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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.