Why don’t I hear more about this issue?
Because it’s not popular to want to lower doctor payments and what’s not popular doesn’t (ususally) get political backing. It’s much easier to continue to kick the can down the road. And he continues:
I would consider joining a liberaltarian alliance to lower the doc fix. Is there one to be had?
There’s a tension I frequently feel about that term, liberaltarian. It seems to me that most of the time it means libertarians coming along side liberalism. Libertarianism basically advocates less governmental involvement on all fronts. It has a purity problem. Liberalism does not; it advocates, mas o menos, egalitarianism. And whatever happens to promote that, be it regulation or free-marketish approaches, liberalism can get on board. So, gay rights and drug legalization are liberal causes because both would contribute to more equality (the former is, really -no-pun-intended, more straightforward and hopefully is understandable sans documentation/citation). Libertarians like those things for reasons more like, Preserve individual freedoms from government overreach! Great, they agree for different reasons. But I would point out that advocating government monopsony is not liberaltarian, it’s liberal. Advocating regulation of health care and banks are liberal causes. Matthew Yglesias gives a nice little summary of how this works with health care:
…the only reason most people are insured today has to do with the non-market elements of the system. First, the tax code provides an enormous subsidy for employer-provided health insurance that ends up putting the majority of employed Americans into large risk pools at the expense of everyone who doesn’t work full-time for a big company. Second, Medicare mops up the largest pool of non-employed people by giving single-payer health care to everyone over 65. Third, a regulation bans discrimination against people with pre-existing conditions as long as they maintain “continuity of coverage” as they shift from one employer to another. Fourth, COBRA allows people to maintain continuity of coverage even if they experience transient spells of unemployment. Fifth, Medicaid and SCHIP give coverage to many classes of poor people who’d otherwise be unable to afford it.
An actual free market approach to health care would require unraveling all of this and subjecting everyone to a world in which you can’t get coverage if you’re sick. Which is exactly how you would expect a free market to work.
So, if libertarianish people want to back regulating health care, they should just say that they side with the liberals on that issue. There’s no sense in saying that it’s somehow a libertarian concern. It ain’t.