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Benefits of incrementalism

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.

  1. 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.
  2. ‘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.

35 comments to Benefits of incrementalism

  • Hmm Im not sure how this post will go down, but its never stopped me in the past. I was discussing private healthcare v state care with my girlfriend (a good lefty). The most overriding arguement against private health care is “What about poor people”. I had to concede she had a point. Whilst a private ‘success’ driven business would no doubt give a better standard of care some provision must be made for people who are unable to pay.

    Subsidised healthcare on a means tested level would probably be the best idea but does give rise to the “I pay my taxes why should those scroungers/criminals/dole cheats get what i get without contributing.

    As admiting she may be right pains me I ask you all what your thourghts are on this.

  • toolkien

    Hmm Im not sure how this post will go down, but its never stopped me in the past. I was discussing private healthcare v state care with my girlfriend (a good lefty). The most overriding arguement against private health care is “What about poor people”. I had to concede she had a point. Whilst a private ‘success’ driven business would no doubt give a better standard of care some provision must be made for people who are unable to pay.

    Subsidised healthcare on a means tested level would probably be the best idea but does give rise to the “I pay my taxes why should those scroungers/criminals/dole cheats get what i get without contributing.

    As admiting she may be right pains me I ask you all what your thourghts are on this.

    Without knowing your stand on using similar methods on, say shoes or cars, one may not be able to counter your position fully.

    Supposing you would not support using these same methods of allocation in other goods, why does health care get special attention? What is it about health care that sets it apart? Isn’t it merely a service or good like any other? It has utilizes technology and human expertise in providing an exchangable good for another (namely money). To invest just this service for special consideration is to invest it with a value that it doesn’t intellectually possess. It presumes to stamp a collective value to what is still an individualistic exchange. If it is so important a commodity, why not just use force on those with the expertise to provide their service at no cost? If that sounds fanciful, then what gives credence to the notion of taking my property to pay them? Lastly, the slow spread of socialistic reasoning over the last 130 years has used this same argument of entitlement on just about every aspect of society and exchange. That is the incrementalism in reverse, once the give away starts, and the impounding of property, it will be extended, by degree, to nearly everything.

  • This is why it’s worth focusing on the delivery of healthcare first before looking at the funding. Even under a cradle to grave healthcare system, private delivery would be much cheaper and of better quality. The next step would be to give subsidised users of such a system an incentive not to waste it on unnecessary or imaginary complaints.

  • ilana

    Toolkien: How can you compare health care to shoes? I can decide how many pairs of shoes to buy depending on my means, but I can’t decide what illnesses I may get. Good health is surely a social good, as a healthy population benefits everyone, just like a well educated population.
    That said, I agree that public health care is inefficient and wasteful, and agree that private provision is better, but there must be some provision for the poor.

  • Just arguing issues like private health care on a pragmatic ‘which is more efficient?’ level is tempting because the examples are right there to point to. “See? Look at those statistics. The NHS is as efficient as a mute interpreter!”

    The problem with an approach like that although it will get you to the result you want in the short term, it doesn’t address the actual, moral reason that state provided healthcare is wrong.

    The state may be less efficient at providing healthcare now…but what if at some future point in time it could be proven that the state is the most cost-effective means of provision of healthcare? Does that mean it should start providing it again? Does that mean I have to be taxed to pay for other’s healthcare?

    I think it’s more important to attack the issue at it’s root – to state that no-one is, in fact, his brother’s keeper, no matter the misfortune of the said brother. Once you establish that expropriation and redistribution is not the way to go in health (or anything else, for that matter) because it’s at the cost of the freedom of the individual, arguments of ‘but what about someone who really neeeeeds it?’ and ‘but what about health access for people in remote areas?’ and ‘but it’s good for the country as a whole’ simply don’t have anywhere to rest.

  • Verity

    Monica puts it very well. If the government were inexplicably suddenly able to provide the best care at the cheapest cost, should it do so? The answer is no. It has no business extorting money from me in order to pay for healthcare for people I care nothing about and may even heartily dislike.

    Alternatively, what worked in the past was churches, synagogues and benevolent societies which cared for the poor in their communities. This, to my mind, is still the preferred method. Although it goes against the grain, I may make an exception for children, because it’s not their fault they have feckless parents.

  • toolkien

    Toolkien: How can you compare health care to shoes? I can decide how many pairs of shoes to buy depending on my means, but I can’t decide what illnesses I may get. Good health is surely a social good, as a healthy population benefits everyone, just like a well educated population.
    That said, I agree that public health care is inefficient and wasteful, and agree that private provision is better, but there must be some provision for the poor.

    How do you NOT compare the two? Why do you buy shoes? To mitigate the effects of cold and roughness your feet would otherwise endure (looked at another way, how many health issues are avoided because you have shoes?). Why do you seek health care? To mitigate the effects of an illness you have to endure. Both are natural occurances mitigable through human intellect and technology. But it still doesn’t excuse confiscating my property, a little or a lot, to mitigate someone else’s issues via Force.

    In all you’ve just reinforced what I said originally, you’ve said that it is ‘different’ without providing solid reasons why it is different. Providing all sorts of services through State programs might be beneficial, but it doesn’t excuse the use of Force to confiscate the resources to do it.

    P.S. I favor the dissolution of public education on the same grounds. I have little love for the idea of State programming of individuals regardless of the supposed ‘societal’ benefits. In fact, I’d rather provide resources for physical health before I’d provide resources for State mental indoctrination. Unfortunately the secondary stage of public borne health care is to do just that, recondition people’s behavior to eliminate health concerns. They just happen to erase liberty along with it.

  • eoin

    Still, Verity, even if you are correct in theory – that form of libertarianism is disastrous for any possibly electable right wing party. If government could provide it cheaper and more widely, most people would go for that.

    I am not at all convinced that private health insurance – the American way – is , in fact, cheaper or more efficient. There is no real market system in health. We do not have enough information to shop around for the best deal after a heart attack, nor can we have any information on the best type for care for the best price in an emergency. Seems that will always be the way.

    Plus the costs of medical care are never ever paid by the actual consumer of the product, everybody who can be, is insured in America – even CEO’s. Nobody wants to pay for the medical costs they may incur, so the insurance industry works as a form of privatized socialism – everybody pays according to their ability, and withdraws according to need.

    Still the same issue, then, with the ” tragedy of the commons”. And health insurance is not, and cannot be, similar to other insurance which evaluates premiums – or refuses service – based on risk. Health insurers have to provide people with chronic health problems insurance at the same cost as everyone else.

    Such an insurance provision is like asking a fire insurer to insure a wooden house beside an active volcano, or a house insurer to insure a house that floods every year.

    Someone with chronic issues, is clearly gonna cost more than he pays in, yet he individually suffers no penalty besides some co-payment for drugs – which is often insignificant, and can also happen in the government provided service

    I should add that the costs are normally borne by Corporations, are thus an effective corporate tax – a tax not paid in Europe, nor China – and are therefore even more opaque to the consumer. If health costs increase to the point where they may involve tax increases in the socialist system, then the health spending could well be cut – certainly happened in Ireland in the eighties, and significant cuts too – but a recession in California after the then stock market crash did not cause health spending to be curtailed. It increased during the downturn, adding more “tax” to the Californian corporation. They could avoid it by off-shoring, of course.

  • I think it’s more important to attack the issue at it’s root – to state that no-one is, in fact, his brother’s keeper, no matter the misfortune of the said brother. Once you establish that expropriation and redistribution is not the way to go in health (or anything else, for that matter) because it’s at the cost of the freedom of the individual, arguments of ‘but what about someone who really neeeeeds it?’ and ‘but what about health access for people in remote areas?’ and ‘but it’s good for the country as a whole’ simply don’t have anywhere to rest.

    Yet this is precisely the type of greedy absolutism I have in my sights. As it happens I actually agree with you that redistributionism is not only massively inefficient but morally wrong but that is neither here nor there. The problem is those three little words: “once you establish”. It will be a long time indeed before you do actually “establish” and during that period the status quo simply worsens. Holding out until you “establish” is a textbook example of the best being the enemy of the good. If your aim is to merely to convince someone of the demerits of the current NHS, it is greedy to aim further and convince them that all redistributionism is wrong. One step at a time: you might still convince them that redistributionism is wrong but before you get around to establishing that and just in case you don’t, you might be successful in getting them to recognise how disastrous a government run health system actually is.

  • Well, just as an observation the Australian healthcare system in which the governent (mostly) pays for it and the private sector (mostly) provides it is far far better than the British system where the government both pays for it and provides it. (In most cases in Australia the government pays most of the cost but a portion of the cost is still borne by the patient, meaning there is some financial disincentive for patients to see doctors for frivolous reasons). The consequences of all this are that if I need to see a specialist in Australia, I will probably see one within a week or two. In England I have waited for six months or more.

    Although this is far from the ideal that I would like to see (basically no government involvement in the provision of healthcare at all), the Australian system is immensely better than the British system. This is in my mind pretty much entirely because of the absence of the dreadful public sector bureaucracies that run everything in Britain.

  • Julian Morrison

    I don’t see incrementalism as working. It hasn’t thus far, and it’s unlikely to in the future. the reason it doesn’t, is that people aren’t fools. When you make a case for incremental privatization, they immediately spot that the arguments you’re tortured into supporting a slight increase would, if let to run to their obvious conclusions, support total privatization. Then they will resist the incremental change with what will look like ridiculously overblown zeal – because they recognise precisely what you’re up to.

  • Julian, you make the mistake of assuming that everybody who supports universal nationalised healthcare do so because they love it exactly the way it is. This just isn’t the case. An Australian type system as described by Michael would be superior to the British system, not just as a step towards complete privatisation but also in terms of cost and efficiency. It is likely that support for reform on such lines would be much more broadly based than support for a more purist libertarian solution.

  • eoin

    There is no libertarian solution: nobody addressed my issues – so let me state it clearly.

    Healthcare – private or public – is always redistributive. The healthy subsidise the sick. The fit subsidise the unfit.

    Fat libertarians who smoke and do drugs and take no exercise, are subsidised, in America and Britain by health conscious lefties in sandals who should be paying less, given their healthy lifestyle ( as they pay less for life insurance).

    If you really want private health insurance to work like a normal insurance policy, then you should be prepared to pay through the nose; being – as you are – a fat, unfit, smoking, alcohol abusing, and drug taking libertarian.

    Be prepared to also produce all medical records of yourself and all known relatives, and expect a premium increase for ever getting sick.

    It strikes me that libertarians are as utopian, and as impervious to logic, as anarchists.

  • An NHS nurse, committed to the free market and opposed to the Nash on principle, this is a subject dear to my heart, and one I’ve argued over endlessly with lefties.

    The problems of health care provision are multifaceted, and include funding and provision issues. My experience is that for most ideological lefties they can no more question the “rightness” of the NHS dream than a Christian can question the divinity of God. Still I try any way. The incremental approach I take is to liken the NHS to an insurance scheme in which the premiums are (broadly) proportional to income, rather than likelihood of making a claim. In that sense the service is “socialised”. However the specific cost of the premium is lost in the mass of general taxation, and unlike proper insurance schemes there are no excess fees. How high would our car insurance be, I ask, if frivolous claims for small breakages weren’t discouraged by the £100 excess fee. In the same way how much NHS money would be saved if, say, a £20 fee was extracted for every initial visit to the GP or A&E, or for every appointment subsequently missed. How many minor injuries presented at A & E would be replaced by cheaper visits to the chemist.

    These minor changes wouldn’t begin to solve the massive, institutionalised problems I see in the NHS every day. They wouldn’t bring in the much needed extra money that only private contributions can produce, they won’t make the NHS any more accountable and they won’t introduce much needed competition. I do think though, that when we do get general acceptance for that small point we undermine much of the ‘universalism’ of the NHS dream, which will make it easier to get acceptance for tackling the other issues.

  • Jonathan

    If one believes healthcare should be provided by the government, then one can ask, guided by the same concern for people’s welfare, why is government not providing food, an immediate need, or heating, shelter etc.? Unless you are posiing these questions to a socialist of the first order I have found this makes those comfortable with government’s role question themselves. As much as I find people like David Carr very entertaining (and correct), heated and emotional rhetoric is unlikely to ‘win’ over those that need to be.

  • Jonathan L

    I am in total agreement with Frank on this one. The general public is not going to go for a libertarian health care system any time in the near future. The terrible state of the NHS is an opportunity to convince people that the current socialist model doesn’t work.

    Our argument has to focus on separating provision and financing. Just five minutes of careful argument is enough to convince most people that just because the state pays for healthcare, it doesn’t follow that the state has to own and run hospitals.

    When this idea has widespread acceptance, we will have won a major battle. The financing is a battle for another day.

  • Ian Bennett

    ManaSystems’ girl friend asked “What about poor people”. Provide them with the means of accessing healthcare, once they have proven both that they need the care and that they need the assistance. In other words (and as usual), the solution is to fund the consumer, not the good or service. I am currently compelled to subsidise health care for rich ill people, poor ill people, rich hypochondriacs and poor hypochondriacs. I have used the NHS three times in the past 20 years.

  • Daveon

    I don’t think that it will prove possible to get rid of government funded healthcare.

    I agree with the idea of a fee for visits to the Doctor (or first visits for a particular condition) and trips to A&E, although you’d probably have to discount on proof of unemployment or something. Trouble is this brings us back to entitlement cards and all the problems with those.

    I’d rather see free at point of delivery NHS only for people on low incomes and move everybody else over to some form of mixed private insurance.

  • Daveon: there are two significant problems with the system you describe, (which, by the way, is what we have in Ireland).

    1. ‘Free at point of delivery’ healthcare is a valuable commodity and this privilege will often be awarded pretty broadly. In Ireland there is a medical card system and you would probably be appalled to discover how many people have medical cards. They get scattered like confetti come election time.

    2. One of the biggest drains on a government healthcare system is its use for petty, frivolous and hypochondriac complaints. It doesn’t take a fool to realise that the type of person who is happy to visit the doctor just for a chat or who will go to the ER because he has a headache or a hangover is cash-poor and time-rich. That is, someone who would qualify for your free at point of entry system. A person who is cash-rich and time-poor would have to be a really serious hypochondriac to sit in the waiting room for the requisite duration. You have to introduce some sort of incentive not to use the system unless you really need it, even if it is only a nominal charge instead of the full cost.

  • Healthcare – private or public – is always redistributive. The healthy subsidise the sick. The fit subsidise the unfit.

    Absolutely, just don’t allow the state to force them. Insurance schemes are just a way of ‘private redistribution’ where the individuals involved still have no say in how their property is redistributed.

    Charities and other benevelent organisations, outside the reach of the state, can also be used to ‘subsidise’ the poor, whatever that means nowadays. I’d happily give 10% of my income to charities of my choice or to the local hospital’s fund for the needy. If only the government stopped taking my money under pretence of redistribution and for ‘social good’.

    You may argue that many wouldn’t but that’s people for you… then the question is who do you trust more, the state or the society?

    And what, pray, is ‘libertarian health care’?

  • Daveon

    there are two significant problems with the system you describe
    :) I suspect there are more than 2…

    I don’t expect to have to carry any ID other than stuff I want to carry and is of use to me from time to time. I certainly don’t like the idea of extending government issued ID beyond the Driving License and Passport. So that’s a problem for me.

    A nominal charge strikes me as a good idea – they have it in France, (although that doesn’t seem to stop hypocondriacs). I’d be interested to see exactly what the costs of un-ncessary visits to A&E and Doctors actually are.

    Sadly, I think it would be political suicide, at least in the UK, for anybody to address this.

  • eoin

    Arianna asked me:
    “What is libertarian health care”

    Actually she asked me to ( in an uncharacteristic fit of pretension, no doubt) to “pray tell” what it is.

    I don’t know – since I never used the phrase. I did say there was no libertarian solution in answer to the comment just above me – which said there was.

    Well , maybe there is – the only libertarian solution to healthcare is a privately insured health care system , unsubsidised by your employer , which evaluates premiums based on risk, increases premiums after a claim, and can deny coverage to high risk individuals like crazy unfit libertarians, old folk, and people with chronic problems.

    Furthermore, to evaluate the risk based premium, people may have to have regular checkups, and the insurance company may demand you lose some weight, or give up smoking, or change some lifestyle habits to ensure continuing coverage.

    The nanny state would have nothing on it, but libertarians would not care since it was not , in fact, the State ordering us about.

    All other systems are a subsidy. I don’t mean in the sense that insurance is a subsidy anyway, the premium payers pay for the users; but in that the premium paid by the healthy subsidises the premium paid by the unhealthy.

    That would be a libertarian solution, and it is clearly untenable. It is not the American system, and nor does the American system eliminate any of the issues inherent in the socialist system, since it is the same thing – just privatised.

  • toolkien

    That would be a libertarian solution, and it is clearly untenable. It is not the American system, and nor does the American system eliminate any of the issues inherent in the socialist system, since it is the same thing – just privatised.

    eoin-

    The point you seem to be missing is that when subsidy is private it is voluntary, when it the State it is coerced. That is the fundemental difference between a libertarian and a non-libertarian point of view. Insurance is a communal pool of resources hedging risk. The pool should decide who is in and who is out. There should be no ‘insurer of last resort’ in the State as it blasts at the very root of voluntary association. The reason someone is not allowed into a pool is that there is near certainty in having a bad incident instead of merely a risk. Those people will have to rely then on direct subsidy by those who have a value in them.

    Perhaps looking at the spectrum of means of paying for health services will be clearer: 1) by the individual 2) by a consortium of concerned individuals who value the sick person 3) obliquely though voluntary giving to third parties to distribute (charities) 4) through a voluntary insurance contract 5) through a forced collective (the State). Which ones are voluntary, allowing individuals to use their own value systems in deciding which course to take and which use Force to stamp another’s value system over one? So while redistribution may occur either way, one is based on individual value judgements (wherein lies liberty) and the other is based on Force (wherein lies tyranny). Any clearer?

    So perhaps you are right that a libertarian system is not likely, that is only because people are so indoctrinated to Statism that another method doesn’t occur to them. People are so weak willed and irrational that oblique Force is the order of the day. But they don’t know when they are cutting their own throats, because all of the ‘advanced’ Western countries are carrying mind boggling amounts of debt (characterized in different ways) that will have to be paid off one day, mostly through debasing currencies and impounding of a majority of peoples labor and property. That is the system we have in place. It is a diseased, irrational system of Force in which liberty is marginalized on its way to extinction.

  • Eoin, it was Jonathan who mentioned “libertarian healthcare” and I assume it was this to which Adriana referred. As to the substance of your argument, you seem to be under the apprehension that there is something wrong in principle with health insurance which is tailored towards an individual’s risk profile and that some sort of injustice would apply to such accurate insurance. Further that this would end up more expensive than the tending-towards-universal health insurance packages currently available (here in Ireland this is called, in a nicely collectivist euphemism, community rating). This is a serious error analogous to the notion that price controls are useful in countering the distorting effects of the “unbridled” market. The principal advantage a market economy has over a dirigiste economy is information. All else flows from this. There is simply no way one body can predict supply and demand, yet prices obtained in the market impart this information effectively.

    The same applies in an insurance market, the more information you have, the better you are able to assess individual risks, the less flab you need to keep going. Let’s say you have two insurance regimes:

    1) Regime 1, insurance companies may not tailor policies to suit individual risk profiles. This means that the company must make sure that they are covered in the event of having to pay out on high risk individuals. They don’t really know what the total risk is going to be so they have to err on the side of caution This puts everybody’s policy up. There is a universal policy analogous to government issue cheese. This represents an inefficient assessment of the total risk.

    2) Regime 2, policies tailored to individual’s risk profile. Now this means that some people at risk of cancer will have to pay more, but people who aren’t at risk of heart disease will pay less and some of those will be included in the former. More information means better risk assessment, and a more efficient prediction of likely cost.

    Of course in the limiting situation, if someone is 100% likely to acquire terminal cancer in the immediate future, he is practically uninsurable (actually, he would still be insurable except the cost would equal cost of treatment plus transaction costs). This is just common sense. Yet someone at a less than 100% risk of cancer (such as myself) still represents a business opportunity for an insurance company. The purpose of health insurance is not to subsidise the sick any more than the purpose of motor insurance is to subsidise inept drivers, it is merely to spread the risk. If you guessed that you had a certain chance of becoming sick, you might take your chances without insurance and instead save up to cover medical expenses when they are required. If you don’t get sick, you get the benefit of the money saved, but that means you take the risk. By insuring yourself, you spread that savings benefit to the insurance company and they take the risk.

  • Verity

    Toolkein, exactly. What Adriana and I both proposed was a return to charities, like churches, synagogues and benevolent societies. And trades unions. Donations to support these organisations are voluntary- except in the case of trades unions which would have to make contributions mandatory, although they would still be voluntary in that joining the union is voluntary.

    Adriana says she would gladly tithe 10% of her income voluntarily to help people who could not afford any form of health care. I wouldn’t go that far, but I would give something every now and then if I thought the charity was well run and fulfilling its stated remit.

    On the other hand, to the question, “But what about the poor?”, I would respond, “What poor?” “The poor” and “the poverty gap” are socialist rhetoric. No one in Britain starves. Or has to do without a Playstation. Or booze. The “poor” of today could afford low cost private health care that only covered real illnesses and real emergencies (not ‘counselling’; not breast augementation; not ‘sex changes’; not fertility treatment, not vasectomies or anything else elective). If they did not take out available very low cost, basic health insurance, that would be their choice and they would be free to fall ill and not be able to find treatment. Adults in a free society should have the right to make their own stupid decisions, and everyone else should have the right not to give a crap when those decisions turn out badly.

  • The US health care system is hardly “private”. Tax money goes to many different health care programs, directly through Medicaid and Medicare and a welter of state programs and indirectly through mandates on hospitals to treat the uninsured, which they do every day in massive numbers. I am certain the US spends more taxpayers’ money on health care, absolutely and per capita, than any of the so-called “socialist” countries. The US mixed system encourages a variety of different models, such as HMOs and regular health insurance, employer plans and self-funded plans. But this is a real benefit, in terms of freedom of choice and progress in the medical sciences. When American politicians start going to France or the UK to have their operations, I’ll know the US system has gone bad.

  • Cydonia

    One of the biggest propaganda arguments used by the Statists is that “ordinary people” can’t afford healthcare.

    The argument is probably false even now, but it is certainly true that health care costs far more than it needs to.

    Fortunately, there are plenty of good libertarian solutions to that problem as well:

    1. scrap compulsory licensing of doctors and other health care professionals;

    2. scrap drug regulations;

    3. scrap all the incidental rules and regulations that send up the cost of running a surgery or a hospital (planning, H&S, employment blah blah blah)

    Result? Health care costs would plummet and the “what will the poor people do?” arguments for collectivist healthcare would look even more threadbare than it does now.

  • Verity

    Cydonia – I repeat. In Britain, there are no poor people. Everyone in Britain would be able to afford ‘no frills’ health insurance if they had to. Would they sacrifice a holiday or a new DV player to do so? Probably not.

    The only people I would worry about would be pensioners, who had their ability to save and thus be independent, leached away from them by successive governments. So far as I can see, they are the only case for subsidised medicine, and this could be phased out eventually.

  • Separating funding from provisioning is indeed a more effective way to argue the case. And once you have done so successfully, arguing the privatization of the funding is a lot easier.

  • Thrasymachus

    It seems to me that libertarians begin with a set of dogmatic premises that are no less problematic, and perhaps even more problematic, than the premises of Marxism. The Achilles heel of libertarianism is the problem of justice. Why? Because libertarians, by accepting the value relativity of economics, deny that justice has a fundamental nature that is discernible by human reason. In other words, libertarians deny the existence of natural right. This undermines the entire philosophical basis of self determinism and makes it defendable only in purely conventional and selfish terms, which is why libertarians spend so much time bashing straw men and so little time discussing how self determinism is linked to equality, justice, and the common good. Only by vilifying the common good can libertarians defend their worldview. It has to be stacked against “statist tyranny” because it can no longer stand on its own. To make the unqualified suggestion that health care is no different from shoes is, in my opinion, not just disingenuous but also unwise.

  • Verity

    Thrasymachus – OK, you have made a very good point. So where do you stand on the state confiscating people’s money in order to provide a wide, not to say lavish, range of health care for total strangers?

  • Thrasymachus

    As for the confiscation of money, first I would ask, do you have a natural right to the unlimited acquisition of property? Is it just for you to own more property than you can use well? Certainly I could not condone the confiscation of money from a good citizen if it rightfully belonged to him. Why, that would be stealing, wouldn’t it? But if there was some justification for the government to exercise its power to tax private citizens in the name of the common good, in the name of justice, it would follow that the money should be spent wisely. Wise spending requires wise men, right? Because it takes a wise man to understand the problem of justice. But is democracy the rule of wise men? For that matter, does democracy promote a virtuous citizenry? Indeed, it can be argued (and often is) that the government does more harm than good when it addresses social issues. This can be viewed in many different ways. One alternative is to radically limit the power of government, lest it turn into an evil beast that extends its authority beyond any reasonable boundaries. I can see the temptation to subscribe to this ideology, and I don’t claim to have the answer to the problem of justice. However, I do not imagine that by rejecting government the problem of justice goes away, or that “free markets” and the value relativity of capitalism are palatable substitutes for the evils of representative democracy. Can we be both ignorant and free? Clearly not. Freedom requires responsibility. Freedom requires virtue. Freedom requires education. Freedom requires wisdom. These are things that Jerry Springer and American Idol do not provide. These are things that are lacking in a large percentage of our population. What is the role of government? In my opinion, to promote these virtues by any means at its disposal. They are classical American virtues, derived from our understanding of nature. I think it’s okay for the government to impose certain “values” (to borrow a term that I despise for its relativistic implications) on its citizens. Otherwise you have a ghost town into which any cause, no matter how base or vulgar, can move in and declare itself sheriff. All it needs to do is sell the most tickets. So where do I stand on giving away lavish health care to total strangers with no strings attached? I’m against it. With freedom comes responsibility. There should be some responsibility attached to “free” health care, too.

  • A. Reddick

    Many are caught on the idea that people have a “right” to life. Unless a person has either performed service valued by others (i.e. earned property), or has ingratiated themselves to others with property (i.e. children, relatives, charity cases, etc.), they do not have any right to existence at all, since existence requires resources that they do not have.

    There is only one absolute arbiter of the value of someone’s life: his or her property. If you can provide services that people (with property) value, they will give you property for those services. If you cannot, then you have no value. (Such services can simply be being a child of a property holder, successfully appealing to charitable insticts, etc.)

    It is completely natural that those with property (who are thus valued by society) can persuade others to provide the medical services that they require to extend life, and that those who have failed to acquire property die.

    The fact that a majority would never support the elimination of a redistributionist form of gov’t supported healthcare is fairly indicative that a just society must be imposed, rather than elected. This is not at all unusual. If a majority choose an immoral system of government, then they lose the right to choose any government.

  • Ah, the ‘Propertarian fallacy’. This shows how easy it is to fall into error when you do not comprehend that justificationism inevitably leads to nihilistic reductio ad absurdum regarding quite literally everything. A. Reddick follows the same chain of logic that lead many into mass murderous genocide last century, which based upon his previous comments here, he is well aware of. We do not propose to engage an crypto-fascist in continued dialogue.

  • Verity:
    “Thrasymachus – OK, you have made a very good point. So where do you stand on the state confiscating people’s money in order to provide a wide, not to say lavish, range of health care for total strangers?”

    I would say that I would like it to do so as little as possible, whilst ensuring there is a safety net to prevent the wanton abuse of some poorer individuals’ lives. I accept many of the arguments on here, but would like to stop the incrementalism at privatising provision. I suspect this may also give more chance for your ‘churches and charities’ to develop, or not!