We are developing the social individualist meta-context for the future. From the very serious to the extremely frivolous... lets see what is on the mind of the Samizdata people.

Samizdata, derived from Samizdat /n. - a system of clandestine publication of banned literature in the USSR [Russ.,= self-publishing house]

How to frame the argument about ‘free’ health care

When Perry referred to the recent comments of US Presidential hopeful Barak Obama, we had another example in the ensuing comment thread of how people lazily refer to the idea that healthcare should be ‘free’. Of course, unless Obama is a total idiot – and I doubt that – he realises that health care, like roads, clean water, defence or food is not free in any sense at all that matters in a world of scarce resources that have alternate uses (such scarcity and the fact they have alternate uses is a classic element of what economics is). Healthcare is not free – it must be paid for, paid out of the time and trouble of other people. The problem, however, is that a lot of people, not just socialists, think that some things in life ‘ought’ to be free although one often finds they are at a loss to say why. Indeed, if you challenge a person by asking, “Why should health, clean water or defence be free”? they will either change the subject, or go bright red with anger, or fail to understand the question at all.

To attack the idea that certain services and resources should be ‘free’ is not, alas, all that easy in today’s politically dumb climate. However, I think I have a partial solution in how to frame the point. If you ever encounter a person who says that healthcare should be free at the point of use, and it should be a ‘right’, then point out that this means that someone else has a corresponding duty to be a doctor, a nurse, a hospital orderly or an administrator. Unless people can be forced to perform these roles, then all talk of health as something that ought to be free is meaningless. Of course, at this point the socialist will blather on about incentives and so on, but what if no one wants to be a doctor or a nurse, regardless of pay? Does this mean that anyone who shows an inclination to like medicine should, at an early age, be conscripted into a hospital like a draft for the Army?

I ask these rhetorical questions because I think that when we try to frame our arguments, it is sometimes easy to lose sight of the fact that actual flesh and blood human beings are involved in talk about “the right to free health care”. Most people these days oppose the idea of military conscription so it ought to be possible to make the case against medical conscription. If we can point out that medical conscription would be a bad thing, then it would be a step in nailing the nonsense that healthcare is a ‘right’.

Here is a book I highly recommend about the whole noxious doctrine of ‘welfare rights’ and how they erode respect for the original, far more coherent rights doctrine of classical liberalism.

Tweet about this on TwitterShare on FacebookShare on LinkedInShare on TumblrShare on RedditShare on Google+Share on VK

38 comments to How to frame the argument about ‘free’ health care

  • Nick M

    Furthermore, Jonathan. I’m sure you’d really love to be admitted into hospital and meet your surgeon who’s muttering that he’s only got 6 more months to go before his service is up. I’m sure you’d feel so much more confident about the outcome of the operation?

    Seriously though. I don’t see a real problem in terms of the Obama thread. I and others used the word “free” in the context of healthcare knowing full well what I meant.

    Perhaps there is a danger when such terms are bandied about loosely by others but I feel that the Samizdatistas (and most of the commentariat) are generally savvy enough to know that “free” is sloganeering as much as so many other terms common in the current political sphere – From “homophobia” to “ethical living” to “pro-life” such terms are misleading and essentially slogans. They are slogans in the hands of the likes of Obama. On this blog they’re just convenient short-hand.

  • Johnathan

    Nick, no, it was the first comment, not the rest of them. But you have to realise that a lot of even quite intelligent people out there use the word “free” in this lazy way and it is always a good point to criticise it.

  • “Always look to the language,” Nick.

    Precision of concepts is always worth the effort.

  • Neil Barnes

    In the UK context I have always wondered why the Conservatives don’t push for a hypothecated health tax. This partly lances the “free” issue, as well as escaping the big image problem the right have when advocating general tax reduction (by allowing us to promise to ring fence health spending).

    Long term it might also be a useful stepping stone to a less state controlled system, by for example, making opting out easier.

  • I’m with Johnathan that there is no such thing as free health-care, though some of it can (as we know) be funded through taxation.

    However, I’m not with him on the need for compulsory service by doctors and nurses, or even dominance of employment prospects by the state.

    As I suggest over on the ASI, commenting on their post Depoliticizing the NHS, one could collect a minimum level of health insurance through graduated taxation, and then route it (at the choice of each citizen) to a commercial health insurance policy, with optional top-up. Then independent and/or charitable hospitals and GPs (and even government run ones) can provide the health-care on whatever basis they choose (provided the several competing insurance companies buy it from them, or the people do directly).

    Best regards

  • Johnathan Pearce

    However, I’m not with him on the need for compulsory service by doctors and nurses, or even dominance of employment prospects by the state.

    Nigel, I did not say that there is a need to compel people to become doctors or whatever; rather, that the doctrine that one has a “right” to “free” health care must, logically, entail that other people must, if necessary, be coerced into providing that care, and if necessary, must be forced to become doctors, nurses, etc. To will the end without willing the means is, therefore, illogical.

  • Jonathan: actually, in my experience, the intelligent ones use the word “affordable”, rather than “free”, by which they, obviously, mean “cheap”. These terms being relative, are handy in murking things up. Well, some basic healthcare can be cheap, by almost any standard, although it is usually the kind that would not require professional care anyway, if it were not for the state forcing us to seek it through mandatory prescriptions etc. My son used to have strep throat so often, that in a few months I was perfectly able of diagnosing it myself. Still, I had to drag him to a pediatrician, fever and all, every time, to get the same prescription for the same antibiotic.

    Of course, once you start talking about the really expensive kinds of healthcare, such as various innovative cancer treatments, then people begin talking about the right to life. Obviously, clean water, education and defence also fit neatly into the “right to life” category. My question is then, why stop there and not include “free”/”affordable” food? I never got a straight answer to that. Well, maybe if I asked some older generation kibbutznik, I would have actually gotten it…

  • You really don’t think it worth trying to come up with something better than that? Really?

    Sure, find ways to increase the number of medical care providers by stopping all the things the state does to restrict supply and thereby raise the cost/impose scarcity.

  • Rob

    Not many people actually believe that healthcare can be free, and even left wing politicians are sufficiently aware that to make such a statements would invite ridicule, which is why they always add the “at the point of use” caveat. In Britain, the Welfare State was sold to the population on the basis of it being an Insurance scheme. Even now a large portion of our Income Tax is called National Insurance and in the public mind it fulfills the same function as house insurance or car insurance. If someone breaks into my house and steals a packet of cornflakes (it actually happened to me once – the police said they were looking for a cereal offender) I would expect to renew my breakfast treat from the proceeds of my insurance claim, it would thus make it free at the point of use. We all know that there will be winners (people who don’t get ill/burgled) and losers (victims of crime and sufferers from illness). The factor which makes all this work for most people is not ones ability to get a prescription for atheletes foot or jock rash, or even a new wing mirror if your car gets a knock, it’s fear – fear of your house burning down of your getting cancer. So people are prepared to put up with a lot just for the sake of peace of mind.

  • Jacob

    I don’t think that Obama, or all other supporters of socialized medicine, think it is free in the sense that Johnathan says. You’re fighting a ridiculous straw man.
    Everybody is perfectly aware that health care costs money.
    The socialists propose an insurance scheme, whereby everybody is obligated by the state to purchase health insurance (directly or via general taxes), so that his health care costs are covered by the insurance, without the need to pay directly at the point of use. An additional feature of this scheme is that the “rich” subsidize the “poor”, i.e. they cover part of the premiums for the poor. A dismal characteristic of these schemes is that they are usually run by the Government (NHS), but this need not be so – in Chile, and seems to me in France, they have such insurance, forced by the Government, but the services are provided by private enterprise.

    This scheme isn’t different from all other well established state run welfare schemes, including welfare payments for the poor, clean water, roads, defense, education etc.
    You can evaluate such schemes, but criticizing the “free” part isn’t relevant.

  • As I suggest over on the ASI, commenting on their post Depoliticizing the NHS,

    Politics is what we call the struggle to control the means of collective coercion. Nothing that is funded via a coerced tax can be, by definition, anything other than political.

  • I think a more common problem in terms of the debate is the difference between people saying healthcare should be “free” (a very uninformed statement) and those who say healthcare is a fundamental “right” (which is just crazy).

    Moore and the left think that in our wealthy society we (as in the government) should be able to provide more for less. While this is a nice gesture, as PJ O’Rourke would say, it’s like you’re trying to fix my wristwatch with a ball-pein hammer. It’s the wrong tool for the job.

  • I believe that the best way to change minds on this issue is to demonstrate how socialized medicine makes health care scarcer – not with numbers and charts but with individual horror stories of first-hand experiences with socialized medicine. For example, I’m aware that some Canadians have suffered complications, sometimes lethal, having to wait many months for treatment.

    I’d like to see someone collect such stories from every nation that has universal health care.

  • Paul Marks

    Quite so Perry, nothing funded by the state (i.e. the taxpayer) can be nonpolitical. Such things can not be in the hands of “non political experts” unless power of tax money is handed over to these “experts” (in which case the polis is a democracy in name only).

    Also nothing that is regulated can be “non political” – as handing over the power to decide what actions or inactions can be punished by fines or imprisonment to “non political experts” does not make deciding such things not a political matter.

    For example, if the price of electicticity is to be determined by regulation then this regulation is a political act (one backed up by the Sword of State – i.e. the threat of violence). “Experts” have no better way of determining the “correct” cost of electricity than an elected politician does (the “objective scientific studies” are just a lot of nonsense). And as for comming up with “correct price” for various forms of medical treatment – “words fail me Conscript Fathers”.

    The “independence of the Bank of England” is a good example of all this.

    A credit money bubble is a credit money bubble. Whether it is created by the orders of elected politicians, or by “independent experts” (who are, in fact, appoited by those politicians) does not alter this.

    Sadly the realm of the political is growing – not shrinking.

    For example, the “Financial Times” (the newspaper that best shows the unholy alliance between the state and politically connected “businessmen”) recently reported that Mr Cameron (leader of the Conservative party of the United Kingdom of Great Britain and Northern Ireland) was “reconsidering” the policy ideas around the “trading of social bads”.

    Such things as “carbo trading” (not carbon, carbo – bread not oil) and “trading” concening other “bad” foods (fat, sugar, salt).

    Not “trading” as in selling these food products to people who wished to buy them – trading as in “off setting” these “social bads” in various ways.

    Supposedly Mr Cameron has gone cold on one form of this policy and now favour another form.

    But, of course, any “voluntary” deal will be under the theat of regulation (“voluntary” in the sense of “give me your wallet or I will smash your face in” strictly speaking still an example of free will, but one influenced by the threat of aggression).

    Sadly Mr Cameron and his associates most likely think that the above is an example of a “market based approach” or “trying to get the politics out of needed social reform”.

  • Millie Woods

    The problem with most government run health care is that it is organized and run by people who are clueless and frequently motivated by useless pc restrictions such as we need more women in top administrative jobs – not we need the best and brightest in the top administrative jobs. Here in Ontario the upper echelons of health care jobs are secretive political appointments with enormous salaries and no accountability and no real qualifications for the job.
    Unfortunately government controlled health care always becomes politicized which leads to such horrors as the tainted blood AIDS deaths of the majority of the country’s haemophiliac population.

  • guy herbert

    AKH,

    . For example, I’m aware that some Canadians have suffered complications, sometimes lethal, having to wait many months for treatment.

    I’d like to see someone collect such stories from every nation that has universal health care.

    I don’t think that’s a much different approach from Michael Moore’s. There are more horror-stories in most systems than one could collect and digest, so you are just engaged in selective dramatisation of a prejudice, whether or not your prejudice can be justified. Popular medical drama series do this better than political pamphleteers, and most are wise enough to steer away from offering pat solutions.

    Real statistics, though they have their flaws, are more persuasive. Comparing survival rates in the US (which of course include the uninsured) and the UK with chronic, potentially progressive, diseases is an interesting one. Quite frequently people last longer in the States. (Despite much higher rates of morbid obesity and other complicating factors.) Which suggests US healthcare is better, for most, than UK.

    A look at the practical mechanisms suggests that in most states the uninsured may get the equivalent of bog-standard NHS treatment, and the insured better, so it shouldn’t be a surprise. The very poor in the States may well avoid the GP, which isn’t necessarily a bad thing unless you have the early stages of something really serious.

    On the other hand, neo-natal mortality seems to be higher in the States than most advanced countries, which needs explaining. My suspicion is that obstetric care is less readily available than it might be because of the danger of malpractice suits. Which suggests the interesting, for most counterintuitive, idea that the way to improve US healthcare may not be to interfere with the patients’ insurance arrangements, but to alleviate some of the risks borne by clinicians by dealing with the tort industry. Fat chance of the Democratic party tackling that one.

  • guy herbert

    Oops. Second line of the above is quoting AKH as well. Sorry.

  • Serendipidous topic – I recently commented against a topic on another blog that “free” healtcare only occurs if you have “free” doctors and nurses and drugs/medical consumables. Ah, yes, it was about Gordon Brown wanting “free” Healthcare in Africa paid for by the UK taxpayer. Utter swine he is.

    Every ‘right’ has an ‘obligation’, so the right to something results in others being obliged. Very quickly this results in indentured servitude, as is the lot of the UK taxpayer.

  • Johnathan Pearce

    Everybody is perfectly aware that health care costs money.

    So pay for it then, Jacob.

    I was not “attacking a straw man”, Jacob, but framing the argument in its fundamentals: when people say that health care ought to be free at the point of use, they mean that someone else should pay and provide for it. And by using the analogy with military conscription, I tried to get across the idea of how if people think health care is a right, then someone else has a corresponding duty to provide it.

  • Jacob

    when people say that health care ought to be free at the point of use, they mean that someone else should pay and provide for it.

    Not necessarily. Maybe they mean – it should be provided via insurance.

    As for someone else paying – why, that’s standard practice with welfare payments, actually with everything government does. Nothing new here.

    When people say that medical treatement should be free at the point of use, they don’t say they have a patent for providing free medical care. They only advocate a different form of financing – via insurance and/or taxes – instead of direct payments.

    Take an analogy: people are forced to buy auto insurance – they are not permitted to drive without it.

    It makes (maybe) sense to ask (or force) people to buy health insurance so that they don’t become a burden on society when ill, like the uninsured in the US, which get “free” emergency room treatement – becoming a burden on the hospitals and other patients that are required to pay higher fees.

  • Johnathan Pearce

    Jacob, I think even the dumbest person who has an insurance policy and pays an annual premium realises that it is not free, even at the point when the policy gets exercised. If my house catches fire and I get a payout, I doubt it is free. With insurance, risks are pooled, that is all.

  • Johnathan Pearce

    When people say that medical treatement should be free at the point of use, they don’t say they have a patent for providing free medical care.

    I don’t understand that sentence at all. What do you mean by “patent”?

  • Jacob

    person who has an insurance policy and pays an annual premium realises that it is not free, even at the point when the policy gets exercised.

    Of course. When Obama and others say “free medical care” they don’t mean what YOU think they mean. They don’t mean that medical care is free, they mean to say: “it is free at the point of consume” – i.e. when you are sick, you get treatment without it being dependent upon payment – you have already paid for it with your insurance premiums.

    You misunderstand or misinterpret what Obama and co. say.

    they don’t say they have a patent for providing free medical care.

    Obama doesn’t say he has found a method for providing health care that costs nothing. He proposes a method by which you don’t pay when you get the treatement. You pay in advance, through insurance premiums (or taxes).

    The point is: when you are sick – you get treatement, unconditionally; that is: at that moment you don’t have to produce the money – i.e. if you don’t have money at that moment you get the treatement anyway, as you are insured (having paid premiums in the past, by yourself, or, if poor, by the help of uncle Gov.).

  • Daveon

    IIRC there have been lots and lots of comparative surveys about quality of healthcare under different systems using lots of metrics, in all the ones I’ve seen Universal cover systems rate higher.

    OTOH this is a null debate pretty much everywhere except the US, Universal Cover won, and probably will continue to do so.

    Personally, annecdotally (because heaven forbid we actually use data), I was happier with my NHS doctor in Ealing than my shiny private one in Seattle.

  • Daveon

    but with individual horror stories of first-hand experiences with socialized medicine

    It would be interesting to collect a sample, somehow adjust it for the sample and also collect first hand horror stories of US style healthcare.

  • Johnathan Pearce

    Obama doesn’t say he has found a method for providing health care that costs nothing. He proposes a method by which you don’t pay when you get the treatement. You pay in advance, through insurance premiums (or taxes).

    So no doubt we can look forward to Obama spelling out how much insurance premia/and/or taxes will rise to pay for all this. That should be fun

  • Jacob

    “…Obama spelling out how much insurance premia/and/or taxes will rise to pay for all this.”

    Of course lefties (and greens) are better at describing and prescribing bliss than at paying for it, or calculating the costs, or grasping the cost. Here you have a point.
    They say: “we need free health care, free education, free housing, carbon free energy, and the costs be damned”.

  • David Waterson

    Some time ago Oz introduced a consumption tax while doing away with some others. The revenue from these taxes was to fund schools and hospitals. This idiot at the pub was ranting on about how free health is exactly that and no taxes need be collected to fund it. I kid you not.

  • Sunfish

    This idiot at the pub was ranting on about how free health is exactly that and no taxes need be collected to fund it. I kid you not.

    He’s right. Health is free. Illness, however, is quite spendy.

  • guy herbert

    It would be interesting to collect a sample, somehow adjust it for the sample and also collect first hand horror stories of US style healthcare.

    My answer is the same as that to AKH. No it wouldn’t be. It would be a serious and misleading waste of effort, because there’s no valid way of sampling anecdote, which is critically reliant on self-selection and the expectations of the anecdotalist. A French person in the British system would see different things as horrific (perhaps everything except the lack of form filling by the patient) from a native Briton.

    This does seem to be how government policy is formed for all sorts of circumstances however. Reaction to horror stories – fixing the rare remarkable problem not the common ones everybody is accustomed to.

  • Dave

    Sorry Guy, I left off the irony markers. There are lots of actual comparative studies to use which don’t use anecdotes.

  • Paul Marks

    Daveon

    There did NOT tend to be “debates” among the general public in various countries before government health care systems (or “private” ones where govermment pays the lion’s share of the costs from taxes) were set up.

    Of course these systems do not really “universal coverage”, but that is harldy worth saying. At least it would not be worth saying if Americans were not being told that having yet bigger government will mean that everyone gets treatment – of course it will not. One has to be good a “playing the system” and even then one may not get good treatment (or even any treatment at all).

    Each system is different – for example in Cuba bribes are common, whereas in Britian they are not (by guess is that in American system they would be – but there we go), but neither system really provided “universal coverage”.

    As for “debate”.

    There were no widespread demands for “National Insurance” in 1911, or a National Health Service in 1948.

    These things were created by political elites – and were matters of increasing power (not reacting to public demand).

    Most politicians and administrators like to “do things”, and academics back them up by saying that X, Y, Z, new schemes will do lots of good. And making standard false claims that they will “only cost……”

    As for the half socialist medical system the United States has now (about half the money spent comming from the taxpayer and the rest of the medical work being strangled by a vast web of regulations) making it less expensive would be easy.

    GET RID OF THE SUBSIDIES (SUCH AS MEDICARE AND MEDICAID AND THE “FREE” E.R.s) AND GET RID OF THE VAST WEB OF REGULATIONS – THE COST OF HEALTH CARE WOULD THEN DRAMATICALLY FALL.

    THE QUALITY OF HEALTH CARE WOULD ALSO IMPROVE.

    However, there is no chance whatever of this happening.

    What will happen is yet more subsidies and regulations.

    This is called the decline of Western Civilization (not just in the United States but in all Western nations).

    The Welfare States can be rolled back in theory – but not in practice (due to the power of the people who control such intitutions as academia and the mainstream media in forming public opinion).

    There is no solution. At least till things get a lot worse than they now are.

    It is possible that when things openly start to fall apart radical reform may occur.

    Sadly I suspect that the powers-that-be will just suggest Chevez type “reform” (i.e. total statism) rather than rolling back government.

    And as such institutions as “the education system” and the mainstream media so greatly influence public opinion……

    Still total statism will, in turn, lead to collapse. And after a very nasty period indeed, civilization may return.

  • I think Barak should just stop talking about “free at the point of use healthcare” and just come clean and say “sanctimonious vehicle for wealth redistribution”

  • Daveon

    Paul – taking a line from John Bolton – I think you’re mistaken there old chap.

    As for “getting rid of…” – what is your proposal for people who are not covered?

  • Paul Marks

    Most people did not use to be “covered” Daveon (if you mean by insurance). And at the prices of health care at the time they did not need to be.

    “But technology has meant that health care prices must go up much faster than wages have risen” – if you believe that I have a nice bridge to sell you.

    As for “coverage” for those who do not like insurance (even at the much cheaper prices that it could be if it were not for the subsidies and regulations) and do not like H.M.O.s (ditto). Then the return of the fraternal institutions (in Britian the name was “friendly society”) would seem to be in order.

    “But what about the homeless guy on the street who has never had the chance to join a working class fraternal organizartion”.

    That is why so many free hospitals and free wards in non free hospitals were built and maintained. Although this has mostly gone down the memory hole.

    As income expands so the amount devoted to charity (not a dirty word) should grow – not shrink.

  • Daveon

    Paul, your answer, which was pretty much word for word what I expected, sums up why your worldview is really unpopular with the majority of people. And why I think Healthcare is a poor topic for Libertarians to tilt at windmills for in Europe. There are other better topics where they can win comprehensively.

    Your other points are distortions and strawmen frankly. Some healthcare has gone up more than most people could ever afford; partial coverage of a population in many areas can have huge net negative effects on everybody and there is a reason why charity isn’t as popular as it was – although its hardly vanished.

    Email me if you like, I think this subject is done here.

  • Paul Marks

    Daveon I explained why health care has increased so much in price above inflation (the cause is, mostly, the very subsidies and regulations that you seem to support).

    Also if you had really read what I wrote (rather than give it a quick scim) you would have seen that I had ALREADY SAID that reform was unlikely (to put it mildly) because of what the majority of people have been taught (by the “education system” and the media) to believe (it is quite true that academia and the mainstream media do not totally control what most people think, otherwise the West would be one big Cuba, but they do have some influence).

    So being told that most people are not libertarians is as much a shock to me as being told that sky is blue.

    As for e.mailing you.

    Why would I want to e.mail someone who accuses me of “distortions” “straw men” – i.e. calls me a liar.

    If you want to claim I am liar show your evidence.

  • Paul Marks

    I am told that Mr Moore has recently been on the “Queen of daytime television” (I will not try and spell the name) show in Chicago.

    Part of his propaganda film “Sicko” was also shown (so much for only the “extreme” left being proCastro, with the “moderate” left being opposed to Marxism – the “Queen of ….” supposedly being part of the moderate left, still it would be easy to refute me on this – as the lady has to do is to invite someone on the show who attacks the various subsidies and regualtions in health care). Doubtless various academics are also making the rounds in television shows and newspapers to demand yet more statism in the area of health care.

    The various news services are also carrying the story (and have been for some time) that business enterprises (they mean certain big corporations) are no longer “against reform” of health care. That some big corporations want the general taxpayer to subsidize them (as another form of corporate welfare) does not shock me.

    Of course “reform” never means getting rid of subsidies (such as Medicare and Medicaid) or regulations (such as doctor licenceing, or the F.D.A., or the compulsory “free” E.R. treatment, or the vast web of regulations that undermine both private insurance and the H.M.O.s – the latter being originally set up to offer a cheaper alternative to insurance that was being made expensive by regulations).

    “Reform” always means (in “education system” and mainstream media land) even more statism.

    I am reminded of an old Russian saying.

    “First they smash your face in, and then they say you were always ugly”.

    First the “liberals” make health care very expensive, with their subsidies and regulations, and then they point with phony horror at the cost of health care – and use this cost as an excuse for total statism.

    Making big corporations provide health care was also an easy to spot tactic. It was designed to influence these corporations to support general taxpayer financing of health care (in order to reduce the burden on the corporations themselves) and some corporations are acting as planned.

    When Americans really do have Cuban style health care (i.e. crap health care for those who are not politically connected) they may understand that the “liberals” have conned them (or they may not).