One-Stop Shopping: Casinos and Hospitals


Last night, I had the privilege of attending the Pacific Research Institute’s first annual Baroness Margaret Thatcher Dinner in Orange County (for those not familiar with PRI, it’s California’s major free market think tank for state policy).

Those of you who’ve been to enough of these kinds of dinners in the past know the drill: you’ll usually see some familiar faces, perhaps make a few new acquaintances, eat the same meal that’s currently being served in every other hotel ballroom in America, and hear a first principles speech that rallies the faithful but leaves you with few, if any, new insights.

That last factor didn’t obtain last night (also, as a veteran of the rubber chicken circuit, I have to concede that the food was pretty good). Keynoting the evening, the always-interesting Steve Forbes went into a riff on the capacity for medical innovation when health care operates in a relatively free market. During a particularly interesting passage on medical tourism, he noted that practitioners in India have managed to lower the price of cataract surgery down to $50.

How? Well, according to Forbes, the surgeons aren’t doctors in anything approaching the American sense. They have simply learned how to perform this one procedure with granular precision, despite a lack of much in the way of any other medical knowledge. Interesting, but probably not something any of us are signing up for any time soon.

It was what he said next, however, that I found arresting, as he had anticipated a loophole in American law that had never crossed my mind. “Most Americans aren’t going to go to India for the cataract surgery,” he said (roughly — I’m paraphrasing from my notes). “But you know where they will go? Indian reservations. That’s sovereign territory.” Once Obamacare takes hold, he noted, the incentive to take medical innovations to tribal lands — and thereby circumvent our growing health care statism — will be overwhelming.

If there’s one good thing about the expansion of state power in the Obama years, it’s this: the playing out of the law of unintended consequences gets ever more delightful to observe.

Members have made 13 comments.

  1. Profile photo of Paul A. Rahe Contributor

    It sounds as if, when I get older and retire, I should move back to Oklahoma.

    • #1
    • February 21, 2013 at 10:36 am
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  2. Profile photo of BrentB67 Inactive

    I like Steve Forbes, but every once in a while he goes off the reservation (or on to one in this case).

    Reservations may be ‘sovereign’ nations, but they are under the thumb of BLM and BIA. The long arm of the federal government will never be far away.

    • #2
    • February 21, 2013 at 10:50 am
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  3. Profile photo of Slug A Thug Member

    This is happening in Canada as well.

    Does that mean that if you travel to Tribal Lands for medical treatment of overindulgence in peace pipe smoking you will be attacked by drones, lest you corrupt Tribal Land with filthy American lucre?

    • #3
    • February 21, 2013 at 10:51 am
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  4. Profile photo of WI Con Member

    It would be cool to get an operation, smokes and fireworks all at the same time.

    • #4
    • February 21, 2013 at 11:08 am
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  5. Profile photo of drlorentz Member

    Amerindian sovereignty seemed like a bad thing when it came about. Under obamacare, it may be transformed. The One may have performed a miracle, albeit an unintended one.

    • #5
    • February 22, 2013 at 1:00 am
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  6. Profile photo of Palaeologus Member

    Boy, Huxley had us pegged.

    • #6
    • February 22, 2013 at 1:42 am
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  7. Profile photo of civil westman Member

    There will be a brief time out as I limber up and give myself an extended pat on the back. I have been suggesting exactly this for years to anyone who would listen. Airstrip in the middle, casino on one side, hospital on the other. Freed from layer upon layer of increasingly absurd regulation and insurance, doctors and nurses – left to their own professional and entrepreneurial devices – could deliver superb care (and I mean ‘care’ not ‘services’) for around 60% of the customary costs.

    Drone in the ointment: the federal government would surely drop the legal equivalent of Hellfire missiles and incinerate the idea. Too bad about collateral damage.

    • #7
    • February 22, 2013 at 2:48 am
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  8. Profile photo of WI Con Member

    Come, to the Potowatami Casino & Hospital!

    • #8
    • February 22, 2013 at 2:49 am
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  9. Profile photo of flownover Inactive

    The reservations in this country will teach those Indian doctors a thing or two about poverty and mortality. Did you know that the life expectancy on some reservations is worse than the worst country in the world ?

    • #9
    • February 22, 2013 at 3:07 am
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  10. Profile photo of MLH Member

    Native Americans receive their health care from the US Public Health Service/Indian Health Service. Been socialized medicine for a while. 

    • #10
    • February 22, 2013 at 3:13 am
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  11. Profile photo of Troy Senik Editor
    Troy Senik Post author
    MLH: Native Americans receive their health care from the US Public Health Service/Indian Health Service. Been socialized medicine for a while. · 1 hour ago

    Forbes’ point wasn’t about the actual health care being received by Native Americans. It was about the fact that medical innovators could set up shop on reservations, basically turning medical tourism into a domestic affair.

    • #11
    • February 22, 2013 at 4:32 am
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  12. Profile photo of GLDIII Reagan

    Medical Cruise ships, staffed by Indian (asian indians not american indians) doctors and nurses, with Bermudian registration. Hopefully they will not be as risky as the floating casinos.

    • #12
    • February 22, 2013 at 12:14 pm
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  13. Profile photo of Frederick Key Inactive

    That explains the new business card I got from my doctor, Sol Running Stag (nee Goldman), M.D.

    • #13
    • February 22, 2013 at 12:35 pm
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