health care

What Does It Mean to Have a 'Right' to Health Care?

If universal access to medical care is the goal, the government is the goalie. It should get out of the way.

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Lynne Cameron/ZUMA Press/Newscom

As the debate proceeds over what should succeed the Affordable Care Act (Obamacare), here are a few basic ideas to keep in mind.

We live in a world of scarcity, which is to say that at any moment our ends surpass the available means to achieve them. We can't have everything now. Thus we have to choose among alternatives. It is obvious that the human race has pushed back the limits of scarcity, but that is the result of human ingenuity sufficiently free to solve problems, or what Julian Simon called "the ultimate resource." Nevertheless, right now we cannot have all we want, so we have to make choices. A quantity of a resource or a unit of labor services cannot be put to more than one purpose at a time. Making choices entails opportunity costs—the benefit we forgo by choosing alternative A over alternative B instead.

Despite the popular misconception, health care is not beyond economic law; it is not a free good that falls like manna from heaven. It has to be produced, which means people must mix their scarce labor with scarce resources to produce the things used to perform the medical services we want. It would be foolish to expect them to donate their labor and resources because other people need them. They have their own lives to live and livelihoods to earn. It would be wrong to compel them. They are not slaves.

In other words, no one can have a right to medical care or insurance, that is, to the labor services and resources of other people—including the taxpayers. We hear a great deal about the need to respect all people; well, respecting people must include respecting their liberty and justly acquired possessions. Without that, "respect" is hollow.

Politicians, of course, can declare a right to medical care, but those are mere words. What counts is what happens after the declaration. Since a system in which everyone could have, on demand, all the medical care they wanted at no cost would be unsustainable, the so-called right to medical care necessarily translates into the power of politicians and bureaucrats to set the terms under which medical services and products may be provided and received. This is crucial: a government-declared "right" (that does not reflect natural rights) is no right at all; it is rather a declared government power to allocate goods and services.

Natural rights—which boil down to the single right not to be aggressed against—require only that one abstain from aggression. Thus all can exercise their rights at once without conflict. On the other hand, government-invented "rights"—such as the right to medical care—cannot be exercised at the same time; the potential for conflict is built in. For example, a person cannot use his own money as he wishes if the government health care system takes it by force through taxation to pay for other people's services.

Since we live in a condition of scarcity we need a way to determine what gets produced in what quantities and how. We obviously want the most value (in the eyes of consumers) for the least cost. That way, we have resources left over for other things we want. How can we achieve that?

Two ways exist for determining how resources and labor are to be used; an apparent third way is simply a mixture of the other two. The first is for the government—fallible, corruptible politicians and bureaucrats operating a monopoly—to decide for everyone. The other way is the decentralized, competitive marketplace. The so-called third way is for politicians and bureaucrats to interfere with, but not completely incapacitate, the marketplace. Only one is sure to produce the most of what people want for less, that is, to raise living standards as high as people wish.

Let's talk about the other way first.

The government solution has a fatal practical flaw: politicians and bureaucrats will not be able to arrange resources and labor services in such a way as to best serve the welfare of everyone—assuming that's what they sincerely want to do. (If they only want to serve themselves we have a different problem.) Why won't they be able to do this? Because, as Ludwig von Mises and F. A. Hayek showed, the people running the system won't know what they would need to know; the critical information about the supply of resources and the subjective preferences for goods and services is simply unavailable: it does not exist as data in any one place in complete form, and much of it is not articulable at all. The rulers would have to make guesses, and their errors would be society-wide and potentially catastrophic. Attempts at central economic planning have always ended in disaster and misery.

The market method of deciding what is produced solves this complex problem. How? Through the price system. When people are free to trade goods and services in the market, they generate prices that inform others (even if anyone is aware of this) about the relative supply of and demand for things. Those prices then guide producers and consumers. While their objective is not to create a grand and complex process that encourages the coordination countless plans, economizes on resources and labor, and enables people to achieve their well-being in an unrivaled manner, that is in effect what they do. This is what Adam Smith meant with his "invisible hand" trope. Prices guide people to do "the right thing."

While rulers have never restrained themselves from interfering with people's peaceful transactions, history demonstrates rather clearly that to the extent they do so, the people without political power tend to prosper. The link between consensual market activity and general prosperity stands out starkly.

Note that for markets to work fully, all people must be free to control their lives, their labor, and their justly acquired possessions, that is, their property. This brings us to a key point in favor of markets: the moral advantage. Control of economic activity by bureaucrats necessarily treats people like property. Planning an economy means nothing less than planning other people's lives. There is no "economy"; there are only people who exchange their money, goods, and labor with one another for mutual benefit. The economy is typically spoken of as though it were a machine that needs tending. It is not. We are the economy our rulers wish to regulate, regiment, and plan.

A keystone of markets, when politicians and bureaucrats leave them alone, is competition. Competition is much-lauded but regularly undermined by alliances of government officials and businesspeople seeking higher profits than purely voluntary transactions would bestow. Virtually all government interference with market activity has the effect of stifling competition. Big companies, for example, can more easily carry the burdens of high taxes and bureaucratic rules than can small or yet-to-be-founded businesses. Government is the source of the much-despised economic concentration.

Stifling competition by force harms society because through competition we learn things we would not otherwise learn. Hayek called it a "discovery procedure." I think of it as the universal solvent because it dissolves problems by dispelling ignorance. At any time there are things we don't know that we'd be better off knowing. We can't hope to learn those things through the decision making of a small group of bureaucrats, even if they try in good faith to puzzle things out. But when people are free to buy and sell freely in the market—confronting real-world alternatives—they hit on solutions to their problems. It's trial and error, but there is no better way because virtually all people participate and through their actions contribute their bits of knowledge, any one of which might lead to just the solution people are looking for. Competition and cooperation are two sides of the same coin, and the cooperative nature of markets ought to make them attractive to folks who are now hostile to them.

This is where the entrepreneur comes in. While in a real sense everyone is an entrepreneur (acting creatively in an uncertain, open-ended world), professional entrepreneurs earn their livelihoods by taking risks in offering novel goods and services to improve people's lives. If their offerings are valued by others, they profit. If not, they lose. The quest for profit and the aversion to loss create unparalleled incentives to serve others effectively. Those who consistently misread consumer preferences and thereby waste resources (from the consumers' viewpoint) will lose so often they will have to find other work, leaving the field to those who are more attuned to consumers' subjective preferences. The only thing that can scuttle this process is the government (plus the privilege-seeking businesspeople it gives rise to), which is able to bail out producers who ill-serve consumers and waste resources.

Competition, it is important to realize, does not simply mean that several companies offer the same product or service. It is a creative function driven by entrepreneurs who take risks in an uncertain world to provide things we'll find valuable. If we are to reap the benefits of market competition, people must be free to improvise without having to obtain permission from a bureaucracy. Note the application to the health care industry: contrary to what politicians and bureaucrats would have you believe, a few insurance companies selling identical policies designed by a government agency is not market competition.

This brings us to an important question in the health care context: what is insurance? Outside the medical sector most people understand that insurance is a way to grapple with uncertainty. Specifically, insurance allows the pooling of resources of many people in order to deal with the small risk of a large financial misfortune for any particular individual in the group. Think of life, homeowner, or auto insurance. For some reason health insurance is thought of differently. Most people expect health insurance to cover every medical expenditure no matter how small, predictable services (like annual physical exams), and illnesses contracted before the coverage began ("preexisting illnesses"). Much of the reason for this goes back to World War II, when the government imposed wage and price controls but let employers offer medical insurance as noncash compensation not subject to income taxation. One of the problems with American health care is that most people get their insurance through their employers, anesthetizing consumers to the true costs of coverage and services. Medical transactions are largely between large institutions (including the government), not cost-conscious buyers and customer-oriented practitioners.

Much of what we call health insurance is not really insurance. No one expects their auto policy to cover windshield-wiper blades, tires, and oil changes (such a policy wouldn't be worth the price), and no one expects to be able to buy a homeowners policy to cover a house fire already in progress or a life-insurance policy for someone who is already dead. Logically, you cannot insure against a certainty. Someone who has a serious illness before obtaining health coverage represents medical expenses sure to be incurred. Call the coverage what you will, but it is not insurance. The government can force others—even insurance companies—to pay for those things, but that doesn't make it insurance. It's welfare, with the companies playing the role of tax collectors. In the process, the insurance market is distorted and the true costs of the implicit transfer of resources are hidden. (I explore this point here.)

Violating economic laws has consequences—even in the health care industry. If the government requires insurance companies to cover already-sick people, they must get the money somewhere. The natural place to look is to younger, healthier people, that is, people who will pay more than they collect. But here come the problems. If insurers charge those people too much, they won't buy policies (knowing that they can buy them when they get sick) and insurers will have to charge older, sicker people enough to cover the costs of their medical care. (That would expose the fact that it is not insurance, but merely a pre-payment plan.) If politicians prohibit insurers from charging older, sicker people more (or much more) than younger, healthier people, the higher level of premiums would drive more of the latter out of the market, making things worse. The ACA attempted to solve this problem by forcing everyone to buy a policy—that is, by violating their liberty. However, many young people preferred to pay the tax penalty for not having coverage rather than buy a policy. That is one reason insurers are fleeing the market and the ACA is sinking.

The lesson is that tampering with the price system always comes to grief. Medical care and insurance are not exceptions. If prices are to do their job, they must be true—that is, undistorted by government controls and mandates. If the government passes rules to expand insurance in order to minimize or eliminate out-pocket-expenses for routine medical services, it makes those services to appear free or near-free to consumers; those misleading price signals then lead to problems that politicians will then act to solve. By overconsuming "free" services—say, by undergoing unnecessary elective tests because "my insurance covers it"—people quite innocently impose costs on insurers (that will have to be recouped from customers) and other people: premiums and waiting times for services will rise. It's supply and demand.

Politicians may believe they can help by giving tax-financed subsidies to policyholders and insurers, but that policy brings its own problems. For one thing, regulations will follow to keep the subsidies (now an "entitlement") from exploding out of control. People may not like the conditions, but as the Supreme Court said in the 1941 Wickard v. Filburn case, "It is hardly lack of due process for the Government to regulate that which it subsidizes."

This raises an important matter: if the government assumes responsibility, directly and indirectly, for the cost of medical care to society, inevitably it will find it necessary to restrict or ration services. That is, it won't allow us to make our own choices because it will have a political and fiscal stake in "bending the cost curve down." As Mises noted long ago, intervention begets intervention. (In this article I debunk the proposition that markets are just another way to ration goods and services.)

Advocates of a government-directed medical system may have the best intentions, but intentions can't override market forces, which are generated by purposeful human action. Moreover, we have no reason for confidence that politicians and bureaucrats will sufficiently distinguish the public's interest (if that can be defined beyond peoples' individual interests) from their own interests. Government officials are no less devoted to their careers and prestige than people outside the government; indeed, power is what may have attracted many to government "service." We must not compare the real-world market to the idealized state, because in reality, state operatives lack both the information and incentives needed to deliver the goods.

Summing up: Health care is a collection of important services, but that does not mean the laws of economics can be flouted without bad consequences. We know that competition works, even in the health care industry: in recent years LASIK eye surgery and cosmetic surgery, which are typically elective procedures not covered by insurance, have gone down in price and up in quality. This demonstrates what happens with consumers are cost-conscious (even when competition is hampered).

Governments at all levels have created the problems that politicians and their consultants tell us only they can solve by force. Intervention stimulates demand by distorting prices and restricts supply by, among other ways, limiting the number of insurers and practitioners through occupational licensing and permitting, capping the number of hospitals and medical schools through accreditation, and making drugs and devices more expensive through the Food and Drug Administration's bureaucratic rules and, importantly, patents. The system is riddled with government-sponsored cartels. (For more on this see Kevin Carson's "Health Care and Radical Monopoly.")

Moreover, government limits access to health care in the myriad ways it impedes people's general pursuit of financial success: state intervention lowers incomes compared to a freed economy and raises the prices of many goods by increasing scarcity and distorting production—that is, it stymies growth in living standards.

If universal access to medical care is the goal, the government is the goalie. It should get out of the way.

This piece originally appeared at The Libertarian Institute.

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  1. Decades of government price control in the healthcare/health insurance have proven what doesn’t work. But the alleged fix of the current policy by another policy of the same type meets the definition of insanity. As one who survived the full wage and price controls of the seventies, I just heave a great sigh, and read the next article.
    The real reason there are high prices in these two markets is that it is impossible to shop. Most people have to take the policy selected by an employer, or at best pick between two bad choices. The rest (if law abiding) have to pick from government pre-selected “marketplace” policies. And as pointed out, health insurance is actually a poor blend of pre-paid healthcare (“free” exams etc) and insurance.
    Health care itself cannot be shopped, because even the providers don’t know what they charge. The amount is based on the whims and negotiating power of insurance company accountants.

    1. The problem is the doctors’ labor union, the AMA. They literally write the laws and artificially limit the supply. All that a Congressman does is change the title from “suggested legislation” to HB# whatever. And collect the bribes, er… campaign donations. Fuck the medical care cartel. Letting pharmacists prescribe would go a long way towards lowering health care costs. Why should anybody pay hundreds of dollars for a permission slip to buy ten dollars worth of medicine?

      1. Why should anybody pay hundreds of dollars for a permission slip to buy ten dollars worth of medicine?

        Thank you thank you thank you thank you thank you thank you thank you

        Now we are two.

        Isn’t it pathetic that even *Sheldon* can’t come out and say “you should be free to buy your health care without government permission”?

        That Reason can’t come out against the government enabled rent seeking of the medical mafia, and for your *freedom* to take care of your health without giving the Medical Mafia their pound of flesh first?

      2. “Why should anybody pay hundreds of dollars for a permission slip to buy ten dollars worth of medicine?”

        No joke to that.

        in the state that I live I cannot even get a simple cholesterol test unless it is ordered by a doctor!

        I used to get it tested now and then when the labs would setup in Albertsons with the same same machine that the lab would use for the simple lipid, trigs, and glucose levels. Few drops, 5 minutes, done. That will be $29 please. They would also do it at one of the gyms that I belonged to a few times per year.

        Now, the hospital had a free health screening day and used the same equipment, no doctor’s orders. So I can the hospital and ask if I can do another one now that a few months have gone by. I want to see how much difference a little change in lifestyle made.

        Nope. They, nor the lab, not anywhere else that I call will do that simple test without orders coming from a doctor. Since I don’t have a doctor that means that I would have to make an appointment with one and then tell him / her what I want done. It would probably cost my insurance company $150 for me to get a permission slip from the doctor to have a test done that you can buy the equipment and do yourself if you are willing.

        Thank you big government for standing in the way of people being proactive.

    2. It is true that the current attempt to fix one failed whack at controlled ng the health care market by regulating the bejesus out of insurance with another, substantially similar attempt is insane. OTOH, this deescribes every attempt by the government to meddle in the health care market during my lifetime. It’s like the War on Drugs: it doesn’t seem to be,doing any good and the no good it is doing has gone on for a long freaking time. Can we stop now, please?

      Sadly, this is unlikely to fly with the electorate, bless their black little hearts.

  2. People need to understand what having a “right” to anything means. A right, in this context, is just the freedom to do something. And to understand “rights”, you have to understand freedom. The defining feature of freedom is that it is an expression of individual sovereignty. Freedom is something that belongs to you and only you. If your doing something depends upon the sovereignty of someone else allowing you to do it, you are not free. You are the recipient of an indulgence from the other person. Leftists and sadly some people on the right who should know better, lump indulgences in with real freedom and end up defining freedom as the ability to do something. And that is not what it is.

    1. The best example to illustrate why indulgences are not freedom is to consider children. If you tell a child that they are free to pick any toy in a store, a leftist would conclude the child is “free to have any toy”. No, the child is free to have any toy provided you don’t go back on your promise. The child can’t, no matter what he does, go and buy any toy he wants without your permission. Even if he had his own money, you as his parent would still have the authority to say no to him buying a toy that you felt was dangerous or inappropriate for his age or was objectionable to you for whatever reason. The child isn’t free. You are free to buy your child whatever toy you want to and can afford. The freedom doesn’t come from the actual ability to buy the toy. The freedom comes from the individual sovereignty of being able to buy any toy you are able to without the permission of someone else.

      1. The real,question is can freedom survive in a society where a majority of adults want to be the equivalent of children with the government as parent.

        Because that is where we are now And moving in the wrong direction.

        1. Slightly out there, I’m watching “state of the nation” on CNN, which is their Sunday morning political show equivalent to MTP and TW. They just did a four minute animated segment in the ‘feud’ between President Trump and Snoop Dog. Nicely illustrating the infantilization of our political elites.

        2. I agree that that is the prevalent attitude. Sadly the only way those people will learn is when they receive “enough government” to personally see the problem.

          Until then expect it to get much, much worse.

      2. Except that you have to pay a fortune for a permission slip to buy the medicine that you need. FUCK THE AMA!

    2. The fact that you have to have the money to buy the toy is just an expression of the responsibility that comes with freedom. If you are the child and your parent is buying the toy for you, you are getting an indulgence and thus have no responsibility to pay for it. If you are free and making the decision to buy the toy for your child, you necessarily have the concurrent responsibility to pay for whatever toy you choose to buy. This is why freedom always comes with responsibility. If you don’t assume the responsibility and shirk it off on someone else, you no longer have the sovereignty over the decision, the person who is assuming the responsibility does. Thus they are the free ones and you are just getting an indulgence.

      1. I am going to refer to you as “Fast John” in the future.

        1. Verbose. You said the same thing just using a lot fewer words.

          1. It’s not really that I couldn’t. It’s more that I am the worlds slowest typer.

    3. So to apply the actual meanings of freedom and rights to health care; everyone does have or should have the freedom to obtain health care. What they should not have is the right to an indulgence for health care. You don’t want that for a couple of reasons. First, it forces other people to assume the responsibility for your indulgence. Second, and most importantly, giving everyone an indulgence for healthcare in fact takes away people’s freedom to have it. Once someone else is paying for your health care, you are like the kid in the toy store. You get whatever toy, or in this case health care, that the people who are giving you the indulgence decide you can have. What you want or what you can afford or are willing to sacrifice to get health care only matters if the people in charge are charitable enough to allow it to matter. If they decide that no, you need to spend your money elsewhere, then it won’t matter that you want the health care and have the money to pay for it, you are not getting it. Why? Because by accepting the indulgence you are giving up your freedom to decide what health care is right for you. Once you give up the responsibility of paying that comes with the freedom to have healthcare, you lose that freedom and get whatever those who are indulging you decide you will get.

      1. What makes you think that contemporary Americans want to take responsibility for anything?

      2. The problem is the violation of the NAP by legislative fiat, collusion between the AMA and various legislatures. Do away with that and prices for medical care would drop like a ton of bricks. Unfortunately, that might mean that Junior can’t attend Harvard with a new BMW.

        1. Well, that is a separate issue. But it is pretty depressing that everyone in the media and government seems obsessed with the price of health care and it never occurs to any of them that the best way to lower the price of something and to give people more access to it is to increase the supply of it. We live in a country with a political and media class so fucking stupid that it never occurs to them that the way to solve the problem of health care costing too much and not being available to enough people is to increase the amount of health care being produced by the country. If that doesn’t tell you how doomed we are, nothing will.

          1. Back in the HillaryCare days, the plan was to reduce the number of doctors because too many doctors means too much medical expense.

            In 1997, the Clinton Administration launched an experimental program in New York State to pay medical schools to train fewer doctors to reduce the “glut of physicians.”

            Seriously.

            Obama expressed pretty much the same idea when he talked about how doctors perform unnecessary amputations.

            1. And one of the most insane provisions of Obamacare was the requirement that you get a certificate of need in order to build a charity hospital. If our concern is poor people not having access to healthcare, apparently the the last thing we want is people building more hospitals intended to care for them.

              How can people be that stupid?

          2. Caveat: This is an exercise in descriptive speech, NOT normative speech.

            It’s not just the media and government that are obsessed with the cost of healthcare. It is also the people – acting as a market force – that are exerting pressure. Now to be sure, that market is fucked up, convoluted, byzantine, and under productive, largely due to the government influence that began around the start of the 20th century. But it is a reality that we are spending a tremendous amount of our productive capacity for marginal benefit. (Yes, I’m speaking of a Utilitarian viewpoint – that’s the descriptive aspect of this. While I do not ascribe to that POV, I must acknowledge that it is widely held and therefore a relevant operating aspect of the current marketplace.)

            Go out to some smaller communities, away from the megalopolises, and see what is left of the economy. It’s pretty much the public sector (schools, etc.) and healthcare, with a smattering of retail. People know we are spending a lot on healthcare because, in many places, that’s about all that is left.

            Which is all a long way of saying that many people do want to put the brakes on the system, consciously or not, they really do not want an increased supply, they want diminished supply and diminished consumption of what could otherwise be productive use of those monies.

            Which is a long way of saying that the politics of healthcare is just economics by another (horribly inefficient, and corrupt as it is) means.

      3. Always enjoy your comments, John. I think you could turn this particular set of comments into a publishable essay.

        1. Thank you. Perhaps I will do that.

  3. How about we cut through the positive rights theory and just address the heart of the argument? If you believe that your “rights” extend to the kinds of things that someone else must provide for you. – Then clearly slavery, of some flavor; is not only moral but perhaps even obligatory. For at least a portion of the population. One might even call these creatures “slaves”, and the other class “slavers”.

    1. I’d rather have doctors as slaves than as gods. FUCK THE AMA!

      1. I would rather have none of the above. Surely this is an even better argument for the old school agricultural kind of slavery. Because if medical/health care is important enough to justify this then it is all the more true for more important needs like food and shelter. I can promise you that a lack of these last items will prove fatal long before the first will be a concern.

      2. As long as the AMA lobbies fight for their power to extract their pound of flesh from me, I’m all for the government extracting their labor by force.

        1. I wouldn’t want a slave to perform surgery on me.

  4. There’s one big problem with the free market – there’s a market for politicians selling the idea of free shit and people are free to vote for them. It’s not just the government selling horseshit that’s the problem, it’s the public that buys it.

    1. (If they only want to serve themselves we have a different problem.)

      (Then we have a different problem.)

      The real problem is, yes, the voters and their lack of understanding of scarcity and rationing. As far as I can tell, economics and civics are no longer taught. Critical thinking, certainly not. The collective idiocy of social media doesn’t help. And the uninformed are a significant voter bloc, and central planners have dual incentives to nationalize healthcare. One is votes, and the other is control.

      1. Doctors have an incentive to cause legislated coercion. FUCK THE AMA!

        1. Fuck the AMA with a rusty pipe.

        2. Show me on the doll where the doctor touched you.

          1. They touch us in our freedom to have the health care we want, to cure ourselves as we see fit.

            And they touch us in our wallets, as they extract their government enabled rent.

    2. That’s not a problem with the free market. That’s the fundamental problem of politics.
      All political acts require the enslavement of some by others.

    3. I am just gonna throw this out there since we are talking about free markets, literally un-signable social contracts and the like. If we elect the makers of the law, and all the powers they exercise are granted, (temporarily and by our leave), then how could it hurt to have the equivalent of a voters complaints/veto section on the ballot when you vote? Right after the Tweedle D and whatever part. Blankish and write in. Starting with “Are there any current laws or regulations that you think should be repealed? Fill in the space below. Feel free to add an extra sheet, if needed.” Any thing that gets 51% is automatically null and void. Vetoed by management.

      1. Any thing that gets 51% is automatically null and void. Vetoed by management.

        There is no large difference between a veto and being able to pass new laws. So what you’re basically saying is that 51% of the voters should be able to pass whatever they want. That may be a form of democracy, but it is not a free society. It’s basically mob rule. It’s two wolves and a sheep voting on what to have for dinner.

        1. For the record. I agree, democracy is nothing more than mob rule dressed up in a suit and tie. But since I am only confining the conversation to eliminating unpopular laws and regulations (which by definition should not really even be a “thing” in a 50%+1 popular democracy), by management veto at the earliest convenient opportunity, such as the next time everyone is already in a booth voting, I see little opportunity for tyranny of the majority. Is there a realistic mechanism where this is likely to develop by the elimination of laws and regulatory shennanigans that politicians and planners impose on us from above? And even here only the ones that by popular veto are proven to be the most illegitimate. As in literally not by the honest consent of the governed? This is more of a thought exercise at any rate. Even if this was put into practice it is not hard to imagine that the courts or politicians would be able to cook up some pretext or another in short order and invalidate the whole thing. While simultaneously managing to rationalize a way for themselves to continue to keep more or less absolute power to do whatever they damn well felt like. On the basis of the legitimate consent of the the governed, social contracts or some such notion.

    4. That’s what you get when you allow non property owners to vote.

    5. It’s not just the government selling horseshit that’s the problem, it’s the public that buys it.

      It’s not “horseshit” at all, it reflects the political power of constituents. Women are politically powerful and vote to get money from men. The elderly are politically powerful and vote to get money from young folks. Etc. The aggregate of these political powers is the kind of massive and irrational redistribution we actually see.

      The problem with our democracy isn’t that people are stupid, it’s that they are actually smart and they are exercising their political power to enrich themselves.

  5. All resources are scarce and must be rationed; isn’t that the first rule of economics? (The first rule of politics is to ignore the first rule of economics.)

    The question is, how are those resources rationed? Statists of course say they want the State to be the rationer, but what they really mean is they want themselves to be the State, because only they know what is good and proper. Everyone else is selfish, bigoted, ignorant, naive, gullible.

    Anyone with half a brain can see the fallacy in that, but the logical conclusion is individualism, which scares most people so much that they refuse to acknowledge the fallacy and would rather have a really crappy State steal their property and tell them what to do.

    And that’s how we got to where we are today, little children. Now go off to bed quick before the libertarian goes into the closet or hides under your bed so as to leave you alone!

    1. Doctors are rationers and statists par excellence. Remember the Grenada invasion? Why were there so many medical students on a small Caribbean island? Because of the AMA’s control over admissions to medical school.

    2. The first lesson of economics is scarcity: there is never enough of anything to fully satisfy all those who want it. The first lesson of politics is to disregard the first lesson of economics.

      — Thomas Sowell

      The first lesson does NOT say that goods and services must be rationed.

      Rationing is the controlled distribution of scarce resources, goods, or services, or an artificial restriction of demand. “Ration” is defined as “a fixed amount of a commodity officially allowed to each person during a time of shortage, as in wartime.” Governments impose rationing because they do not like the result of voluntary transactions in the market.

      1. I used “rationed” in the broader sense of not handed out to all comers, that because something is scarce, not everyone can get all they want. “Rationing” in your sense is a subset of that.

  6. Excellent article.

  7. It would be foolish to expect them to donate their labor and resources because other people need them; they have their own lives to live and livelihoods to earn. It would be wrong to compel them; they are not slaves.

    Wow (and yay). The reason zampolit must be on break on Sundays.

    1. Zampolit?.. Well fuck me with the wikipedia. Learn a new word every day. Did you get beat up a lot in school kid ? I did find this charming dude after practicing some google-fu…..Zampolit… I suspect the only reason for the pistol had more to do with those unfortunate sorts that had no desire to sacrifice themselves for the glorious Homeland/Motherland than the rival socialist gang they were in a pissing match with. This is just a theory.

  8. +1 shtrafbat

  9. No Tony or DanO responses? I am disappoint.

  10. The ACA created no rights.

    It created obligations. For me, it created an obligation to purchase a government-specified medical insurance policy.

    The best rights-related thing that can be said for ACA is that is provided funding to states to expand Medicaid eligibility, which facilitated the states to give many low-income people the “right” to a crappy Medicaid policy.

  11. I have always been a free trader! I made my living in the trading pits of chicago, watching price discovery before my very eyes! The problem with a free market for healthcare isn’t an easy one! Let’s say someone chooses not to use their resources for health insurance,
    they then go to an ER for a heart attack or stroke. The avg. cost of those events is around 250k. Who pays?
    Unless you have those that choose no healthcare to sign a waiver to get no healthcare, what do we do?
    One idea may be to handle it like auto insurance. Most states require some form of liability insurance so you cannot infringe on another’s property! Maybe the answer is a mandate for catastrophic care, while leaving physicals, mammograms, prostate exams, colonoscopies etc. as additional care that they can purchase or not. For if you don’t address catastrophic events, what do u do with an unconscious automobile accident victim who has no healthcare? As someone that has traded in “free” markets for 4 decades, we must realize that healthcare has some very different aspects than typical supply and demand. It is a product that no one wants yet everyone needs! As you said though resources are limited. The tough conversations need to be had!

    1. they then go to an ER for a heart attack or stroke. The avg. cost of those events is around 250k. Who pays?
      Unless you have those that choose no healthcare to sign a waiver to get no healthcare, what do we do?

      Why should they have to sign waivers? You don’t need $250k to treat a stroke, you only need $250k to treat a stroke if you’re looking for the absolute best treatment options. You pay for the treatment you can afford and/or your insurance premiums cover, and you live with the consequences.

      As someone that has traded in “free” markets for 4 decades, we must realize that healthcare has some very different aspects than typical supply and demand. It is a product that no one wants yet everyone needs!

      I don’t need much healthcare. If I get a heart attack or a stroke, I want to die. That’s not even a financial decision, it’s a quality of life decision. Furthermore, most middle class people, by the time they get a heart attack or a stroke, should have enough equity in their houses and/or retirement savings to be able to pay $250k. If they don’t, they haven’t saved enough.

      The tough conversations need to be had!

      The only thing that makes these conversations “tough” is that some people think that society somehow owes them the best possible medical care while they can spend their money on whatever they like.

      1. You can’t expect a doctor or hospital to let you die, especially if you are unconscious when you arrive. You may think you want to die now but I don’t believe you will when the time comes. So bottom line is you are liable to be a burden on some health care provider, so it is only reasonable to require that you be able to pay, even if you have insufficient wealth.

  12. If universal access to medical care is the goal, the government is the goalie. It should get out of the way.

    Ah, Sheldon, I worried for my sanity. When I saw the subtitle, I thought I would have to praise one of your articles. I thought you would stand up for my right to purchase health care from anyone happy to sell it to me, without government regulation for either of us. If only Sheldon agrees with me, surely the easiest explanation is that I have lost my mind.

    But no. Even Sheldon, the voice of unreality of the ideology of unreality, can’t really bring himself to write an article with a full throated defense of health care freedom for consumers and producers of health care. Besides a few throwaway lines about deregulation, it’s all just kvetching about how the government distorts the market for *insurance* of our completely unfree, government monopolies galore, government controlled provision of services.

    When will someone at Reason grow a pair of libertarian balls and say I shouldn’t have to run about town paying the regulation enabled rent seeking fee of $150 for an audience with a doctor so I can plead for a permission slip to buy a $10 monthly supply of a generic I’ve taken for a decade?

    When will my natural rights be seen to include the right to protect my health as I see fit without getting a permission slip from a government enabled rent seeking mafia?

  13. The comments about economics in the article are generally good. However, the article still falls into the trap of assuming that more healthcare actually translates into better health. The most insidious part of “free health care” is that it actually doesn’t generally make people healthier. If you look at health outcomes vs health care spending across countries, you’ll find that beyond a couple of thousand dollars per person per year, there aren’t significant improvements. More spending on health care does not equate with better health outcomes.

    The best way of staying healthy is to eat well, avoid excessive stress, exercise, and avoid dangerous activities. And the biggest cause of out-of-control health care costs in the US is that people don’t do that because they assume (correctly in many cases) that they don’t have to because doctors can generally mostly fix whatever harm they are doing to themselves.

    1. Well put.

      Re: ” And the biggest cause of out-of-control health care costs in the US is that people don’t do that because they assume (correctly in many cases) that they don’t have to because doctors can generally mostly fix whatever harm they are doing to themselves.”

      You touched on the moral hazard, which I delve into here:

      “Will Obamacare make a bad situation worse?”
      relevantmatters.wordpress.com /2012/05/21/ will-obamacare-make-a-bad-situation-worse/

      Delete the spaces in the link.

  14. The problem is that the government is artificially denying people access to health care through its myriad rules and regulations.

    If you are sick, can you go to the local store and buy medicine yourself?

    No, you have to get a permission slip from a doctor. And the store has to be licensed. And the drugs are similarly controlled.

    1. Isn’t it pathetic that even at Reason, even with lunatic Sheldon, basic healthcare freedom is not even discussed as a possibility?

  15. Other countries manage to have single payer systems that their citizens are happy with. I don’t know of any country happy with a system like you propose. I guess American ingenuity is not what it is cracked up to be.

    1. Other countries manage to have single payer systems that their citizens are happy with.

      Every dictator who won 100% of the vote must be enormously popular! Not only is no other explanation possible, but it’s not even necessary. Happiness achieved!

      Seriously, Taiwan is borrowing to pay for medical care and has a running shortage of doctors. On top of that there’s no general metrics regarding the amount or outcome of care given making it exceedingly likely* that they’re borrowing money while still failing to meet even modest levels of care by other standards. Similar sorts of vagueness and number-fudging can be had (by both sides) regarding single-payer healthcare. Part of the reason Cuba’s fertility/birth rates are the way they are is because the state openly/routinely encourages mothers, via doctors, to abort at virtually any sign of complication. Good luck implementing that.

    2. aajax|3.20.17 @ 2:02AM|#
      “Other countries manage to have single payer systems that their citizens are happy with. I don’t know of any country happy with a system like you propose.”

      Yep, those folks are just dying to get some of that “free” care, it you get what I mean.
      —————————–
      “I guess American ingenuity is not what it is cracked up to be.”

      I guess your lack of knowledge is everything its cracked up to be.

    1. I’ve got a whole page of replies for assholes who spam like you do…

      Here’s one pic from it… http://www.plusaf.com/homepage…..people.jpg

      Now fuck off and die.

  16. “Two ways exist for determining how resources and labor are to be used; an apparent third way is simply a mixture of the other two.”

    There is a fourth way: Compassion.

    We are not simply individuals, we are social animals. Our species possesses the quality of empathy, which is an expression of enlightened self-interest. (Without empathy, we would have evolved into something quite different.)

    As social beings we come together in various groupings – family, clan, tribe, neighbourhood, town, etc – to “do unto others what we would have them do for us.” We help each other. Not out of altruism, but because we recognise that to be virtuous and effective, selfishness must empathise.

    Then again, many people don’t seem to want to be free. They feel all cosy and warm in their slavery, secure in their PATRIOT Acts and capital punishment. Maybe the best they can hope for is Ryancare. Maybe it’s what they deserve.

  17. Incredibly well done, Sheldon. Since it is written in plain language, it should be a mandatory study for economics students everywhere. I shall spread it as far and wide as I can.

    Aside from pointing out why the ACA is failing, you explained precisely why the Soviet Union collapsed and why Venezuela is headed in the same direction.

    I tip my hat to you.

  18. The preamble to the Constitution does suggest the we should have the right to life, liberty and the pursuit of happiness. It’s difficult to manage that if you are dead because you couldn’t afford healthcare which by some measures happens to 45,000 Americans every year.
    But in a larger sense, why would even a Libertarian want a healthcare system that inarguably is the most expensive in the world while delivering the 37th best results? It doesn’t make any sense.

  19. I’d say that a right to healthcare is the same “right” that illegal immigrants have to hop the border and thrive on tax funded benefits, including schooling, medicaid, housing and food. Can there be a right to one and not the other. Richman thinks so.

  20. It should be noted the cost of health care is considerably higher than it would be in a true free market where people were allowed to provide their services to the limits of their ability. The problem started when the AMA (union for doctors) was able to convince the federal government to regulate the medical schools so that fewer doctors were produced. This of course raised the incomes of those in practice through restriction of supply. No different than what the United Auto Workers was able to do in the 1930’s when it had the “favor” of President FDR behind it. All unions know that reducing the supply of “available” workers will force employers to pay higher wages and benefits. The exact same thing is true of “all” professional organizations. They effectively use the power of state to gain higher incomes for themselves at the price of higher costs to everyone else. In a libertarian society these organizations would not be allowed to exist in the form we see them today because they use “force” (provided by government) to gain their objectives.

    1. Did they regulate the schools before or after medical licensing laws?

      Before or after it was made illegal for you to treat yourself?

  21. Since when properly working our bodies heal themselves we have a irrevocable right to healthcare. But if having a right to something means it’s free someone owes me a lot of money for the 2nd Amendment.

  22. Sheldon, let me make a point you and a slew of other people may have missed on this topic…

    The “Right” everyone is talking about is probably mis-stated.

    It should be something like, “Nobody has the right TO DENY ANYONE ‘the right’ to PURCHASE Health Care.”

    Everyone’s bitching about the right to RECEIVE it, i.e., have it “Provided to you” and probably at Someone Else’s Expense.

    That’s a popular but bullshit argument or goal.

    But nobody should be able to make it impossible for anyone else to GET Health Care (services, insurance, whatever) if they want it.

    If they can’t afford it, it should be legal for charitable organizations to pony up the money (or employers or your Aunt Sally.)

  23. The real,question is can freedom survive in a society where a majority of adults want to be the equivalent of children with the government as parent. IMO for pc and IMO for windows 10

  24. The problem is that the politicians have sold the “right to healthcare” as a promise of the Constitution or at the very least, Natural Law. And they want to load up the healthcare program with unsustainable goodies like covering pre-existing conditions and “children” on the parent’s policy until age 26.

    Speaking of the age 26 “right” does anyone know where that came from? Some bureaucrat who thought it would be cool to protect a favored class of parents of “children” until they finished graduate school?

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