After all that has been written and said about health care reform over the past six months, it is virtually impossible to offer much that is original. Much of the editorial commentary in favor of the various concepts floated by the left reflect such an ignorance of the realities of economics, human nature, incentives, and markets that it is not worth the time and space to refute them. I’ll just throw out one question involving their organizing principle that, to any rational analyst, should undermine the entire basis: How can we adopt a new system of financing health care that supposedly will add 47 million new insured people while reducing the cost of the system on a budget-neutral basis without rationing of care and disastrous increases in taxes? It violates the law of non-contradiction on its face, and if the American people ultimately buy into anything close, they will have fooled me (again).
There has been one unique take on the debate that is the best I have seen, coming from the school of thought that I had believed to have been totally silenced, which is the one that asks: Is equality of health care a fundamental right?. I have previously attempted to make the case that it isn’t, and I continue to believe that there is a strong case there, but I am no doubt in the minority, and certainly so since at least the time of Franklin Roosevelt’s enunciation of his “Second Bill of Rights” in the early 1940’s.
In this vein, I was struck by the commentary of Dr. Thomas Szasz, author and emeritus professor of psychiatry at Upstate Medical University in Syracuse, New York. Rather than paraphrase his premise, I will simply quote the critical passages from his recent essay in the Wall Street Journal:
“The idea that every life is infinitely precious and therefore everyone deserves the same kind of optimal medical care is a fine religious sentiment and moral ideal. As political and economic policy, it is vainglorious delusion. Rich and educated people not only receive better goods and services in all areas of life than do poor and uneducated people, they also tend to take better care of themselves and their possessions, which in turn leads to better health. The first requirement for better health care for all is not equal health care for everyone but educational and economic advancement for everyone.
We must stop talking about health care as if it was some kind of collective public service, like fire protection, provided equally to everyone who needs it.
If we persevere in our quixotic quest for a fetishized medical equality we will sacrifice personal freedom as its price. We will become the voluntary slaves of a ‘compassionate’ government that will provide the same low quality health care to everyone.”
A final thought. I have previously written about “public choice theory” (May 2003), a concept which is applicable in the current debate. This theory was originally formulated by Nobel Laureate James M. Buchanan and in simplest terms is nothing more complicated than the espousal of market-based principles and systems for the delivery of public services. Critics of this theory seem to believe that rational people, when acting on certain desires or needs normally delivered publicly, do not behave as they do in markets, that somehow they set aside human nature and become immune to the dynamics and incentives of market forces. The sooner we rid ourselves of this nonsensical policy thinking, the sooner we can come to grips with the realities of the market and incentive systems that will be necessary to rationalize our health care finance system.
