary professional standards and certifications within the medical profesion. The problem with this is, first, that they are coercive, and hence violate the rights of patients and practitioners; and, second, that the standards for governmental licensure are imposed through political decision-making and legislative fiat, rather than being determined through open debate and consensus over best practices within the health care market.

As a result, they often use the force of the state to shut down debate and impose requirements that have nothing to do with medical fact and everything to do with political pull — as when state licensure laws were used to attack feminist women’s health centers, midwives, or other alternative medicine providers, even without any evidence that any identifiable patients had been harmed or were even dissatisfied with the service. Or, to return to our original topic, when state licensure laws were used to blackball doctors who were providing perfectly adequate care, but who were seen as “underselling” (that is, providing competent care at costs that were affordable by ordinary working people) during the political campaign against lodge practice in th 1910s and 1920s.

John: The truth is that of all the industrialized countries, America is the only one with a private for profit system,

Didn’t you read the article? “America” doesn’t have a private health care system. It has a government-imposed health care system. The market is dominated first, by direct government control, and, second, by the operations of a handful of corporate privateers who depend entirely on a combination of government subsidy and government-imposed barriers to entry for their day-to-day operations and long-term strategy.

A freed market in health care would look completely different from the “system” that you and I face today.

John de Laubenfels: Would you give companies that research and produce new drugs NO protection from competition,

You are correct that I do not believe that protectionism for pharmaceutical corporations is an adequate argument for imposing government-granted monopolies.

If you want to “protect” pharmaceutical companies’ existing business models, do so on your own dime by boycotting competitors and directing your money to first movers. (Hey, it worked for Tolkien.) But I’m not nearly so invested in protecting current business practices in the pharmaceutical industry, and I’d rather that you don’t use government monopoly to force your protections on my pocketbook.

John de Laubenfels: starting the moment someone gets ahold of the new drug, analyzes it, and creates a knockoff? Nothing for all the money the original company has spent doing trials? I don’t think that such a system would be either fair or likely to motivate companies to produce new, life-saving drugs.

On the cost of doing drug trials, of course, in the same sentence where I advocated the abolition of patents I also specifically stated that I supported the abolition of the FDA, which would dramatically reduce the compliance costs involved in developing new drugs and bringing them to market. So I don’t know what you’re referring to here. (Of course, if companies want to do internal testing they can do so, but in voluntary independent oversight systems, the costs of running trials are typically assumed by the independent watchdog organizations themselves, as part of their institutional charter.)

However, if it turns out that it’s no longer profitable for big, for-profit corporations to do medical research, then — horrors! — it may just turn out to be the case that medical research has to be carried on by non-corporate or not-for-profit institutions. But I hear we have some of those. And I’m not typically impressed by broken-window arguments that fail to take any account of the value of the unseen alternative uses to which money might be put, if not for the coercive government intervention.

David,

When I write that “voluntary mutual aid societies and workers\’ unions” are among the “myriad other ways for free people to choose individually to cooperate without cash exchanges,” I do in fact mean for the word “voluntary” to mean something. I agree with you that government labor bureaucracy, and government agencies (such as the National Labor Relations Board in the U.S.) that force employers to bargain with unions based on a majority vote of the workers, are violations of the rights of employers to chose who or who not to bargain with. But that’s no more an indictment of unions per se than the existence of government-supported monopoly corporations or government-created captive markets for large corporations (such as government-protected electrical, gas, water, local cable, or telecom monopolists; or such as the government’s use of force to, e.g., force unwilling customers to buy auto insurance) is an indictment of corporations per se.

Labor unions, as a form of voluntary association, existed and flourished in the United States (to take one example) for about 65 years before the Wagner Act was passed, and during that time they did their work without government patronage, and, indeed, often in the face of government persecution and tremendous amounts of violence, directed against even nonviolent strikers. Today, there exist successful fighting unions that do not participate in the NLRB system, either because they object to the bureaucratic process (as with the Industrial Workers of the World), or because the workers they represent are legally excluded from NLRB recognition (as with farmworkers’ unions such as the UFW, FLOC, and the Coalition of Immokalee Workers). In fact, in an age of plummeting union membership and constant schism among establishment unions like the AFL-CIO or “Change to Win” (ha, ha), these non-recognized unions are among the only unions that can report any real success in recent organizing drives. I conclude, therefore, that labor unions can and do exist without “government sanctions of monopoly and compulsion.” You admit as much at the end of your comment; but given that it is true, it’s curious that you’d object to including them on the list of forms of voluntary association that free people might choose to engage in. Do you also object to saying that free people might set up private schools, since after all schooling is mostly carried on these days by government and at taxpayer expense?

That said, while I agree, again, that the NLRB and its regulations are instances of coercion, I can’t agree with your claims about union shop or agency shop contracts. (That is, contracts in which a union and an employer agree that new employees must become a member of the union, or must pay in a fee as a substitute for their dues if they choose not to become a member.) There is in fact absolutely nothing in free-market theory which would forbid an employer from making such a contract as part of a bargain with a labor union; in a free market, employers and workers can make any kind of contracts about hiring and firing that they want to make. The fact that unions have an artificially strong bargaining position due to NLRB coercion is, of course, a violation of the rights of the employer; but adopting a particular kind of restrictive hiring agreement as a result of that bargaining, even in the existing unfree market, is not a violation of the rights of non-union workers. Prospective workers do not have a right to override private contracts in order to secure some particular job, and bosses have no moral obligation to give jobs to workers who won’t join the union, if they have have agreed to sign on to a more restrictive set of hiring practices.

Nor can I agree with your claim that a strike is an “example of union coercion.” This is absurd; all workers have a right to quit working, either individually or en masse; thus they have a right to go on strike. And if workers decide to join a private association, like a labor union, which has private disciplinary procedures for members, then that association has every right to hold them to their agreement. If you don’t like it, you should quit the union. If you can’t quit the union without quitting your job, you should quit your job. Losing a job is sad, but it’s not a violation of your rights. The world doesn’t owe you a living and if, in order to get a job you wanted, you agreed to sign on to a contract stipulating that you’d join the union and abide by union decisions to strike, then you can hardly complain that you’re being “coerced” just by being held to the terms of your contract. Nor can I agree with the claim that a union picket line is, just as such, a threat of violence against those who would choose to cross it. Of course, there have been cases in the past where people who nonviolently crossed picket lines were subjected to vigilante violence against their persons or against their property. That sort of thing is wrong, dead wrong, and should be condemned as invasions of the freedom of those who would chose to cross them. But there is nothing about a picket per se that demands or threatens that kind of bad behavior: there are lots of perfectly peaceful picket lines, and I can’t for the life of me see why the violence of some picketers should be used to impugn other picketers who never threatened anything of the sort, or who conscientiously swore off any kind of violence whatever. Certainly the form of unionism I have in mind, when mentioning labor unions as one potential form of voluntary cooperation, is the form of unionism that FW Joe Ettor proposed, when he said, during the great Lawrence textile strike of 1912:

“If the workers of the world want to win, all they have to do is recognize their own solidarity. They have nothing to do but fold their arms and the world will stop. The workers are more powerful with their hands in their pockets than all the property of the capitalists. As long as the workers keep their hands in their pockets, the capitalists cannot put theirs there. With passive resistance, with the workers absolutely refusing to move, lying absolutely silent, they are more powerful than all the weapons and instruments that the other side has for attack.”

Finally, I think it is a mistake to claim, as you do, that government labor laws unilaterally put a “heavy thumb … on the unions’ side of the scale.” It’s true that government labor laws grant substantial privileges to a certain kind of labor union (the kind that wants and can get NLRB recognition). But it also imposes substantial regulatory burdens; the government patronage comes with government strings attached. For example, it is completely illegal for NLRB-recognized unions to engage in wildcat strikes, secondary strikes, or secondary boycotts; they are absolutely forbidden from holding out for closed shop contracts and, in “Right to Work” states, are legally forbidden from even getting a union shop contract; union hiring halls are illegal; declared strikes can be, and have been, declared illegal by the arbitrary fiat of the President of the United States. All this means that some unions are privileged by the NLRB system — generally, relatively conservative business unions, like those in the AFL-CIO and “Change to Win,” who operate mainly through collective bargaining processes with management, who limit their tactics to backroom negotiations and limited strikes, who limit their goals to job security clauses or benefit packages in a conventional labor contract, and which retain a team of professional labor lawyers, union bosses, and full-time “organizers” to do their work. Meanwhile it burdens or outright criminalizes other kinds of unions, which used to be much more prominent in the pre-Wagner era — rank-and-file-run unions like the I.W.W., who generally refused collective bargaining, favored minority unionism, direct action on the shop floor, solidarity strikes, general strikes, union hiring halls, and other forms of action that didn’t depend on maintaining any kind of bureaucratic interface with the boss or the State.

For more on wildcat unionism and free market principles, see my articles “Free the Unions (and all political prisoners)!” [1] and “In reply to a reply by Walter Block and J.H. Huebert” [2], my series of articles on the Coalition of Immokalee Workers and the series of victories it has won through government-free wildcat unionism [3], and Kevin Carson’s essay “The Ethics of Labor Struggle: A Free Market Perspective” [4].

Hope this helps.