April 24, 2017


Are We All in Favor of National Healthcare Now? (Bruce Frohnen, 4/24/17, Imaginative Conservative)

It is worth noting, then, that the logical conclusion of Obamacare, Ryancare, or even Trumpcare, so long as it retains the assumption of federal guarantees, is nationalization. The logic of a national guarantee is risk-sharing. And risk-sharing always means redistributing from those with more to those with less. With income guarantees this means redistributing wealth directly. With health care guarantees it means taking from those who do not need the care to those who need it. So far, this may sound charitable and decent--after all, we already tax the young and healthy to pay for the old and sick through Social Security. The problem is that, with health care in particular, we are not dealing with merely a problem of health--that is, of the absence of specific, catastrophic illnesses or injuries--but also with demand for preventive care and the like. That is, we are dealing with regular, routine services that cost money. Moreover, most people tend to want more healthcare services than they actually need; we go to the doctor when we are not actually sick, seek procedures that make us look or feel better but are not necessary for survival, and so forth. In other words, it is extremely difficult to control costs for health care without resorting to some form of rationing. This is why so much money is wasted in insurance schemes that emphasize savings through oversight and various limitations on patient (and even doctor) choice. Indeed, once the "right" to healthcare or any other positive right is established, nationalization actually appears more efficient than the Rube Goldberg machinations common within the American administrative state. Both in the end result in draconian rules, distorted incentives, and ultimate systemic failure.

What social democrats, in whatever party, fail to recognize is that various "positive rights" to things like welfare, healthcare, and education, merely grant power to the government, to the extent it wishes, to take over portions of society, substituting its will for the decisions of various persons and associations throughout society. Americans, having a deep-seated aversion to federal power, have allowed national aggrandizement only incrementally and under the guise of various regulations and guarantees. The result retains the appearance of freedom and the reality of chaos. It also retains a consistent tendency toward further federal power, and toward further erosion of freedom. After all, one can provide a good everyone wants for free (or highly reduced cost) only by rationing its distribution, substituting force for voluntary transactions.

None of this is to say that people do not, as persons possessed of human dignity, have a kind of right to health care. It is up to all of us to support charitable causes and institutions that provide health care, as well as food, clothing, shelter, and education, to those who cannot afford them. 

There is much here that is correct, but the pieces do not fit together coherently.

It is entirely accurate that the citizenry of every developed democracy demand that their government provides risk sharing where health care is concerned. But it is not the case that they/er are making a demand for services when needed.  What people want is the assurance that permanent insurance coverage provides that those services will be accessible and affordable when needed. It is the guarantee of the thing, not the thing itself.

Thus, a viable system of charitable causes and institutions would have to provide health insurance to everyone who can not afford it, not services to those who seek them in a physical/fiscal emergency.   

The freedom Mr. Frohnen speaks of--wherein I am to be free of health insurance, you are to be free from helping pay for it and providers are free to not provide me services if I can not pay or I do not meet their charitable norms, is a freedom that societies have universally decided against enjoying.  

Instead, we want liberty in this field of our lives, as in so many others. The requirements of republican liberty are significantly different than freedom, often antithetical to it:

Classical republican writers maintained that to be free means to not be dominated--that is, not to be dependent on the arbitrary will of other individuals. The source of this interpretation of political liberty was the principle of Roman law that defines the status of a free person as not being subject to the arbitrary will of another person--in contrast to a slave, who is dependent on another person's will. As the individual is free when he or she has legal and political rights, so a people or a city is free insofar as it lives under its own laws. 

A system that left health care piecemeal and much of it subject to the good will of charities would be--has been--entirely arbitrary.  National Health is one way of ameliorating this arbitrariness, but so would be any universal health care coverage scheme.

We here prefer a system of universal catastrophic coverage combined with HSAs.  This affords coverage for those extraordinary occasions when people require it, while building up savings throughout their otherwise healthy lives--which wealth can then be used to pay for genuinely needed care as they age and die and potentially leave enough at the end of life to be added to their successors' savings.  

Note that this system vindicates the goal of freedom too, perhaps more effectively.  For one of the truths that we conservatives have always avoided is that the rich man and the poor man are not equally free, because the absence of any government bar on an activity does not, in practice, afford them equal access to it.  Wealth ultimately decides whether that access is actually available.  Without it, freedom is illusory.  And a political party/philosophy, that tries to force illusory freedom on the citizens instead of offering a system consistent with republican liberty is unlikely to prevail in the long run, nor does it deserve to. 

Posted by at April 24, 2017 6:03 AM