Monday, July 27, 2009

On socialized health care

I'll try to get to Book VI of the Republic either tomorrow or Wednesday. In the meantime, a few words, if I may, on the subject of socialized health care. The problem with this debate, as with so many in politics today, is that one who believes in free markets can get caught trying to defend the status quo, which is, almost always, an awful amalgam between government bureaucracy with a bare semblance of free exchange. But it would be a mistake to do so. The present system is bad, everyone knows it, and anyone who stoops to say a word in its favor will only raise suspicions about his credibility.

The simple fact of the matter is that health care would look radically different in a free society. Most purchases, for routine checkups and the like, would be made with cash; there is no reason to involve insurance companies over ordinary and foreseeable circumstances. Insurance could be purchased to guard against unlikely, but catastrophic, events. It is also possible that payment plans could be made with the provider of medical care; there is no need for the doctor to receive all of his money up front if he doesn't demand it.

Such checkups could take place anywhere, and those conducting such would not need to be licensed by the State. Since the State limits the number of doctors licensed in a given year, this artificially limits supply. This results in shortages and higher prices for medical care. Even though this can be easily gleaned from a study of basic economics, it is amusing to consider how often politicians make policies which can only result in the opposite of what they intend--and then act surprised when mere whim cannot override economic law.

Now, Obama and company are insisting that socialized health care will be a boon to everyone. We know this isn't the case, since Government programs always pick winners and losers. Nonetheless, it is not always easy to for tell who the winners and losers will be. It is not always the case of the poor benefiting at the expense of the rich--which, though perhaps unjust because of the violence involved in wealth redistribution, would at least give the illusion of appearing to be charitable. For one thing, the rich will always be able to opt out of a socialized system by using their money to purchase services elsewhere, either in other countries or in the black market which always emerges if the State refuses people the right to sell a good for which sufficient demand exists. For another, it is easy to see the poor being stuck in waiting rooms in crowded inner cities; and in severe cases the long waits may even prove fatal. In any event, at the very least the employees of the State will benefit since they will be paid with money which is extorted from the citizens.

Back to the point, it is again discernible from an appreciation of the laws of economics that subsidizing a good--that is, allowing a good to be purchased for a cheaper price than would otherwise exist on the free market--increases demand for that good. In his book Ten Things You Can't Say in America--which, by the way, was my first serious encounter with libertarian thought--Larry Elder uses the example of heat in an apartment complex. So long as he paid for the heat he used, Elder was careful to only use that which he needed. But when the landlord lumped heat in with the cost of rent, it no longer made sense to come home to a freezing apartment to save money. Instead, he kept the heat on all winter. The costs of the good were being paid for in large measure by his neighbors. This is very close to the system we have now with health care, and this will only be compounded with a socialized system.

Now, we can argue that Elder should have been a better person and willingly avoided using his heat except when it was necessary. But it is absurd to expect that he, or anyone else, would really do this. Perhaps a few ascetic saints would conserve heat; but the majority of us would be liberal with our usage because there is no real incentive to be stingy. It is foolish therefore, to lament that men are not angels, only to turn around and erect a scheme in which mild deviltry is encouraged.

Most of my argument, to this point, has been essentially utilitarian: Government run health care will provide a less valuable product at a higher cost. But it is still possible that we would prefer such a system if we believed that health care was a human right. In a certain sense, this is a better argument because it recognizes that making a case that the State will, for the first time in recorded history, do something efficiently, is not a very strong one. This is especially true when the "reform" bill is over one thousand pages long. It's not good to try to emulate the Vogons.

There is one problem with this line of argument however, and that is that health care is not and cannot be considered a right. It might be desirable for all to have health care, but the most we can do is insist on a right to life. That those pushing for a right to health care also maintain a "right" to abortion, which violates the real right to life which all humans--born and unborn--possess, is but another of life's tragic ironies--but I digress.

My argument can be made clear in two ways. First, a right must exist in all times and at all places. We cannot, for instance, insist that man has a right to Internet access for the simple reason that Internet was not available for the majority of human history. We would then be forced to argue that our rights to a future undiscovered good were presently being violated, which sounds like something the Red Queen might say. Health care is analogous to the Internet: it is the product, not only of technological advances but, even more so, of the capitalist system which provides a means whereby goods and services can be allocated ever more easily to a growing mass of people. It is good that it now exists in some measure, but it can be no more considered a right than can the toaster. A good standard is that if Robinson Crusoe could not claim it as a right, it cannot be treated as one.

Again, if health care is right, we must ask how we are not to violate it. Put thus, it seems a peculiar question, but this is only because health care is not, in fact, a right. If we ask the question of life, it becomes more clear. We honor a man's right to life, at the most basic level, by not killing him. But how are we to honor his right to health care? Must we be forced to do all that we can for our neighbors? Charity demands that we give both of ourselves and our possessions for the good of others, but if a doctor goes home to bed rather than treat his thirtieth patient of the day, he cannot be said to be violating his neighbor's right to health care. As cogent an argument could be made that his patents are violating his right by compelling him to go short on his sleep. But where on earth, then, are we to draw the line? Plainly, health care is not a right.

Libertarians, and especially Christian ones, need to be careful that in their haste to make a case for a free market solution, they not only avoid sounding too callous, but also make clear that they are acting in the best interest of all humanity. This can be difficult; it is certainly something I rarely, if ever, succeed in doing, and I don't think I have done so here. In expiation, I offer this final thought. When something becomes a right, and when this right is enforced by State force, we no longer receive the benefits that accrue both to recipient and donor when the latter gives charitably to the former. Pope Benedict XVI is significantly to the left of me economically, and--it must be said in fairness--far more in line with traditional Catholic social teaching, but for this reason his point bear especial attention. Taken from his first encyclical, Deus Charitas Est (28.b), I give him the last word:

There is no ordering of the State so just that it can eliminate the need for a service of love... The State which would provide everything, absorbing everything into itself, would ultimately become a mere bureaucracy incapable of guaranteeing the very thing which the suffering person—every person—needs: namely, loving personal concern. We do not need a State which regulates and controls everything, but a State which, in accordance with the principle of subsidiarity, generously acknowledges and supports initiatives arising from the different social forces and combines spontaneity with closeness to those in need... In the end, the claim that just social structures would make works of charity superfluous masks a materialist conception of man: the mistaken notion that man can live “by bread alone” (Mt 4:4; cf. Dt 8:3)—a conviction that demeans man and ultimately disregards all that is specifically human.

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