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An [[Compulsory cartel#Types of compulsory cartels|economic totalitarian]] medical welfare state is a welfare state program that has pushed out the [[market economy]] for health care, which was offering health care directly to patients on contract basis, meaning that patients cannot buy health care anymore. This is achieved by (1) coercing insurance companies, by [[regulatory law]], to accept all customers or patients applying for the state-regulated public basic medical insurance policy, while (2) the regulation for this policy, requires [[egalitarian]] treatment of all customers or patients offered health care and the reimbursement of all health care treatment prescribed by a gatekeeper medical doctors to public basic medical insurance patients, and (3) basic insurance policy is obligatory for all residents in a country.<ref name=zorginst/> It may be referred to as a form of [[Rhenish capitalism]]. While this system allows for a broad private enterprise market of health care services offered only to public basic insured patients with prescriptions from a gatekeeper, this system has the side-effect of the driving out of health care offered to patient seeking individually contracted medical services without gatekeeper doctors prescription. It therefore eliminates the [[market economy]] in health care.<ref>Thousands of Netherlands residents on lengthy waiting lists for primary doctors. https://nltimes.nl/2024/03/21/thousands-netherlands-residents-lengthy-waiting-lists-primary-doctors</ref> This system effectively puts all residents on a medical [[welfare]] program, offered by private enterprise (market-driven), which is rationing medical services and goods. For this medical system the quality of its goods and services cannot be independently verified by free individual contract, and therefore the people have to rely on this medical system itself to verify the quality of its own services.<ref>Verify yourself at the largest private diagnostic healthcare provider in the Netherlands, whether colonoscopy and gastroscopy's are available: prescan.nl. (+31 74 255 9255)</ref><ref>Verify yourself why www.bloedwaardentest.nl the largest private supplier of blood tests in NL does not perform its laboratory services with any dutch laboratory and has all its samples transported to Germany.(+31 85 065 37 47)</ref><ref>Verify yourself why www.bergmanclinics.nl the largest private supplier of medical services in NL offers its services only and normally with a prescription from a gatekeeper.(+31 88 9000 500)</ref>
[[File:Three-toed_sloth_crossing_road_in_Costa_Rica.jpg|thumb|left|[[Three-toed sloth|Sloth]] on the road.]]
The market-driven medical welfare state is a form of economic totalitarian welfare-state capitalism,<ref name="milton">{{cite book |first=Milton |last=Friedman |author-link=Milton Friedman |title=Capitalism and Freedom |year=1962 |isbn=0-226-26421-1 |page=17|publisher=University of Chicago Press }}</ref><ref name="mises">{{cite book |first=Ludwig |last=Von Mises |author-link=Ludwig von Mises |title=Planning for Freedom |year=1952 |page=1}}</ref><ref name="berg">{{cite book |first=Andreas |last=Bergh |title=Sweden and the Revival of the Capitalist Welfare State|year=2014}}</ref> in the sense that there is [[private enterprise]] free-market but no patient contracting (also called '[[Over-the-counter drug|over-the-counter]]') free-market. The public medical insurance policy becomes a [[compulsory cartel]] of private-enterprise public insurance companies and medical goods and services companies which results in an effective [[government-granted monopoly]] of these medical goods and services.<ref>{{cite web|website=Mises.org|year=1950|author=Melchior Palyi|title=Compulsory Medical Care and the Welfare State, (C13,p118) 'Competing sellers vs. Buying Monopoly'|url=https://mises.org/library/book/compulsory-medical-care-and-welfare-state}}</ref> It distributes medical goods and services to the patients in a Marxist [[egalitarianism|egalitarian]] way, but does not use the classical Marxist state ownership of all means production. Note that Marxist egalitarianism can, in reality, be of the middle-stage or end-stage type depending whether distribution happens according to contribution or necessity. Formally the gatekeeper general practitioners will determine the necessity of treatment and diagnostic health care.
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