Discussing nationalised healthcare with those of a leftist frame of mind, it occurs to me that one is put at a disadvantage in attempting to demonstrate the merits of a private healthcare system if one restricts the options to a public health system versus private health system. This tends to conflate the separate benefits a private system would provide. Nationalised healthcare systems are wasteful and ruinously expensive but there are actually two separate phenomena contributing to this.
- Any business which is run by the government will have priorities unrelated to those of the customers of that business and will tend to provide the product or service it wants to provide, in the quantities it wants to produce as opposed to providing the product according to the customer’s demand. This leads inexorably to unsatisfied customers, gluts, rationing and shortages.
- ‘Free’ healthcare is a problem similar to the tragedy of the commons. If there is no cost to be borne by availing of ‘free’ healthcare, there is no corrective against frivolous use of this service. The phenomena of bored pensioners visiting the doctor for a chat is solely that of a system where that doctor’s time is paid by the taxpayer and not the loquacious geriatric. Hypochondria, held in check by a pay-as-you-go system is positively rewarded by free healthcare.
One is further disadvantaged by conflating nationalised health with redistributionism per se. Thus, if the matter for discussion is simply nationalised health versus private, one must not only convince the sceptic of the benefits of the market but also to abandon a, perhaps cherished, redistributionist outlook. Yet, it is not necessary to do so if these issues are separated. In agreeing to set aside the issue of redistribution in the first place it ought to be possible to agree with the leftist interlocutor that the government does a lousy job of running the health system. An ardent supporter of cradle to grave healthcare, if intellectually honest, may be persuaded to concede that, so long as the government still pays for it, healthcare would be better provided by the private sector. If this step is accepted, such an intellectually honest leftist might also note the role of incentives when healthcare is provided on a no-cost basis. In an alternative system, an individual might be provided with health vouchers or subsidised insurance, perhaps a no claims bonus might apply or a policy excess. In such a system, the government still picks up the tab but there is at least some incentive for the user to modify his consumption.
By separating the issues it may be possible to reach wider agreement on privatising health than would be possible with the issues lumped together. It is probably worth adopting such an incrementalist approach in lieu of the ‘greedy’ approach of the absolutist. For most of the issues which concern libertarians, a step in the right direction is not only useful in getting closer to one’s goal, it may also offer a noticeable improvement in its own right.