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Nov. 7, 2009 - Freedomain Radio - Stefan Molyneux
57:17
1504 Freedomain Radio - Interview with Dr. Mary Ruwart

An interview on the US health care crisis with Dr. Mary Ruwart, http://www.ruwart.com

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Well, thank you so much for joining us.
This is Stefan Molyneux from Free Domain Radio, and I have with me this evening the highly esteemed Dr.
Mary Ruart, who is an expert on healthcare and has a most impressive presentation on the staggering, a stupefying cost that the FDA adds to drug prices and therefore to overall healthcare.
And if you've not seen it and you ever get a chance to see that presentation, I saw it in New Hampshire in March of 2009.
And it was very good.
And I'm very, very pleased to have her on the show tonight.
We're going to chat.
Well, she's going to chat.
I'll feed a few questions and then she's going to dazzle us with her expertise.
And if you would like to ask some questions of Dr. Ruart, then you can go to FDRURL.com forward slash chat.
and you can ask whatever you like, and I will relay it along.
Sorry, we're going a little bit low-tech today, but that's the nature of the beast as we stand.
So, thank you so much for dropping by, and I was wondering if you'd like to spend a minute or two to introduce yourself and rattle off your vital statistics?
Oh, sure. Well, I am a former research scientist.
I was at the UpGen company for 19 years, and my background is in biochemistry, biophysics, and surgery.
And I first got interested in this whole idea of what the government is really costing us in terms of prices at the pharmacy or rationing of health care.
And what they're trying to do about it, of course, is just the opposite of what they should be doing.
And one of the things that I noticed when I was working over these 19 years is that the regulations in the pharmaceutical industry were increasing so much that I used to joke with my colleagues that we no longer had time to find life-saving new drugs because we were so busy jumping through the hoops that the government put in front of us in form of regulation.
And you can actually calculate what the cost of those regulations are because most of them were implemented in 1962 by the Keefoff or Harris Amendments to the Food and Drug Act.
And it's about 80% of the cost of new drugs that we pay for at the pharmacy are due to these regulations, which incidentally don't make us more safe at all.
They actually harm us.
They've increased the timing on the introduction of new drugs from about five years.
It used to take about five years from the time we'd discover it to the time we'd get it to the people who needed it.
It now takes 15 years on average.
So that's 10 years.
And when I was working with AIDS drugs, for example, by the time the FDA gave us permission to test our drugs in people, all the AIDS patients in the country who wanted that drug had had it.
And that's because they had hired black market chemists to make them and distributed them throughout the AIDS network.
And they actually did a pretty good job in terms of safety.
So it seems that we have increased the number of tests so much That people literally die waiting for life-saving drugs.
And that business of dying waiting is more costly in terms of lives.
I calculate that we probably have lost about 4 million lives since these amendments were passed in 1962, just from this increase in time.
And the cancer patients, a group of them recently got together and sued the FDA. They wanted...
They wanted to be permitted to buy new potentially life-saving drugs after they had been tested just a little bit in people so that they knew they were probably safe but they didn't know if they worked or not.
They just wanted to buy them and the courts ruled that they had no constitutional right to do so.
They had no constitutional right to try to save their lives with a drug that had not been approved by the FDA. So this is very sad.
The Supreme Court, incidentally, checked it out and refused to hear the case.
Was there argument that it was a sort of slippery slope, that there was no real way to say what you could or couldn't take that may or may not be harmful, like they just wanted to keep the door shut, rather than their argument might have been some sort of slippery slope thing?
Oh, I'm sure. I mean, if that had passed, if cancer patients had been allowed to buy drugs from the pharmaceutical firm at that stage in the testing, Then, of course, other groups would have wanted to do the same thing.
And if you allow purchase at one stage, why not at every stage?
And, you know, there was a time when the only thing that the manufacturer had to do was to show that the drug was safe for its intended use.
And these 1962 amendments for the Food and Drug Act changed all that.
That's really where we started to go wrong.
There were regulations before then, but they were fairly minor compared to these 1962 amendments.
Yeah, I mean, there doesn't seem to be any limitation on the amount that bureaucracy can pile upon an otherwise sensible process.
There really is, because there's no market demand or competition that would make them want to make the process easier.
And of course, if the FDA disapproves a drug that is beneficial to people, nobody ever knows because they can't take it.
Whereas if they approve a drug that harms people, you know, everybody rains thunder down upon the heights on them, right?
Right, and you know, of course, every drug has a side effect.
There's no drug that doesn't.
So every time an FDA examiner approves a drug and puts their name down on the approval paper, well, they're asking for trouble, essentially, because there will be side effects, and if these side effects become widely known or people are very vocal about their complaints, they'll have to go to Congress, and Congress will essentially...
Read them the riot act and who wants that so there's a lot of incentive for FDA examiners to try to think of every test that they can think of for the manufacturer to do before they approve it and you know you can't blame them their neck is on the line so so here we have a situation where the the FDA really can't fulfill its charge because we ask the FDA only to approve drugs that are safe and effective and there's no drug That is safe for everybody.
There's no drug that's effective for everybody.
So, you know, they can't really do what people expect them to do in the first place.
It's a very sad situation.
And of course, there's no, I mean, peanuts aren't safe for everybody.
We don't ban them, or some people will get a reaction to them.
And of course, the other argument, which of course is pretty clear to most people, is that there is a side effect to medicine, of course, but with reference to the age patients you mentioned, there's a side effect to not getting medicine as well, which is called being dead, which is probably about the worst side effect you can think of, but that, again, doesn't really factor in as well, because It's the problem of what's missing rather than what's present.
If there's a disaster, everybody knows.
If someone doesn't get cured who could have, then people don't really know.
As I'm sure you know, the same thing occurs in economics, right?
The government subsidizes some company and jobs are created.
But nobody ever sees the jobs that weren't created because of that subsidy taking money out of the productive citizens' hands.
So it really is these skewed incentives that just create this silent epidemic and, of course, If some foreign power had imposed a system that resulted in the deaths of four million Americans, I'm sure it would be considered an act of war, but because it grows domestically, people don't see it nearly as clearly, which is very tragic.
Well, yes, and you know, that's really just the beginning.
For example, one of the other effects of Having such a long development time and such costly development time because, of course, the longer time it takes, that means more tests are being done.
It's costing more money. One of the other things that happens is innovation is destroyed.
And innovation is really what pharmaceuticals are all about because if you find a drug, for example, that cures cancer rather than having to put somebody through surgery and radiation and chemotherapy, well, obviously, even if that drug is expensive, It's going to be a lot less expensive than surgery, radiation, and chemotherapy.
So it's very important to have innovation.
And there have been studies that have shown how much innovation we lose because of these regulations and the additional cost and timeline.
And the minimum loss is about 50%, 5-0, half of our innovations.
Yeah. And if we're losing that many innovations, you can actually calculate What that loss amounts to in lives because we know what the drugs currently on the market save.
And when we do that calculation, if we assume that these drugs are just as effective as the ones on the market, that's about 16 million lives.
Oh, and that is just beyond shocking.
Oh, I know. Everybody's been affected by it.
Everybody has a family member that's died early.
There's also, if I remember rightly from the chat that you gave in March, there is a problem At the margins of things, right?
So if you come up with a pill that is going to be universally popular, like something to deal with, erectile dysfunction or something like that, and you come up with a pill that, you know, lots of guys are going to want to get their hands on, then that is going to, you're going to do all the trials and all the tests.
Or if you come up with some antidepressant that you know is going to be prescribed X number of millions of times, you're going to be willing to jump through all the hurdles.
But for illnesses which have a smaller demographic, the profit motive is To go through all the regulatory hurdles is far less, which, if I understand it rightly, means that a lot of less common ailments are kind of pushed off to the side as simply no longer worth it, whereas they would have been worth it in a previous time period with fewer regulations.
That's true. And there are a lot of things like that.
In fact, it's becoming more and more important that a drug at least have the potential to be a blockbuster because it costs about a billion dollars to develop a new drug.
If you're counting, you know, the capitalization that occurs over those 15 years, out of pocket is somewhere between five and six hundred million dollars over that time.
So it's quite costly.
And I remember when I was at the Upjohn company that when I started there, We were pretty laissez-faire about developing drugs.
As long as they were going to save lives, you know, they were considered seriously.
But it became an economic choice.
After a while, we'd have to analyze the market and decide, are we going to actually be able to recover our development costs or not?
In fact, one story that really was near and dear to my heart is I actually got a call from the FDA examiner for my section And he said, Dr.
Ruart, I understand that you've applied for a patent for prostaglandins and liver disease.
And I said, yes, that is the case.
He said, I'm so glad because there's nothing for liver disease.
And, you know, we lose 100,000 people every year and all we can do is tell them to go home and rest.
So we're very excited here at the FDA. We want to help you any way we can.
Oh no! Don't help me, whatever you do!
Well, actually, you know, obviously the FDA is trying too.
I mean, they're humans too.
They want this drug on the market so that they can have it too.
So, yeah, they have some incentive to help out.
But the problem is this.
You know, liver disease is a chronic disease.
It built up over many years.
It probably would take several years to treat.
So we knew we'd have to treat patients for many years.
No one had ever cured liver disease before, so we didn't know what to look at exactly.
It's not actually easy to tell how bad liver disease is.
So we had to think of new procedures to test it, and of course, we didn't know how many patients we needed to show the statistical significance that the FDA wanted because no one had ever done it before.
And consequently, what we finally figured out was that if we We went into the clinic and did all these tests and we didn't quite have enough patients or hadn't given quite the high enough dose or didn't pick the right thing to look at and had to do the study over that by the time we got to the marketplace the drug would be generic already.
It would be off patent and we couldn't recover our development costs.
So we didn't do it.
And that's how we lose innovation.
Life-saving innovations are lost because of that.
Well and not to put a dollar figure on human suffering too much but It is, of course, catastrophic to the economy that 16 million people have died prematurely.
I mean, of course, many of them who would be in their prime, many of them, of course, at the height of their careers and so on.
The medical care costs, the lost income, of course, lost taxation to the government and so on.
I mean, the economic figures must just be beyond staggering.
I mean, that's higher than the entire loss of life in World War I. I mean, it's a staggering, staggering figure.
Yeah, 16 million.
And of course, I haven't even begun to tell you, because in addition to the 16 million that probably have been lost, lives that have been lost through loss of innovation, and the 4 million whose lives have been shortened because they, you know, died waiting for new drugs that eventually came out and were life-saving, there's also the prevention aspect.
The 62 amendments basically outlawed prevention.
What it did is it made it impossible For a drug company to go to doctors and say, hey, vitamin E will cure this disease without going through all of the rigmarole that the FDA now demanded.
And of course, since you can't patent vitamin E anymore, it's in the common market, you couldn't recover your development costs.
It would essentially be generic as soon as it hit the market.
So what happens, for example, is I was on an airplane talking to the guy next to me and he said, I'm so glad to meet you because you work for Upjohn, and I understand Upjohn's working on these new drugs called Lazaroids.
And we named them Lazaroids because they're named after Lazarus, who rose from the dead, you know, through the intervention of Christ.
I mean, that's how remarkable these drugs seem to be.
And he said, can I get some?
Because I have this condition.
He told me what it was, and it was something that, yes, probably could be treated by them.
So I said, I'll check with the project team manager.
And when I did that, the project team manager says, well, we're not at a stage in development where we can give him any drugs or put him in a study, but tell him to take lots of vitamin E. He'll do the same thing.
Why are we spending all this money developing this drug that's going to be really expensive when we could give vitamin E? Well, Upjohn was one of the biggest manufacturers of synthetic vitamin E. And it would have been happy to go and tell doctors about the wonders of vitamin E, but it couldn't because it couldn't recover the cost of jumping through all these FDA hoops.
So the moral of this story is that there are many, many nutrients that actually prevent disease or can be used to treat disease that are not being talked about, even though they're inexpensive, and they're not being talked about to our doctors.
I mean, if you read...
Health magazines, you can find this information and try to treat yourself, but your doctor won't know about it because the drug representatives can't come to them and talk about these things.
And so the doctors get most of their education from the drug representatives.
So what they learn about are expensive new drugs and they don't learn about prevention.
And actually, it's interesting because I had a doctor tell me that once when I had a question about something to do with health.
He's like, well, I can't really talk about it here, but look this and this up on the internet and you'll get all the information you need, which is kind of a weird thing in a way.
It's sort of like my mechanic handing me a hammer and saying, go for it to fix your car or whatever, but it did work out.
And even though this stuff is very cheap and very efficacious medically, it's because...
To recommend it as a cure for an illness or as a way of alleviating an illness, or I guess even preventing an illness, you would have to prove it with all of these multi-hundred million dollar tests.
Is that right? That's right.
That's right. And sometimes it doesn't even prove it.
I mean, you have a high probability that it will work against placebo.
But, you know, every drug, whether it is actually effective against placebo or not, will be effective in some people because of the placebo effect.
So in a way, when we have a disease, especially where we have no treatment for it, it doesn't really make sense to tell people that they can't, or to tell doctors that they can't talk about the possibilities of certain nutrients or even certain drugs that are used for something different,
because if a patient is, you know, we don't really understand the placebo effect a lot, but if the patient gets enthused about it, We know that sometimes things can go on with placebos, which are essentially sugar pills or nothing, that helps the patient get well.
We don't understand this effect, but it does happen.
When we ban things that haven't been fully tested, especially in a disease where there is no cure, we likely are Setting up a situation where people will die needlessly because some will be cured by the placebo effect.
It's just what happens. Right.
So banning vitamin E, which I'm no doctor, of course, but I doubt that unless you took a whack load it would be at all harmful for you.
You're banning the placebo effect, which has some significant, as far as what I've read, it has some significant effect upon people's certain kinds of disorders.
Right. Not only is, you know, and think not only about the placebo effect, but the reason it's called vitamin E It's because we can't make it, and it's unnecessary for us to live.
So it may be that, for example, if you took a lot of vitamin E, it would favorably affect certain parts of your body function, and then maybe that would help your body be strong enough to fight off whatever is creating a problem for you.
You know, there's a lot of interaction between nutrients and health of the body and the drugs we take and things of this nature, and so it's very difficult to, in my mind, to To set up a system where people are denied information and doctors are discouraged from getting information about inexpensive therapies that have some good basic science behind it.
Right. Now, another question that I'd like to ask you, and I don't know if there's any good answer to it, but if there is, I'm sure you will have it.
At the same time, as there seems to be these absolutely crushing restrictions upon drugs that Seem to be of great value.
At the same time, it seems to me that the barn door is left wide open for drugs that statistically have at best questionable benefits.
And I'm thinking about things like antidepressants and so on, which according to my reading, and again, I'm no expert, but what I've read is that it's very, very tough to find how an antidepressant is better than a placebo.
And so there's also lots of drugs that I have been proven effective in adults that are also given to children, though they have not been tested in children, and that's a significant thing.
I'm also thinking about some of the ADHD medications, the Ritalin and so on.
They're all being given to kids.
I don't think that they've gone through multi-decade studies or at least a decade-long study on the effects, and there does seem to be some long-term effects upon children's mental development if they're on lots of these kinds of drugs.
So it does seem like they're very, very restrictive on things that might be beneficial.
But other stuff that is of questionable benefit, to say the least, I mean, the door is wide open.
People just stampeding through and making hundreds of millions of dollars off these things.
Right, well, you know, and there's several reasons for that.
First of all, with the children, obviously, from a scientific standpoint, we know quite well that children handle drugs differently than adults.
And when you're treating children, you want to be, in my opinion, as careful as possible because obviously there's some unknown factors here.
I'm actually amazed that there is such widespread prescribing for children.
Now the other thing, especially when we're talking about something like antidepressants, usually what ends up happening is there are populations of patients who benefit greatly by having these things, but once they get on the market, And then someone talks to a neighbor and finds out that they've been really helped by this.
You know, they want to go to their doctor and get it.
And as time goes on, more prescriptions are out there and people are different.
You know, genetically people are different.
So now instead of this narrow test population that the drug started with, its distribution becomes more widespread.
And then there are certain subsets of the population, you know, small groups in the Population that don't respond well to these drugs, and sometimes it can cause serious problems.
You know, we've heard a lot about the potential for suicide in some teens, especially, who take some of these antidepressants.
Just the opposite of what you would think would happen.
But, you know, that's the way it goes.
Our science just isn't good enough at this point in time to account for genetic differences.
And this is why we have side effects in drugs that are approved.
There's a lot we can't predict from animal studies, and there's a lot we can't predict from the limited human trials that we do when we go for an approval.
So one should always be careful about taking a new drug and pay attention to the effects it has.
And sometimes the doctor won't know.
I mean, each of us, when we take a new drug, we have to pay attention and let our doctor know if we have unusual things going on.
Right. Because all of us are different.
You know, that's That's part of the risk of taking a drug and that's why These are very powerful compounds.
They need to be used sparingly, and only when absolutely necessary.
You're hearing this from a pharmaceutical scientist.
Right. I think that's where we want to get these kinds of facts from, because there's less, obviously, no political corruption, less economic incentive for the overprescription.
And of course, the relationship between the pharmaceutical companies and the doctors can be, you know, again, there's lots of nice people in both fields and lots of people who are very well-intentioned and so on.
But there does seem to be a little bit of a sort of unholy alliance, you know, when viewed from certain angles, not of course in every interaction, but there does seem to be a fair amount of that going on where you will get, you know, big bonuses for prescribing certain things as part of a trial or you'll get, you know, dinners or vacations or this sort of stuff.
Or is that less common now?
I know it used to be common at least probably five or seven years ago.
Is that relationship still going on between the pharmaceutical companies and the doctors with the idea that they get pills into the hands of the doctors, which keeps the patients moving through the doctor's room fairly quickly, right?
Oh, you have this, take a pill, rather than talk about lifestyle, nutrition, exercise, alternatives, and so on, which is more time-consuming.
I think there is a little bit of a kind of a pill for every ill that a lot of people have a kind of vested incentive in pursuing.
Well, and you know, to be very honest, too, that's partly our fault as patients.
You know, we go in and we want a miracle drug.
We don't want to have to diet or change our lifestyle in order to have lower blood pressure, for example.
And so, you know, we go in and we ask for a pill.
And, of course, the doctor may actually try to educate us on nutrition and try to educate us on lifestyle changes.
But if we don't have incentive to do that or if we think we can kind of get around it by taking a pill, that's what we tend to do.
So, you know, we have some responsibility there as patients as well.
So when you sort of say, I'll take a Lipitor with my hoagie, that's probably not what the doctor would best want, right?
Yes, exactly.
And then the other thing is, you know, regulations on doctors play into this too.
When I wrote the first version of Healing Our World, I actually called up the AMA headquarters to find out how many courses of nutrition that each doctor had to take.
And what I found was that most medical schools did not even require a full term of nutrition.
And so the doctors are basically When they go to medical school, I give them the impression that nutrition isn't that important.
I think that's probably changed a little bit now, but still, when you think about it, when there isn't much emphasis put on nutrition in training our doctors, of course they don't think it's important.
And the reason that that's out there is because the AMA, through the medical licensing boards on which its members sit, control what is taught to our physicians.
And so, of course, the tendency is to have a very homogeneous program rather than a variety of different viewpoints, if you will, on medicine.
It used to be before the medical licensing boards were in place and just about anybody could practice medicine is there were a lot of different modalities available.
So, you know, if you went to a doctor, he might emphasize lifestyle changes or if you went to another doctor, he might emphasize Some type of drug treatment.
So it just depended on which viewpoint you favored in your physician.
So there was a lot more variety.
And of course, I'm sure there were charlatans too.
But there are today too.
I mean, there's a belief that somebody has an MD and they're certified by the boards that they're competent.
But in fact, that's not the case.
There's been many incompetent I'm just thinking of the logo you might come up for that.
It's quite striking. Sorry, go on.
You know, and of course, I'm not knocking the average physician.
You know, they've chosen the profession because they're dedicated to helping people, let's face it.
But at the level at which the American Medical Association attempts to influence law, there's an awareness that if we have few doctors, we're going to have larger salaries.
And there has been an effort made politically to limit the number of practitioners.
And This is one reason why until recently we didn't have many women physicians because when the AMA started their board certifications, they went around all the medical schools and the ones that trained women were simply not given accreditation.
So women were not allowed to be physicians after This happened in the early 1900s, although before then they had been quite prominent.
Yeah, and of course there were midwives and nurses who had a much wider scope of practice in the 19th century and up until the early 20th century that were then, you know, stripped of those privileges by the AMA so that there would be less competition.
There's this sad belief that because the regulations come about because consumers are being harmed and the consumers get together and they say, gosh, You know, there's way too many bad doctors out there.
Please, please, please, can we create a governing body to regulate and control the supply and accreditation of these doctors?
Or lawyers or whoever. And when you look into it historically, I've never found one example where that is actually the case.
What happens is all the professionals get together and they say, I don't know, there's a lot of competition here.
How can we use the government to limit entry, to raise the barrier to entry, to limit people from doing what we do so that we can make more money?
It's always the professional association imposes it on the public.
It seems to be never drawn from the desires of the public.
That's right. And it's very discriminatory, too, because when the AMA started dominating the licensing boards and the licensing boards started saying things like, well, you can't apprentice to be a physician.
You can't go to night school.
The only thing that we'll allow to pass through the accreditation process are, you know, full-time schools where you have to take four years off from work and study.
Which is rich white men, right?
Exactly. So how could the...
People who had to work during the day, go to night school, or couldn't apprentice with anybody, they couldn't be doctors anymore.
So it became, you know, we began drawing our doctors and physicians predominantly from the, you know, upper middle class or the upper class because that's the only people that could afford to take four years off and pay for the incredible amount of money that the tuition was.
It's just mind-boggling when you think about how discriminatory it is.
And it's discriminatory not only at the level of the people who want to become physicians, minorities and women and so on, but it's terrifically discriminatory for people at the lower levels of society economically who, because You can't be a doctor by going through something part-time or by apprenticing.
All the doctors that come out charge so much that their services are then beyond the economic reach of the lower classes, minorities and single mothers and so on.
So it's discriminatory, not just in the professional sense, but also from the customer sense, because it drives the prices up, which dries up the access at the lower levels, which of course inevitably leads to demand for government intervention to extend healthcare down below A certain income barrier, which of course is only, they only don't get healthcare because of all these restrictions in the first place.
Well, right. And, you know, there was an interesting study on electricians.
Since every state has different licensing laws, somebody compared all of the accidental electrocutions in each individual state and compared it to the severity of the licensing laws.
You know, how hard it was to jump through the hoops.
And what they found is that the more stringent the regulations, the more people in that state died of accidental electrocution.
And that was because of just the effects you are describing.
You know, people who were poor looked at the price they were going to have to pay to have an electrician come out and change their light switch or whatever, and they decided they'd try to do it themselves.
And of course, then, in many cases, they didn't know what they were doing, and they were electrocuted.
Whereas the rich people are fine.
The rich people can afford it so they don't get themselves zapped, right?
But the poor people do. And it's always struck me as funny, tragic funny, as all these things generally are.
It's always struck me as funny that everything that happens in society rests upon information technology.
And, I mean, whenever the doctor does anything, he's always dealing with some sort of computerized system.
And the strangest thing is that there are no restrictions to entry.
Bill Gates didn't have to go through eight years of school or get $150,000 of debt in order to found Microsoft.
He just dropped out and started a company.
I have had some experience in the software entrepreneurial fields with a master's in history.
So there's no accreditation requirements for the infrastructure which everybody uses to do their job.
And that is the fastest growing, most powerful, you know, reaches all the way down the economic ladder and provides access to astounding amounts of information and computational power, even to the very poorest people in public libraries.
And so it's sort of weird that The professionals who say you cannot have excellence without accreditation all rely on an informational infrastructure that has been created and produced with no barriers to entry and no accreditation whatsoever.
And that just seems to me kind of strange, but inevitable.
And I'm very glad that there aren't those restrictions on software, otherwise we'd all be, well, there would be not, fundamentally.
Yeah, that's a very good observation.
In fact, I think that's one of the reasons our economy has survived in spite of the stress that's been put on it by regulation and taxation in recent years.
We've had the computer industry almost totally unregulated, growing in leaps and bounds and creating an incredible amount of wealth in terms of our ability to handle more things with fewer people.
You know, it's just been wonderful.
So what ends up happening is people who are not, you know, who I guess we talk about as being displaced maybe from the regular job are able to go out and do other things and create wealth in other areas.
Because obviously, let's face it, if you have an accounting firm and you have to hire 100 people to take care of maybe 1,000 clients, obviously that's not as efficient as if your 100 people could take care of Of 10,000 clients.
So it really, really has increased the ability of one person to do a lot of work and create a lot of wealth that way.
Yeah, sorry, go ahead.
No, go ahead. Well, I was just going to say that Ayn Rand's been a lot in the news lately, and of course a lot of people who are interested in our sort of approach to solving social problems, sort of voluntarism, pacifism, and so on.
know a lot about this and of course in Atlas Shrugged there's this machine that generates electricity from the air or energy from the air or something like that and it's always sort of struck me that IT and John Galt destroys it because he doesn't want to extend the life of the sort of parasitical society that he lives in and it's always sort of struck me that IT is that sort of thing and of course Ayn Rand could never have imagined it would be but information technology has extended and increased the amount of wealth within society To the point where we've just created this monstrous parasitical class.
And I've also sort of thought, and I know we're slightly off topic, but without at least three tangents, it's just not a show that I'm involved in or a speech.
But it's also sort of struck me that the government is so reliant upon information technology to collect its taxes, right?
You simply could not. If you didn't have electronic cash registers, if you didn't have computerized payroll systems, if you didn't have all of that stuff...
If people were still fundamentally on a sort of cash or barter economy, there's no way that taxes could be 30 or 40 or 50 percent.
There couldn't be deductions at source.
There couldn't be any of these things.
And so the government is so dependent, you know, on its survival, on the information technology industry, that I think they've sort of said to themselves, well, we don't really want to regulate this because then we're going to completely muck it up and then we won't be able to collect all the taxes that this has enabled.
So I know this is just sort of a by the by, but it sort of struck me as...
It's an interesting possibility.
I don't think it's a conscious motive, but it probably is somewhere in there.
Well, I hope that they keep their hands off for a long time, because that's really going to cripple our economy if they ever do that.
And all these talks about taxing the internet and things of this nature are very scary, because that is what has kept us going.
Oh, absolutely. That's what's kept our head above water, and if they start fooling with that, I fear that we will have a collapse.
And just to sort of return back to where your expertise shines, I'm sure, of course, that you've been asked 10 million questions about, you know, the healthcare legislation that I guess has just passed the House.
Do you have any, I guess, any synthesized things to say about that?
Because I think it's quite a fascinating piece of legislation, but I'm sure that you have smarter things to say about it than I would.
Well, it's almost 2,000 pages long, for one thing.
I think it's 1990 pages long.
It's... I don't know.
Let me start with the thing I'd like to say the most, which is that all of us need to get on the phones and call our senators.
And not just once.
We need to be calling them every day or every other day and letting them know how we feel about these bills, because these bills will truly destroy our health.
First of all, I understand that The estimates indicate that we'll put another one-sixth of our economy under government hands with this health care bill.
Now, if you've read some of the economic studies on the impact of government spending on wealth creation, you know that the larger percentage of our wealth that government spends or controls, the less wealth we make In other words, GDP, Gross Domestic Product or Gross National Product, GNP, goes down when government spends more.
So by putting another sixth of the economy into the government's hands, we are going to create a situation where our economy is just going to take a big stumble and probably a fall.
Now, from a personal point of view, Those of us who are approaching our golden years are really going to get slammed because what this bill does is it's going to create a situation very much like Canada and Britain have,
which is that everyone's going to want to go to the doctor for their sniffles and consequently there isn't going to be the expensive care That one needs in the later years of life, where you normally spend about 80% of your healthcare dollars the last few months of your life,
those options, those potentially life-saving options, are not going to be available to us, and the seniors are going to be told that they just need to go home and die, that there's nothing for them, just like they are in Canada.
Or there's going to be a long waiting line like there is in Canada.
In Canada, there's a two-year wait for cardiac surgery.
And, of course, most people die waiting.
So the ones that have money come to the United States where they can get in immediately and have their problem taken care of.
Or if they have political connections or they know a doctor or someone, they are in the medical care field, then they can jump the queue.
But for everybody else, they're out of luck.
Exactly, exactly. So what the seniors here can look forward to if this passes is that they will be not given treatment because that treatment is going to be given to the younger people.
And the sad thing is, I guess it would be different if the young people were also going to get life-saving treatment perhaps, but that's not how it's going to go.
What's going to happen is there'll be an expansion of the type of health care that we can kind of consider optional usually, like going to the doctors for our sniffles, and there will be less of that care over the surgery or the radiation, chemo, new drugs, that would actually save our lives and make a big difference in our life expectancy.
That won't be there for us.
And that's what's happening in other countries.
This isn't something I'm making up.
This is actually happening in other countries.
You know, my sister lives in Michigan and she works for an orthopedic surgeon and he's inundated with Canadian patients that come over for hip replacements because, you know, people don't want to spend the year or two in the long line suffering, needing hip replacement and can't be walking around or anything.
I mean, that actually can be Life-threatening if it lasts long enough because if you lose your mobility, a lot of things happen to your body that aren't good.
Yeah, you mean in terms of muscles and bones and so on, right?
They deteriorate. It's like being in a spaceship.
Yeah, exactly. You can't move, so you lose your muscle tone and then when you do get the surgery, it's a harder recovery.
There's a lot of negative things about this in terms of the human cost.
So there's a big financial price tag.
They're estimating a trillion dollars over the next 10 years, and we all know that that number should probably be quadrupled at least.
At least. At least.
And, of course, what's going to happen is the same thing that has happened in the other countries that have universal health care research is going to stop.
You know, this is one of the few countries left where the medical doctors actually...
Can do significant research, but that's all going to stop because doctors aren't going to be getting, they're not going to be getting condensated for that, and they're also going to eventually, I'm sure, be told that they can only make so much money and they can only see so many patients, just like they are in the other countries that have this socialized medicine.
And it's very sad because the benefits, if any, are few and the tragedies that will be created are many.
So it's just something we all need to get out and get on the phones about.
You know, the House vote was very close.
It was 2.20 to 2.15.
Yes, it was very close.
Two more phone calls. Yeah, I was just agreeing.
It was surprisingly close.
But, sorry, go on. Yes, yes.
And the Senate, we need to make sure that it doesn't pass the Senate because if it does, you know...
We're all going to suffer.
And only those of us who can afford to go overseas, like to India or something, to get health care are going to be able to do it.
And who knows what will happen.
Maybe we'll be outlawed from doing that even.
You know, in Canada, for example, for many, many years, there hasn't been the private option.
If it was covered by the national health care, you couldn't just decide you were going to pay for it in Canada and buy it.
You had to go overseas to get it.
And I fear that's what's going to happen here.
All indications are that you will not be allowed to buy a service privately that is being covered under universal healthcare.
Right, right. It is always mind-blowing to me, and I still don't know what bizarre psychological phenomenon this is, but it always seems bizarre to me that people...
They interact with the government on a fairly regular basis, right?
You pay your taxes, you have to renew your driver's license, and of course, every time you do anything with the government, it's annoying, it's inconvenient, it's a hassle, it's a problem, it's crowded, it's dirty, it's, you know, it's like a Stalin public's washroom.
I mean, it's just awful, right?
And, of course, the people on the left We recognize, you know, all these minorities are being thrown in prison.
I think America has more blacks in prison than they do in college.
And America has this, you know, war on drugs, which the people on the left hate.
And America, you know, got involved in these wars in Iraq and Afghanistan, which the left-wingers hate.
And so they have these huge problems with the government.
And of course, the people on the left know that this is not the government's first kick at the can to provide health care for those in need.
I mean, this is like the fourth or fifth kick at the can starting from the 1930s.
You know, Medicare, Medicaid, some of the stuff that went on under the New Deal was all designed to do this.
And it's still not solved, even with all the additional wealth in society.
So there's government that can't give you a driver's license in a decent amount of time, that can't That gets involved in wars, throws too many of its citizens in jail, this monstrous beast of a leviathan that the people on the left have enormous and fundamental moral problems with.
Hey, let's give it healthcare.
But it's the same government.
It's the same government that starts wars and throws people unjustly in jail and tortures people.
It's the same government that you're now handing over your doctors to.
And I don't understand why people can just have so many problems with the government and then think that it suddenly turns from this dragon devouring virgins into this shining white knight that's going to pull everyone to the Promised Land.
It's bizarre. I know.
We seem to have a split personality when it comes to things that we really want or want everyone to have.
And I've noticed this even among people, you know, libertarians, for example, who are the greatest freedom-loving people in the country, that on occasion I do run into people who say, oh, I agree with everything the libertarians say.
I'm a libertarian.
Of course, except in this particular area, obviously the government has to do it here.
And I think maybe that's a natural progression of learning about liberty, because of course liberty is really about the non-aggression principle or the good neighbor policy.
It's about deciding that we aren't going to aggress against our neighbor.
We're not going to steal from them.
We're not going to lie. We're not going to hit them or start the war.
And if we do, that we're going to compensate them and make it right.
And somehow, I think that until that is really embraced as not just the way we want other people to act, but the way we want to act because we realize how valuable it is and how it helps create the society that we want, until we really grasp that fully, we're going to have these pockets of areas where we think somehow the government is going to do a good job for us or is necessary.
It's kind of a matter of education.
We now live in a society where most of our children and young people, young adults, really don't remember how freedom worked.
They don't remember how the schools used to all be private.
They don't remember a time without the income tax.
They don't remember a time without Social Security.
They don't remember a time without welfare.
They can't always envision how liberty would work, and that's why, one of the reasons that, you know, I put my book Healing Our World in the 1992 version on my website for free, because it gives examples of how liberty works, and I think all of us have to really decide that we're going to study how liberty works, because that's where we get hung up.
Most people believe in the moral arguments for liberty, but what they come back with is, well, you know, Liberty is a wonderful thing, but it doesn't save the environment, it doesn't help the poor.
We need to have government for these things.
And if they only knew that liberty has been tried in the real world and found successful in just about everything that we'd ever want, then I think that it would be easier to grasp the principles and stay true to them.
When we think there's these exceptions, you know, we tend to slip up.
Yeah, I mean, no one cares about the abstract poor more than they care about their children.
And I've asked people this.
They say, oh, well, we need the government to help the poor.
And it's like, well, you care about your children more than the poor, and you don't use violence to provide for them.
So, why would you suddenly invoke this massive gun of the government to solve problems about things that you're less concerned about?
Because surely, if you're concerned about the needy, the first thing you should go is turn your children over to the state and have the state take care of them because the state's got enough money, right?
It's like, no, no, no, no. I would never use violence to take care of my own children.
But, you know, then you cross into this abstract world of society and suddenly all bets are off.
Personal morality goes out the window.
And the state just becomes an amoral tool to achieve what you want.
Whether what you want is to supposedly help the poor or just to solve your own conscience to believe that something's being done about the poor.
Because there's very few people who want the government to help the poor who actually go and volunteer and help the poor themselves, right?
It's always, well, I feel bad about it so someone should just go and do it and I'll give all this power away to these people.
And they don't actually follow up to find out if the poor are actually being helped.
I'll send you a link if you're interested.
I interviewed a fellow who's come up With a very critical book on the Canadian healthcare system, where he talks about, he says, it's a very, very powerful statement at the beginning of the book, which may be of use to you as you debate this topic.
He said, access to a waiting list is not access to healthcare.
And I just, when I read that, it just, you know, I had goosebumps, you know, because that is a very, I live in Canada, so I'm intimately aware of this kind of stuff.
And it's true, they've done studies that say That the number of people who do not have access to healthcare because they can't find a physician, right?
I mean, again, it's not just waiting lists.
Like, 20% of people in certain parts of Canada simply can't get a physician.
Physicians won't take new patients.
They can't get one, so they have to go to the emergency room for sniffles.
It's crazy, right? And he's found that the proportion of people in Canada who don't have access to healthcare system with our socialized, wonderful medicine is about the same As it is in the United States, with the exception being that we can't buy it.
And that is a very big exception.
Exactly. Well, in fact, that's happening with Medicare patients, and even Medicaid patients as well.
There are doctors that simply won't take them anymore because the government isn't giving a full reimbursement.
It's not worth their time and trouble.
And that's what a lot of seniors are going to face under a system Like the one that's being proposed.
The Medicare patients will simply have difficulty finding a physician who will take them because they're going to cut back on that so much in favor of this universal plan, supposedly universal plan, that seniors are going to get short shifts.
I mean, seniors should really be coming out against this in a big way because they're going to be the first ones to be harmed.
Oh, absolutely. I've never had trouble getting a doctor because I come, you know, bouncing in from the gym and I'm relatively young and I'm in great health.
And so they're like, yeah, you know, you come in for your checkup.
It'll take 10 minutes. I'll get to Bill.
But, you know, if I come in and I'm 73 with multiple ailments bent over and coughing, I think there's no way to know for sure, but just based on economic self-interest, again, embedded in the desire to help people, but just economic self-interest, those kinds of people are going to take a lot more time per dollar than someone who's younger.
So I think you're right. The slant is going to be against those who have the most complicated, challenging...
I mean, it's complicated and challenging stuff where medicine is at its best, right?
Because that's where you really want that Dr.
House genius to burrow into your symptoms and come up with something brilliant.
You know, if you have a, you know, I don't know, you have to have a finger reattached.
That's not brain surgery, so to speak.
And of course, you want a good doctor, but it's the complicated stuff that you really want people to dig into.
And the way that the system is going with the increased demand, I mean, if you suddenly open up healthcare to 20, 30, 40 million more people, it's not like you've suddenly manufactured all these new doctors.
It just means that the doctors are going to be, you know, the conveyor belt is just going to go a whole lot faster.
And that Well, it's not only that.
You know, the physician is going to look at the 80-year-old person who comes in with diabetic complications and say, you know, I can either spend my time with this person or I can help 20 people who are Younger and who are going to live longer.
This guy is going to die within the next year or two, probably, no matter what I can do.
I can extend his life a few months, but not more than that, so why should I bother?
These other people might actually save their lives, you know?
Right, right. So it's going to be that kind of...
And that's going to be encouraged, I believe, by the way this thing is structured.
You know, the original bill that the House changed in order to pass actually required people To have end-of-life care counseling in which they were going to be basically encouraged to sign papers, you know, like do not resuscitate orders.
Because think about it for a moment.
If a person's family member is dying, normally today one of the considerations is financial.
You know, do we really want to have...
Our mother, our father hooked up to this machine while they're in a coma for the next year.
Right. I mean, there's a financial consideration there.
But if there is no obvious cost, you can imagine that a lot of people are just going to say, oh, you know, there's always a chance.
Right, right. Leave them hooked up for a year.
Sure. And so, of course, the government's going to have a lot of incentive to put pressure on these people, In fact, I believe the government will be eventually putting pressure on seniors as the baby boomers come to need lots of medical care.
I predict that what we will see is encouraging these seniors basically to take a suicide pill or not come in with their symptoms and just go home and recognize that they're not going to get treatment.
Well, you could be right.
My thought would be that the way that it generally works is not even something as proactive and grimly honest as take a suicide pill.
It will be, you need to see a specialist, there's a seven-month wait, while knowing that, you know, in that time period, the illness is going to progress to the point where, I mean, this happens in Canada with depressing regularity, that people who have ailments, they get referrals to specialists, they have some fast-spreading cancer, and it takes them two or three or four or five months to see a specialist, and then it's too late, right?
So it's not, and fortunately, I mean, because if it was that, People would revolt, but it's a much softer kind of, you know, just slide people under the bed or into the quicksand, so to speak, so that nobody can really quite tell what happened.
It's going to be harder to do that, though, because what's coming up is the wave of baby boomers is so huge.
I predict that there may be some protests.
Oh, yeah. We'll see.
We'll see. I just hope the best...
No, sorry, go ahead. I was going to say, I just hope the bill doesn't pass the Senate.
I really hope that we aren't faced with that here in the United States.
And I really, again, I just want to encourage your listeners.
Find out who your senator is.
Get on the phone. Don't call just once.
Keep calling. Make them know that you are serious about this.
And get all your friends and relatives to call, too.
Because the vote's going to be close again.
And this time we need it to fail.
Because if it doesn't, well, let me put it a different way.
In calling, the life you save may very well be your own.
Right, right. Now, I just wanted to sort of respect the hour limit.
I just wanted to make sure that people get your website, ruwart.com.
And ruwart.com forward slash healing is where you have very generously made your book available.
I know it's available for purchase as well, but an earlier version, if I remember rightly, is available on your website for free.
That's correct, yes. I want everyone to have access, and especially those who are overseas and find the shipping cost horrendous.
Right, right. Well, yeah, I mean, I've put all my books out for free as well, and I just find it's much more satisfying.
You know, it is challenging, but it's much more satisfying, so I certainly commend you for that.
And I really, really have enjoyed our conversation, and I really do thank you for taking the time.
I will publish this as quickly as possible to get your message out.
I'm not such a huge fan of political action, but that doesn't matter because I'm not in the United States and I'm not facing down this legislation with the passion that you are.
I will put this out either tonight or first thing tomorrow so that people get the message that you want to get across to them and can make their decisions accordingly.
But I really respect the passion that you put into communicating about these issues and also the in-depth research and statistical analysis that you've put into teasing these grim but Incredibly eye-opening statistics out of this morass of data.
It's a really wonderful thing that you've done.
Well, thank you. And I appreciate all you're doing to help the cause of liberty, too, because you're helping people like myself get the word out.
And without our partnership on this, it wouldn't be happening.
So I appreciate your efforts as well.
All right. Have a great night. And thanks again for the conversation.
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