Can We Have “Universal” Medical Care Without Coercion?
"Good government" isn't so good.
The recent loss of what supposedly was a “secure” U.S. Senate seat by Democrats in Massachusetts has triggered a firestorm of speculation about the future of the Democrats’ “health care” bill. For the current legislative season, so-called ObamaCare looks to be dead or at least dormant.
“Politically dead” is a temporal term, however, and there is no doubt that President Obama and his congressional allies are going to formulate an alternative strategy and then try once again to ram “universal care” through the legislative process. In this piece, I don’t deal with the politics of universal care, but rather with the larger collectivist and coercive reasoning that accompanies its implementation.
Ever since the Progressive Era, Americans have been told that there is a difference between “good government” and “bad government.” “Good government” provides all sorts of services that poor people cannot afford, such as medical care, transportation, housing, education, and even food. (“Bad government” arrests, imprisons, and generally acts like an occupier.)
Obviously, “universal care” falls under the “good government” label, and when conservatives or libertarians complain about “government on our backs,” the “Progressives” are quick to reply that government “gives” us all sorts of goodies that we never would have unless there were intervention by the State. While this sounds good, I remind readers that government provides nothing without coercion, so when someone speaks of “good government,” that person really is claiming there is “good coercion.”
What comprises “good coercion”? It is the application of force that supposedly serves a “greater public good,” the “greater good” being medical insurance for those who did not have insurance before. Clearly, a philosophical issue is before us. Should government force someone not only to pay for health insurance for someone else (through taxation), but also to purchase a government-approved health insurance policy for himself?
Advocates of such coercive measures are quick to accuse private enterprise of being “exploitative and oppressive.” (Listen to a speech by Ralph Nader or read the latest issue of The Nation or the editorial page of the New York Times.) Something does not quite make sense, however.
No one has forced me to purchase the vast amount of things that I own and use. Instead, I choose to purchase them, and that includes health insurance. (I would prefer that the health system not be dominated at all by third-party payments, so I could purchase insurance for potential catastrophic events, but nonetheless I do purchase my insurance voluntarily.)
Contrast what I just have described to the purchase of government-produced goods. As a taxpayer I am forced to pay (on pain of arrest and imprisonment) for products that other people use, from roads (which, at least, I use myself), public schools, Social Security and Medicare, and, of course, “national defense.” It does not matter if I wish to use those products or support them; I have no choice but to help pay for them.
Thus it is with “universal” medical care. The plan is for the government to force everyone to purchase an “insurance plan” and pay for others to purchase such plans as well. No one is permitted to opt out (unless one is part of an old-order Amish sect).
Proponents of such a policy claim that unless everyone is forced to participate, the system will not provide “equal care,” and therein is the lynchpin of the whole system. From taxation of “Cadillac” plans to forcing everyone, regardless of health, to purchase policies, the government is attempting to enforce an egalitarianism that is in the best interests of no one but the political classes.
There is no way that the plan can make everyone better off. Instead, like so many other tax-and-spend schemes, it seeks to make some people better off by making a lot of other people worse off, and such a plan can be put into place only with brute force. It is a truism in economics that people won’t deliberately and knowingly make themselves worse off. The political classes know it, and perhaps maybe others are beginning to understand.
Comment by Terri K on 27 January 2010:
“(I would prefer that the health system not be dominated at all by third-party payments, so I could purchase insurance for potential catastrophic events, but nonetheless I do purchase my insurance voluntarily.)”
That is what I’d like too (I have no insurance at all, and pay out of pocket for services) but “good government” has decided that such a policy should not even exist in my state.
You’re so right about this latest iteration of coercion benefiting no one but the political class but most people won’t get it until it’s way too late.
Comment by Mike S on 27 January 2010:
Excellent points are made in this article. I would like to extend the idea of the coercive “costs” a bit further than taxation and compulsory purchasing of government-approved health insurance. It shouldn’t be a great leap of the imagination to predict that if, as a nation, we were to accept the false premise that our health care is a right and therefore we can compel others to provide us with services that we would also have a responsibility to remain healthy. Therefore, if the “good government: folks prevail yet the grand scheme of providing everyone with “appropriate” health care while lowering financial costs turns out to do neither, it would be entirely predictable that the next steps would be other compulsions or prohibitions designed to alter people’s behavior. Legislation intended to ensure that people eat right, exercise, and refrain from dangerous activities would all make perfect sense once one has accepted the trade of liberty and personal choice for the so-called security of coercive beneficence.
Comment by Capt. A. on 27 January 2010:
Says ANDERSON: … “As a taxpayer I am forced to pay (on pain of arrest and imprisonment) for products that other people use, from roads (which, at least, I use myself), public schools, Social Security and Medicare, and, of course, “national defense.” It does not matter if I wish to use those products or support them; I have no choice but to help pay for them.”
*****************
Poppycock! No choice? Poppycock on steroids!
At this point in time Americans DO have choices … just not FREE choices. And in the foreseeable future the American government’s coercive efforts will continue to increase—nothing but lousy choices. Hey, the “puking-dog democracy,” voted in by the booboisie reigns. The “masses of asses” have spoken! Why would anyone want to live the “only life you will ever have” under a master’s lash and bare the ever-heavier yoke (taxes)? Is there a REAL solution to this ever-increasing problem? Yep!
LEAVE the United States jurisdiction, and if necessary, RENOUNCE CITIZENSHIP! However, because of tribal inculcation and governmental propaganda/control of gov. schooling … those same “masses” can’t seem to “find” the trees through the forest. You want real freedom, liberty, financial privacy, personal privacy and private property rights? Simple! GET OUT of the controlling thugatarian’s jurisdiction! Most people dream away their lives with the illusion that everything would be perfect—if only… More nonsense! It takes action! Leave. On this issue both truth and history are on my side. America is a place to be from. And that’s sad, but true.
And Bill, there’s no rhetorical device used here. You want truth? I just gave it to you.
C’est la guerre,
Capt. A.
Principaute de Monaco
GMT +1:00 CET
“Anyone who needs to be persuaded to be free, doesn’t deserve to be.” ~ L. Neil Smith
Comment by Jim Davies on 27 January 2010:
There are two words which have no proper place in the political discourse of a free country. Those words are “mandate” and “ban”. Both are instances of coercion, and are thrown around much too freely these days.
It matters little whether the issue is health care or anything else. A government which is truly “good” leaves each of its adult citizens free to make his or her own decisions. Government officials who propose mandates or bans, supposedly under the
banner of doing these things “for our own good”, or “to serve a greater public good”, more properly deserve the label of “tyrant”.
Pingback by Militant Libertarian » Can We Have “Universal” Medical Care Without Coercion? on 28 January 2010:
[...] by William L. Anderson, Freeman [...]
Comment by Dave Coyne on 31 January 2010:
After the Great Fire of London in 1666, in which two square miles of the city were reduced to ashes and rubble, insurance companies formed brigades to extinguish fires for their clients. Their self interest and their clients’ interest coincided. This was the free market at work. You got what you paid for. But if you had a fire and no insurance, you were on your own.
Catastrophic fire could strike anyone at any time with no warning. You could be on top of the world one day and completely ruined the next. Buying insurance was a prudent response for those who could afford it.
It probably seemed reasonable at the time. Here in America, we did not have government-run fire departments until the middle of the nineteenth century. But now that we’ve tried the public option, government-run fire departments seem to be working pretty well for us. If there is a fire, we call the fire department and public servants rush to the scene to put out the fire. It’s pretty simple and seems to work.
As a conservative, it seems clear to me that the government should not do things for people that they can do for themselves. Gerald Ford said a government that’s big enough to give you everything you want is big enough to take everything you have. I think you have to respect a political leader who had the wisdom to hire a speech writer who could come up with a great line like that.
Still, it seems equally clear that there are some things we can do better if we pool our resources. Rugged individualism can be a good thing. So can cooperation. We’ve tried free market health care. Compared with other developed countries, who all have universal health care, we really aren’t doing that great. Standing on principle can be a good thing. Sometimes it’s also good to learn from experience. If one approach isn’t successful, it makes sense to consider alternatives. As W.C. Fields said, “If at first you don’t succeed, try, try again. Then quit. There’s no point in being a damn fool about it.”
Comment by Terri K on 31 January 2010:
Dave,
We’ve tried free market health care? Really? When? Calling the current state of health care in the US “free-market is a fallacy. It is NOT free-market in any way, shape or form!
I am all for cooperation as long as it’s voluntary. Unfortunately, we serfs aren’t even allowed to cooperate with each other to come up with a better plan because of the bazillions of rules and regs imposed by the federal government. This latest iteration of what amounts to government-run health care is anything but voluntary. We are going to be forced into it (under threat of fines and imprisonment) and we are going to be forced to pay for it.
If you haven’t yet read it, check out Bastiat’s fabulous essay, “That Which is Seen and That Which is Not Seen”. Give it some thought, and you might even see the fallacies in your fire department argument.
Pingback by Can We Have “Universal” Medical Care Without Coercion? « Reboot The Republic on 2 February 2010:
[...] From The Freeman [...]
Comment by Dave Coyne on 3 February 2010:
Terri,
Thank you for raising some valid issues. And thank you for calling my attention to Bastiat’s essay. It’s been thirty years or more since the last time I read it, but it still speaks eloquently to issues we face today. I’m sure the world would be a much better place if his ideas received the attention they deserve.
I have to agree with you that it really is more than a bit of a stretch to call our health care system a free market. But I have to confess that I don’t know how we can untie the Gordian’s Knot that our system has become. Once the general public realizes that free markets have advantages over government regulations, which will likely take generations, it may take many generations more to untangle the mess we’ve made.
In the meantime, innocent people are dying needlessly because they do not have access to health care. And millions of others are being financially destroyed by their efforts to obtain the health care they need to stay alive.
I don’t mean to imply that the health care systems of all the other industrialized countries are ideal. But the fact remains that they get a lot more and pay a lot less than we do. I think we can keep a free market as a long-term ideal, while making our system less-bad and saving lives in the meantime.
I don’t believe people have a right to heal care. I can’t find fault with Ayn Rand’s argument that the right to another’s services is the very definition of slavery.
Perhaps you might agree, though, that when people are harmed by our government, our government has a moral obligation to try to repair some of the damage. We have allowed our government to create a health care system that is so overpriced and inefficent that millions can’t afford any health care at all. It seems to me that our government created this mess, and our government is obliged to clean it up. In my view, to simply walk away and do nothing is not morally acceptable.
What do you think?
Dave Coyne
Goshen, Indiana
Comment by Terri K on 4 February 2010:
Dave,
Amen on Bastiat! Indeed, the world would be a much better place if his ideas received the attention they deserve.
I am wholly in agreement with your last paragraph: in short, the system is broken. My issue with the current iteration of the health bills, aside from the fact that people will be forced to participate, is this: government created the problem; there is no way more government is going to fix it.
In my circle of friends, even among the self-described leftys, very few are in favor of the proposed bills.
While I’m no expert on the subject, I’ve done a lot of reading and research on “how we got here” primarily because when I was growing up, health care was certainly more free-market oriented, and it was inexpensive and very good.
At every turn, it was incremental government intervention, either directly or indirectly, that is to blame. That health care is tied to employment, an absurdity in the first place, is a result of wage and price fixing under FDR. Then there are all the laws preventing insurance companies from competing across state lines and those that require that certain conditions be covered, regardless of need or desire.
Big Insurance, of which I am no fan, likely wouldn’t even exist were it not for the HMO Act in the 70′s. No one ever mentions the negative market effects of Medicare and Medicaid or the fact that it has become unsustainable. In fact, I have come to the conclusion that the primary reason for the current health care bills is a back-door attempt to eliminate the unsustainable Medicare deficit. I’m no fan of Al Gore but he was right on that issue; assuming we’re going to have Medicare, the funds should have been in a “lockbox”.
Because of Big Insurance, consumers have been completely divorced from the true cost of health care–a moral hazard in and of itself. Now, people rush to the doctor for a hangnail since it’s virtually “free”. At my former job, I once explained to my staff how much our employer contributed to our health policies (and also how it effectively drives down wages). They were shocked.
I could go on and on…
What I would like to see is more choices and a movement toward the free market, even if in baby steps. The republicans who suggest allowing the sale of insurance policies across state lines are on the right track but sadly, few of them would know a free market if it bit ‘em in the rear and none of them can properly articulate to the dumbmasses how a free market would make health care more accessible and less expensive. Even Ron Paul, who totally understands free markets and is a physician, doesn’t articulate it well.
Sadly, they can’t even come up with the example of Lasik surgery and how costs have come down dramatically over a short period of time. Nor can they articulate how charities and pro-bono work by doctors took good care of the poor in the past.
And then there’s the issue of congress being bought and paid for by Big Insurance and Big Pharma.
Were I in a position to do so, I would suggest evaluating every law related to health care, examine the negative effects those laws have had, and proceed to revoke or nullify those laws. I would at least like to see more choices and competition for a start. For example, I would like to buy a high-deductible, inexpensive catastrophic care policy and pay out-of-pocket for routine office visits. I asked my PCP what she thought about the new legislation and she also agreed that we need to essentially “go backward”.
But as a citizen, all I can do is attempt to influence my legislators and attempt to educate others on free market principles. I also explain to friends who rail about Big Insurance how, if we really wanted to kill it, we’d all simply drop out of the system (unimaginable in most people’s minds) and seek our own free market solutions.
I’ve done this myself both out of necessity but also in order to not wait for government to fix my personal problems. My children and I are uninsured (I am currently seeking a catastrophic care policy mentioned above). I have successfully negotiated reduced prices for office visits, sometimes 1/3 (!!!) of “normal” costs, and for the couple of ER visits we’ve had, the hospital has bent over backward to work with me on payments. I have also taken advantage of one of the local pharmacy’s inexpensive annual plan for reduced drug costs. Incidentally, I have never been turned down for services.
Thank you for the discussion, Dave! I think it’s a very important to discuss these issues but sadly, other than democrats and republicans bashing each other, there’s not much discussion of the real issues.
Comment by Dave Coyne on 4 February 2010:
Terri,
I’ve enjoyed our discussion. I’m sure you know how frustrating it can be, trying to discuss issues with people who do not share your basic principles. Like talking to the proverbial wall. It’s a pleasure to have a conversation with someone who speaks my language. Hopefuly, as time goes on, there will be many more of us.
Dave Coyne
Comment by Terri K on 5 February 2010:
Dave,
Yes it’s often very frustrating but I keep talking to those proverbial walls every chance I get. I absolutely live for that rare person who responds, “hmmmm, I never thought of it that way before”.
It was hearing something in a new way, plus a little intellectual curiosity that brought me to the place I am today.
It really is up to us to “create” more of us by changing hearts and minds (a friend of mine calls it “a revolution between one’s ears”). Sheldon Richman has a good piece on this very subject today where he says, “There’s no more urgent task that to fan the flames of political cynicism, emphasizing that what’s wrong with health care, finance, and energy won’t be fixed by electing the “right” person or party next time around but rather by removing the obstacles to bottom-up, decentralized solutions.
Indeed.