“A medical student wants to choose a specialty where she can create the most value for others. But since specialists’ incomes do not reflect relative scarcity, there is no way for her to know which field is best.”

This is incorrect. A medical student or doctor has opportunities to learn about the real-life, real-person impacts of specialities she might engage in. This is part of the public’s reasonable expectation that she will consider medicine an elevated and caring profession. Whether she is a free-market enthusiast or a budding socialist, on becoming a doctor she enters into a social contract that exists independently of economic considerations.

“Suppose a wealthy person donates money to build a new hospital. To staff it, the hospital pays wages sufficiently high to draw doctors, nurses and administrative personnel from other parts of the system. Would this new hospital cause unmet needs to go up or go down? Who would ever know?”

This is incorrect. Any hospital worthy of the name makes conscientious assessments of its impacts on the surrounding communities, including benchmark measures of similar communities elsewhere. Any hospital, whether for-profit or non-profit, which does not make such assessments violates the same social contract incumbent on the hypothetical medical student above.

In the real world, the medical profession sells itself to the public, to the government, (and even to itself) as committed to health for its own sake. Under such a self-created aura of implied altruism, it is fraudulent for the medical profession to see its positive aspects as ratified simply by the obtaining of profit.

We rely exclusively on altruism to provide organs for transplant operations in the United States. The result is an organ shortage that gets bigger every year. Today, over 98,000 Americans are waiting for organ transplants, and most of them will die waiting. Every year, 8,000 Americans die because of the organ shortage. At the same time, every year Americans bury or cremate 20,000 transplantable organs. There is no doubt that this terrible waste would be reduced if we weren’t relying on altruists for our entire supply of transplantable organs.

Here are a couple of pieces on this subject, written by me and Professor Lloyd Cohen of the George Mason University Law School:

The Limits of Altruism and the Power of Self-Interest http://www.techcentralstation.com/082305B.html

Organ Socialism
http://www.lewrockwell.com/orig6/cohen3.html

Thanks, and keep up the good work.

Invididuals should and often do act according to the Golden Rule. But…

Systems must be designed to harness, not oppose, the laws of human nature, else the systems will fail. Communism reverted to fascism within weeks. The Animal Farm didn’t work. The first Thanksgiving was a disaster; the second a success because in the interim they converted from communal to individual ownership. Nobody washes a rental car.

California dreaming doesn’t work in the real world. Why do we need to keep repeating these experiments?