Of Course You Have a Right to Health Care

HealthInsEveryone has a right to health care.

There, I said it. You have a right to health care. I have a right to health care. Our grandparents have a right to health care. Even illegal immigrants have a right to health care.

What you don’t have is a right to make someone else pay for it or to force someone to give it to you. Your right to health care — and mine — is exactly the same as your right to a big screen HDTV: If we can pay for it (whether directly or through insurance) and we can find someone to sell it to us, we have a right to it.

By definition, there can be no rights granted by government. Rights inhere in us as human beings. “Legal rights,” by contrast, are mere entitlements or privileges. If a law creates such a “right,” another law can take it away. And the very concept of a “right” for one person that necessitates the abrogation of the inherent rights of another to fulfill is self-annihilating.

Our current social structure is, of course, rife with such so-called rights. The fact that we countenance such abuses does not justify expanding the abuse, of course. We tacitly accept the ongoing abrogation of our real rights to provide ephemermal privileges to others because it’s easier than fighting back, we feel guilty, or we see some utility in it. But that does not make it right.

The solution to decades of government distortion of the health care industry is not more government. It isn’t enough to scrap Harry Reid’s abomination of bribes, buy-offs, and backroom deals. We need to go back to the post-WWII price fixing that started us down the path we’re on and rip out the whole skewed structure root and branch and really start from scratch. We need to make the industry an actual part of the free market for the first time in generations. Such a solution would also have the enormous benefit of being a lot easier to regulate.

FILED UNDER: Health Care
Dodd Harris
About Dodd Harris
Dodd, who used to run a blog named ipse dixit, is an attorney, a veteran of the United States Navy, and a fairly good poker player. He contributed over 650 pieces to OTB between May 2007 and September 2013. Follow him on Twitter @Amuk3.

Comments

  1. legion says:

    Then you are, I take it, against the insurance industry practice of using any fanciful excuse they can come up with to pull coverage from people who’ve been customers for years before making a claim, since this effectively removes their access to health care _after_ they’ve paid for it?

  2. Raoul says:

    I am not sure what your are saying here. I feel I have a right to live in a country that can provide me and everyone with healthcare. Obviously, this is not happening. Are you actually offering a solution? Sounds more like rant.

  3. Dave Schuler says:

    You’d need to go back a lot farther than that to “make the industry an actual part of the free market”, at least to the Pure Food and Drug Act of 1906. I for one don’t particularly relish the notion of healthcare in a completely free market but that’s what it would take.

    Nostalgia ain’t what it used to be.

  4. Triumph says:

    What you don’t have is a right to make someone else pay for it or to force someone to give it to you.

    I’ve been arguing this for years.

    The thing that gets me is that Emergency Rooms are REQUIRED BY THE GOVERNMENT to provide health care to everyone who comes in their doors, REGARDLESS OF ABILITY TO PAY.

    It is stain on Reagan’s legacy that he actually signed the Emergency Medical Treatment and Active Labor Act into law in 1986. This is government involvement in the market at its worst since it requires providers of a commodity to give away their product.

    I admire Reagan as much as anyone else, but this socialist law that he enabled is disgusting and should be overturned immediately.

  5. Dodd says:

    I feel I have a right to live in a country that can provide me and everyone with healthcare.

    I assume by “provide” you mean via the government. You absolutely have the right to look for and move to such a country, if it exists. You do not have the right to force me to live in it with you and have my real rights taken from me to make it happen.

    Which it never actually will. Approximations, perhaps, but never the Shangri-La of equal, high quality care for everyone you feel would magically materialize if only enough people wished it so. (BTW, this paragraph is sort of a rant; my post is not.)

  6. Steve Plunk says:

    I believe there is an acceptable middle ground (though not necessarily right in the middle) between complete free market health care and socialized health care.

    The current path of more government is indeed a road to serfdom as far as medicine is concerned. What is lacking is a truthful discussion and the ability to try reforms and gauge their success. Movement in the right direction would be easy to discern. We didn’t get where we are at overnight and we won’t fix the problems overnight.

    I suggest the first step in honest appraisal would be to quit saying the system is broken. For most people in this country their health care is top notch. Costs are high but we demand, either through ourselves or government, the best of care. It’s the fringes that need work along with some cost control ideas.

    I’ll drone on once again and say it’s a hundred little one percent solutions not a single piece of legislation that is the answer.

  7. Dave Schuler says:

    I agree that there are workable, practical alternatives between a completely free market approach to healthcare and a completely socialized system. However, I don’t agree with this:

    I suggest the first step in honest appraisal would be to quit saying the system is broken.

    That’s like the story of the guy who jumped over the Empire State Building who was heard to say, as he passed the 50th floor, “So far, so good”.

    The present system includes Medicare and Medicaid. They aren’t separate from it, they’re part of it. At present rates of increase their cost is unsustainable. Similarly, at present rates of increase individual healthcare insurance will become increasingly out of reach.

    The system really is broken. We just haven’t hit the ground yet.

  8. Zelsdorf Ragshaft III says:

    Raoul, because of problems concerning connectivity with the internet, I responded to your post similarly to what Dodd wrote. I would like to expand. Have someone read to you the U.S. Constitution. Ask them to explain to you what the “bill of rights” deliniates as “RIGHTS”. I served, Raoul. I was prepared to shed or spill blood to ensure your freedom from those advocating exactly what you claim as a right. Government which has the power to give you everything has the power to take everything from you. That is not a trade I am willing to make just so you do not have to take responsiblity for your own shit.

  9. Michael Reynolds says:

    Dodd:

    What are you, a teenager?

    You can’t make me, I didn’t ask to be born so you can’t tell me what to do. Waaah.

    Grow up.

  10. john personna says:

    Boring. Do I have a “right” to national defense? Or is it just a political outcome?

  11. What are you, a teenager?

    Mr. Reynolds once again elevates the discussion in his own inimitable manner.

    Boring. Do I have a “right” to national defense? Or is it just a political outcome?

    Hmm…, that depends. Are you claiming to be a nation?

  12. Steve Plunk says:

    Dave, Unlike the guy falling we can change direction. The path we are on leads to a broken system but we’re not there yet.

    You’re very right that Medicare/Medicaid are on an unsustainable path. Costs need to be controlled and the only workable way for that to happen is through rationing or free market approaches. I’ll take the free market approach. Expanding the Medicare/Medicaid system into a single payer government run plan only makes the problem bigger.

    We need a nation of good medical consumers but the system has taken away that ability. Small changes, or experiments if you will, could point us in the right direction to control costs.

  13. Dave Schuler says:

    That’s a very reasonable response, Steve. You and I appear to differ in our views of how serious and intractable the problem is but I don’t have a problem with differences per se.

  14. ptfe says:

    @Zels & Dodd: Interestingly, “promote the general welfare” is actual language in the Constitution. I’m curious how you interpret this phrase. Perhaps you’ve opted to ignore it because it’s a preamble. Or perhaps health care does not potentially fall under these auspices.

    @Dodd: The argument that health care isn’t included in the Constitution is about as effective as saying that the government may not tax persons without cars to build roads: it’s laughable. The power of taxation exist (in the Constitution), and the ability of Congress to allocate funds exists (also in the Constitution), so the ability of Congress to allocate funds garnered through taxation to build roads also exists. Big bonus for drivers; big loss for people without cars. It turns out that the government is infringing on what you apparently feel are your rights (or what you apparently feel are other people’s rights) all the time, but you probably aren’t out there complaining about it. Instead, you’re probably out there complaining about how someone should really fix up that one stretch of road because it’s go so darned many potholes.

    And if your argument is that Congress is mandating a purchase, and you genuinely think that’s different from taxation, you’re obviously not creative. Step 1: Congress sets up a health care tax. Step 2: Congress says you’re exempt from that tax if you subscribe to a (private) exempt plan. Step 3: Party at Aetna’s corporate offices.

    With all that out there, please indicate to me which actual Constitutional right is being infringed upon. Points only if you show your work.

    @Zels: Do you actually know what the Bill of Rights is? It’s a framework for preventing infringement, not a framework for “providing” rights. Seven of the original nine enumerated “rights” are constructed through negation of governmental authority. All subsequent amendments grant additional authority to the government that is otherwise exempted by prior amendments (c.f. 18th Amendment); make specific certain elements of the Constitution’s “other bits” that weren’t previously delineated (c.f. 17th Amendment); or assert additional regions which are exempt from government intrusion (c.f. 24th Amendment).

    And just as a general comment, an HDTV does not fall under any Constitutional auspices, and it transcends silliness to assert that allowing access to goods and services vital to individual health and, potentially, survival is equivalent — fiscally, governmentally, or morally — to giving everyone a television.

    It’s hazardous to enter this arena, as Constitutional Law isn’t at all my area of expertise, and I can probably be torn apart by someone with a solid backing of case law. But attempting to make a prima facie ridiculous Constitutional argument, rather than — as I believe Dave Schuler has at least modestly effectively done — a sound policy argument is, to me, asinine.

  15. Dave Schuler says:

    Interestingly, “promote the general welfare” is actual language in the Constitution.

    I have no idea how Dodd would interpret but it but “general welfare” is a term of art that distinguishes between things that are non-rivalrous and non-excludable (like national defense) and “particular welfare” which consists of things that are rivalrous and/or excludable (life healthcare).

  16. Michael Reynolds says:

    Ah, the magical free market, solution to every problem.

    *cough* AIG *cough cough* Lehman *cough* Citi *cough.*

    It’s sort of like Harry Potter, see, the market merely has to discover the right quasi-Latinate spell or potion. Fiximus Healthicus!

    All better. Magic!

    Ladies and gentlemen, just one bottle of Doctor Friedman’s Cure-all Elixir and you’ll be pain-free, worry-free, and cartwheeling around like a teenager.

    Drink the Kool-Aid er, elixir, and repeat three times: “There’s no place like the University of Chicago. . .”

  17. Steve Verdon says:

    @Zels & Dodd: Interestingly, “promote the general welfare” is actual language in the Constitution.

    It is hard to promote the general welfare by reducing the welfare for some while possibly increasing it for others. And considering that it is impossible to measure welfare, how exactly would you go about doing this?

    Regarding cars and roads:

    Public good subject to congestion. Healthcare, private good. Two very different types of commodities. In other words, I can see using government to provide some amount of public goods. In fact, this is part of the answer to the general welfare issue you bring up. But it is not the answer to health care. You know, that private good thingy.

  18. john personna says:

    Boring. Do I have a “right” to national defense? Or is it just a political outcome?

    Hmm…, that depends. Are you claiming to be a nation?

    Everyone from Homeland Security to the Marines are out there defending me right now, even though (shockingly) I am not a nation.

    Neither would I really claim that I have a “right” to their sacrifice. We are fortunate nonetheless that we pull together for the common good.

  19. Dave Schuler says:

    Everyone from Homeland Security to the Marines are out there defending me right now, even though (shockingly) I am not a nation.

    Sadly, no. The defense apparatus defends the nation; that individuals are defended is simply because defense is non-excludable.

  20. john personna says:

    LOL Dave, you are making a laughable semantic argument, no doubt because you fear the implication.

    Yes they defend “individuals” as shocking as that is when they defend a nation!

    No doubt that’s a new-fangled thing, and in the old days nations managed to be defended while not defending citizens. (No? Guess not.)

    The implication, by the way, is that we can choose whatever “common goods” we want. National defense is an oldie and a goodie, but there is no reason health care or cat care shouldn’t be on the list.

    It’s by mutual agreement, and not natural law.

  21. Dave Schuler says:

    You are simply wrong on the facts, john personna. There is an impressive body of law going back 150 years that the U. S. government and its agents doesn’t protect individuals.

  22. Steve Plunk says:

    Michael, Free market solution are not “magical” but rather they are practical. They work better than other solutions in most cases and yes there are instances of profiteering but there’s government corruption on the other side. So despite your creative response I’ll stick to free market solutions as the best way to go with health care.

  23. wr says:

    SV: “It is hard to promote the general welfare by reducing the welfare for some while possibly increasing it for others.”

    Of course it’s hard, but it’s also the role of every government — every community — in the history of mankind. That is what we do when we come together as a civilisation — we say “we are taking these assets from these people and distributing them in this manner.”

    When we tax people who have money and use the funds to pay other people to put out fires, even fires in the homes of people who have not paid the same amount of taxes, we are promoting the general welfare (by keeping as many houses as possible safe from fire) by reducing the welfare for some (those wealthier individuals who have paid more taxes) while possibly increasing it for others (people whose homes will not burn down despite their inability to pay for private fire protection).

    If you have a fundamental objection to this, that’s fine. You are essentially saying that you despise all civilisation, but that’s certainly your right.

    But forgive me if I don’t take anything else you say too seriously.

  24. Michael Reynolds says:

    Steve:

    Free market = good, government = bad, died a painful death about 18 months ago. Our great-great-grandchildren will still be paying the burial costs.

    The dichotomy is mostly nonsense. Show me a place on planet earth where a completely free market exists.

    Show me a successful nation or thriving economy where government does not play a major role.

    Make a list of the 20 most successful economies in the world and point to the ones where a completely free market exists.

    What we have had since this country began, and what we have today, and what we will always have, is a sort of Venn diagram with overlapping circles of government and market. What we need going forward is to find solutions that work without leaning on ideological labels or phony dichotomies or simpleminded good/evil narratives or naive fantasies of a perfected world.

    We wil continue to have markets and we will continue to have government involvement in same. We have tools: markets and government. Taking those two facts as givens, now find a solution.

  25. Raoul says:

    How health care is provided is immaterial to me; but obviously the current system is not working. Only retirees, government employees and large corporation employees are guaranteed affordable health care. How bad does it have to get before current troglodytes clamor for change. How many needless death is too many? If the private enterprise cannot do it then the government ought to. A real case scenario: a recently laid off sixty year old woman with diabetes found herself without insurance. What should she do? No company would offer her protection and MEDICARE starts at 62. Former Republican congressman Tom Davis tried to encourage her to hang in to 62 and then said “Good Luck.” How can one defend the current system baffles the mind.

  26. John Personna says:

    So Dave, would you have said to Halsey at Pearl Harbor, “you’re only here for the government, not the people?”

    Would you have said that to a pilot scrambled on 9/11?

  27. John Personna says:

    (governments sometimes break the social contract, but they rely on it as the basis of their power.)

  28. legion says:

    Sorry to reach back so far, but this seems important:

    The present system includes Medicare and Medicaid. They aren’t separate from it, they’re part of it. At present rates of increase their cost is unsustainable. Similarly, at present rates of increase individual healthcare insurance will become increasingly out of reach.

    Well, if it’s the _cost_ of healthcare that is causing this lack of access, mayhaps we should look at fixing things driving healthcare costs up, rather than trying to fix the _insurance industry_. Fixing problem A would likely fix symptom B, no?

  29. c-red says:

    I applaud, I haven’t read a more blatant bit of selfish sophistry in awhile. I’ll play your game for a bit because it looks fun.

    There are no natural “Rights”. You are given an existance in a world of fickle fate, random chance and a bunch of apes that would generally be better off if you were dead. It is generally a precarious and painful thing.

    Some time ago, the apes started getting together and realized that if they worked together and didn’t kill each other off, everybody could live a little more comfortably. Eventually one of the smarter apes wrote up a document stating that for the apes to be people they should have rights. I believe it went something like “Life, Liberty and the Pursuit of Happiness”. Somehow I can’t seem to remember the ‘if they have a buck’ part of that statement, but hey that particular ape was wealthy, maybe he forgot to mention that part.

    Leaving off the philosophy of whether healthcare is a “Right”, or just plain right we get to the common good. Our current healthcare system is broken. It does not provide minimum care to a large portion of the population, it ties people to employers, and it provides a inadequate return for the dollars that we do spend. (Specifically, we pay more per person (on average) for a lower quality or span of life.)

    If the fact that we are currently maintaining the least economically efficient form of basic health services (emergency room medicine), the competitive edge lost for businesses with overwhelming health costs (not to mention the loss of small business prospects because of the same reason) and sky rocketing costs of the various health bureaucracies and such don’t make you want to reform the system, then maybe this will; a happy, healthy citizenry has always been more conducive to prosperity than a nervous angry citizenry.

    As for the free market argument, we don’t have one in healthcare, suck it up. In my opinion healthcare should be a public utility like law enforcement and fire protection. Health insurance companies are little more than a leeching middle management that adds no value to the end product.

    As for your statement about forcing you to live in a socialized healthcare country, i’ll turn it back on you; there are many countries where your vision of privately paid healthcare will never be threatened, A few of them are even habitable, feel free to head out at anytime.

  30. Kenny says:

    a recently laid off sixty year old woman with diabetes found herself without insurance. What should she do? No company would offer her protection and MEDICARE starts at 62. Former Republican congressman Tom Davis tried to encourage her to hang in to 62 and then said “Good Luck.” How can one defend the current system baffles the mind.

    how about she pay for doctor visits out of pocket for those 2 years. God forbid we spend any of our hard earned money on ourselves.

  31. Steve Plunk says:

    Michael, We agree there’s no such thing as a completely free market and probably agree that there shouldn’t be. We also probably disagree with where in the middle of free market and pure socialism we should be. I’m arguing we need to move one way and you are arguing the other. Once again I find it irritating that instead of arguing the real argument you post something like “free market=good, government=bad”. No one is saying that and reducing it to that level doesn’t advance the discussion. No one is claiming government is all bad. I’m not going to play the name that country game.

    As Dodd says in the beginning, more government involvement is not the answer. Zero government involvement is not the answer either. It’s got to be in the middle and I think more to the free market end by far.

  32. sam says:

    @Dave

    “general welfare” is a term of art that distinguishes between things that are non-rivalrous and non-excludable (like national defense) and “particular welfare” which consists of things that are rivalrous and/or excludable (life healthcare).

    Could someone provide us with an account, on the basis of the foregoing, why police protection and fire protection are public goods, but health care (health protection) could not be?

  33. Steve Verdon says:

    Of course it’s hard, but it’s also the role of every government — every community — in the history of mankind. That is what we do when we come together as a civilisation — we say “we are taking these assets from these people and distributing them in this manner.”

    But it doesn’t necessarily promote the general welfare. If you were to confine the “distribution” to public goods you’d have a leg to stand on. That such a distribution is often nothing more than transfer payments (welfare, corporate or otherwise) tends to leave you without much to stand on.

    If you have a fundamental objection to this, that’s fine. You are essentially saying that you despise all civilisation, but that’s certainly your right.

    That is just an outright stupid conclusion. One can be in favor of civilized behavior and against coercive taking of other peoples property and wealth. In fact, I’d say the a person who holds such a view is probably more civilized than you.

    Michael,

    Free market = good, government = bad, died a painful death about 18 months ago. Our great-great-grandchildren will still be paying the burial costs.

    Too right and it is because of government programs not the minor amounts of money that the financial crisis has caused to be added to our nation’s obligations. Medicare will make the recent budge deficits look like a stroll in park on a beautiful May afternoon.

    And we got that due to government, not the free market.

    Show me a successful nation or thriving economy where government does not play a major role.

    Speaking of false dichotomy that is a fine one you got there. Is Plunk really saying zero government? Or is he saying less government, minimalist government? You take an argument about the size and scope of government and turn it into one of either what we have no or zero government. Its a dishonest and intellectually bankrupt tactic in arguing, IMO.

    What we have had since this country began, and what we have today, and what we will always have, is a sort of Venn diagram with overlapping circles of government and market. What we need going forward is to find solutions that work without leaning on ideological labels or phony dichotomies or simpleminded good/evil narratives or naive fantasies of a perfected world.

    We wil continue to have markets and we will continue to have government involvement in same. We have tools: markets and government. Taking those two facts as givens, now find a solution.

    What you neglect to include is that government invariable relies on coercion and is thus, less preferred, IMO, than the market. The market is people engaged in voluntary transactions that they feel will make them better off.

    Raoul,

    How health care is provided is immaterial to me; but obviously the current system is not working. Only retirees, government employees and large corporation employees are guaranteed affordable health care. How bad does it have to get before current troglodytes clamor for change.

    The system will have to reach a stage where it is literally can no longer be sustained. That is my guess. When things really go tits-up so to speak. In about 20-30 years or so would be my guess based on current trends.

    We’ll have higher taxes, lower growth, and almost surely less health care and probably higher interest rates as well. Higher unemployment on average as well will be my guess too.

    A real case scenario: a recently laid off sixty year old woman with diabetes found herself without insurance. What should she do? No company would offer her protection and MEDICARE starts at 62. Former Republican congressman Tom Davis tried to encourage her to hang in to 62 and then said “Good Luck.” How can one defend the current system baffles the mind.

    Yes, it sucks. And down the road it will get worse. Not better is my guess. Politicians all too frequently take the easy road. They only take the right road when it is also the easy road.

    And lets not overlook the govenments grubby paws all over the current situation. Medicare has helped push up costs. This is indisputable. The tax exempt status of employer provided benefits has created an incentive to gold-plate and over use. This too is a direct result of government policy. Would the woman in your example have insurance absent these things? I don’t know, maybe or maybe not. But these policies have certainly made it harder not easier.

    So Dave, would you have said to Halsey at Pearl Harbor, “you’re only here for the government, not the people?”

    John, Dave is right you are wrong. National defense isn’t done an individual basis, but on a national basis. Hence the word “National” in National Defense. If militarily there was a need to retreat from the east coast in the face of determined enemy, the military would likely abandon lots of people there in doing so.

    c-red,

    Leaving off the philosophy of whether healthcare is a “Right”, or just plain right we get to the common good. Our current healthcare system is broken. It does not provide minimum care to a large portion of the population, it ties people to employers, and it provides a inadequate return for the dollars that we do spend. (Specifically, we pay more per person (on average) for a lower quality or span of life.)

    What makes your comment interesting to me is that the current legislation by the Democrats is one that would further entrench our current system. A system you say is broken.

    You are a drone.

  34. ptfe says:

    It is hard to promote the general welfare by reducing the welfare for some while possibly increasing it for others. And considering that it is impossible to measure welfare, how exactly would you go about doing this?

    Well, there’s no perfect system for estimating “welfare”, but I’d posit that, starting with your presumption that changing the health care system from one that’s largely profit-based to one that’s more public-oriented will decrease your welfare, you feel that ensuring you (and millions of others) can afford to pay for HDTV is more of a promotion of a community good than preventing millions of people from losing years of productive life due to treatable diseases that they can’t afford the treatment for. Kind of shocking for a person who likes to tout economics as the lynchpin of his worldview.

    Regarding cars and roads:

    Public good subject to congestion. Healthcare, private good. Two very different types of commodities. In other words, I can see using government to provide some amount of public goods. In fact, this is part of the answer to the general welfare issue you bring up. But it is not the answer to health care. You know, that private good thingy.

    Wow! Economics classifies them differently! Unfortunately, I figured you’d understand the power of analogy and the extensibility of the law a little better than that. If you can find me case law where anybody has used economic theories of “public good” to justify one expense while striking down another, this argument might go somewhere. Simply asserting a lame (and, I might add, incomplete) economic concept and holding it out as a legal force doesn’t do it.

    @Dave: Ditto. The framers weren’t economists, they were writing a legal document. They were, by and large, lawyers and philosophers. It’s not clear how you jump to a particular classification of economic goods covered by that statement, particularly when (a) there’s limited case law even discussing the phrase (that it’s a “term of art” seems a bit of a stretch, given that it’s never been used as the foundation of a decision); and (b) it’s been previously asserted to indicate that the framers were concerned about public health in an eminent domain case (see Ellis vs Grand Rapids) — two areas that would be economically considered “exclusive” and “rivalrous” in the public forum.

  35. Steve Verdon says:

    Well, there’s no perfect system for estimating “welfare”, but I’d posit that, starting with your presumption that changing the health care system from one that’s largely profit-based…

    And right there you went right off the rails into nonsense land. How many hospitals are for profit. Is Medicare for profit? Medicaid? Are federal and state employee insurance programs for profit? Much of our health care industry is not for profit.

    Wow! Economics classifies them differently! Unfortunately, I figured you’d understand the power of analogy and the extensibility of the law a little better than that.

    I don’t think you know what the word extensibility means. Further, your analogy is faulty becuase you are trying to draw a parallel between a public good and a private good.

    If you can find me case law where anybody has used economic theories of “public good” to justify one expense while striking down another, this argument might go somewhere.

    WTFAYTA?

    Simply asserting a lame (and, I might add, incomplete) economic concept and holding it out as a legal force doesn’t do it.

    How is it lame? Because you don’t agree with it? Because it is inconvenient for your argument? And it isn’t incomplete at all.

    And I wasn’t making a legal argument I was pointing out that it is faulty to use a public good (even one subject to congestion) as justification for public provision of a private good. While it may make legal sense it makes not econonimc sense and it can lead to over-use, escalating costs, and so forth…why a situation alot like what we have today.

  36. To the extent a free market exists it provides an environment for anyone and everyone to come up with practical and profitable solutions. To the extent a free market is restricted by regulation or fiat it limits the solutions to those dictated by “officialdom” which frequently has motivations other than providing practical or cost-efficient solutions. This is a huge, huge distinction in the available pool of solution providers and purchasers and helps explain how America became successful in the 19th and 20th centuries compared to all the established world powers.

    For another angle, look at all the social engineering built into the tax code and imagine that paradigm now applied to the delivery of health care with preferred classes of deliverers, preferred classes of customers, privileged diseases, and the inevitable rationing based primarily not just on cost but on politics that the single payer system will require.

    I, for one, do not welcome our new overlords. I do not look forward to “health care” czars effectively running the country as they budgets and purview will swamp all the other aspects of federal governance combined.

  37. Dodd says:

    @Zels & Dodd: Interestingly, “promote the general welfare” is actual language in the Constitution. I’m curious how you interpret this phrase. Perhaps you’ve opted to ignore it because it’s a preamble. Or perhaps health care does not potentially fall under these auspices.

    The general welfare clause is not a catch-all for any old thing the Congress gets into its collective head to foist on us because they decide it’s for our own good. Indeed, given the incontrovertible intent of the Founders to create a government of limited, defined powers, that argument is self-annihilating.

    @Dodd: The argument that health care isn’t included in the Constitution is about as effective as saying that the government may not tax persons without cars to build roads: it’s laughable

    Always with the cars, you people. At least this time you didn’t try to pass on the nonsensical “making you buy health insurance is no different than making you buy car insurance” trope.

    Our highways are actually built and maintained by the states. The feds contribute to them for national defense purposes. I don’t actually agree that they should — I’d prefer all limited access freeways be converted to toll roads, preferably operated by private entities (the federal government should have no say, obviously, in what municipalities do for local travel). I addressed that point in my post: the fact that this abuse exists does not justify still further abuses.

  38. Michael Reynolds says:

    Steve P:

    At a number of places in this thread you make the assertion — as though it were self-evident — that more government is not the answer. That’s what I was challenging.

    That assumption rests on another: that there is something inherently preferable about a market solution. So you freight your argument with an assumption for which you offer no factual support. It’s faith. And that sort of faith is what I was satirizing.

    If we’re really looking for answers let’s avoid starting with a set of faith-based assumptions.

  39. ptfe says:

    @Steve: It’s good to know that hospitals aren’t profit-based. And since Medicare and Medicaid apparently make up a majority of our health care system, moving to one that’s even more public won’t have much effect.

    I don’t think you know what the word extensibility means.

    A rather odd assertion. Perhaps you can give the word some thought, then get back to me.

    WTFAYTA?

    You raised “public good” as a dissimilarity. We were talking about the legalities (Constitutionality, actually) of the situation. But you failed to provide any evidence that, in any legal arena, “public good” is used as any sort of metric. It’s an economic idea, and while it can inform the discussion, it’s not useful on its own unless there’s some reason to think it forms the basis for decision-making. TWTFITA.

    As for public good, you can’t hold out an attempt at an idealized system that can’t classify a variety of everyday items as somehow complete. You even had to clarify roads as “subject to congestion” — twice. Is that part of the theory as well? Or are you taking license to patch a little hole? It’s useful for a specific level of thinking, but it doesn’t provide much depth of understanding beyond a generic classification scheme.

    And now we get to the crux of it:

    And I wasn’t making a legal argument I was pointing out that it is faulty to use a public good (even one subject to congestion) as justification for public provision of a private good. While it may make legal sense it makes not econonimc sense and it can lead to over-use, escalating costs, and so forth…why a situation alot like what we have today.

    Typically, what we do when we’re making a shift from the legal to the economic arena is qualify it like this. Note that my original comment was regarding legality. You dragged the economic stage into the legal arena. I was simply trying to show how your economic arguments don’t hold legal water. Whether they make for good policy (read the last paragraph of my comment) is a different question, which you seem to be attempting to address.

    @Dodd: Okay, so that raises the question of where you think government responsibilities should lie. What aren’t our rights to expect from the government as the governed? You seem to think that regulation to allow access is an intrusion — when you say, then, that “regulation would be a lot easier”, what counts as reasonable regulation? At some point you fall into gray area, and at some other point, you fall into someone’s idea of “rights” vs “responsibilities of a government”. Making a blanket comparison of access to health care to the purchase of HDTVs does nothing to increase the relevance of your case.

  40. Herb says:

    What you don’t have is a right to make someone else pay for it or to force someone to give it to you.

    Where is this even happening? Who’s making you pay for their health insurance? Gimme a name.

    And forcing someone to give them healthcare??? Where is the doctor being forced to provide healthcare against his will? Where’s the insurance provider with the gun to their head?

    Seriously, Dodd, lamer than usual.

  41. steve says:

    Just got home from a day of providing health care. This was a pretty non useful post. Unless you are willing to describe what you mean by free market reform, it means nothing. Less than nothing actually as it just espouses vague talking points, which anyone can do. Here, I’ll give you some more lines for the future.

    I support law ad order.

    I support strong national defense.

    I believe in limited government.

    Write something useful, please.

    Steve

  42. Dodd says:

    Where is this even happening? Who’s making you pay for their health insurance? Gimme a name.

    Lame indeed. Even leaving aside your inapposite conflation of insurance with health care, you honestly can’t think of any examples of one person being forced to pay for another’s health insurance? Really?!?

    In reality, the post isn’t about insurance; it’s about medical care. The fact that so many people treat the two things as coextensive is no small part of the problem.

  43. anjin-san says:

    For most people in this country their health care is top notch.

    You either have very simple thought processes or very limited life experience. I suppose its possible you have both. Certainly that statement would tend to support the latter.

  44. anjin-san says:

    Lame indeed. Even leaving aside your inapposite conflation of insurance with health care, you honestly can’t think of any examples of one person being forced to pay for another’s health insurance? Really?!?

    Somewhere, not too far from where you live, there is a guy who makes a lot more money than you do, and has a much nicer home. He pays more taxes. Why is he being forced to help pay for your fire and police services? Perhaps if you need an ambulance someday you should be forced to pay in cash on the spot so that your well to do neighbor does not have your hand in his pocket. What kind of a fracking freeloader are you anyway?

  45. Dodd says:

    Why is he being forced to help pay for your fire and police services? Perhaps if you need an ambulance someday you should be forced to pay in cash on the spot so that your well to do neighbor does not have your hand in his pocket. What kind of a fracking freeloader are you anyway?

    Even if I were to accept, arguendo that your analogy was perfect, how many times do I have to repeat that the fact that we already have a certain level of abuse of our rights in the system is not justification for more?!?

    @Dodd: Okay, so that raises the question of where you think government responsibilities should lie. What aren’t our rights to expect from the government as the governed? You seem to think that regulation to allow access is an intrusion — when you say, then, that “regulation would be a lot easier”, what counts as reasonable regulation?

    I’ve stated the starting point, which can be restated as supporting negative rights and, at best (generalizing here), being very suspicious of positive rights.

    What I haven’t done is stand up inside the typical strawman of opposing all regulation. Yes, I will tend toward the minimal intrusion side, but I recognize (as almost everyone does) that some is always needed. If we actually rationalize the system in accordance with the general philosophy set forth here, we can argue over how much exactly.

  46. DL says:

    “Do you actually know what the Bill of Rights is? It’s a framework for preventing infringement, not a framework for “providing” rights”

    Yes, and contrary by 180 degrees to its purpose, we have a constitution teacher who claims that it doesn’t give the almighty government enough power and he seeks to “reform” America -and the fools elected him. George Washington he’s not!

  47. Stan says:

    One of the bits of misinformation conservatives peddle is that emergency room care is free. It isn’t. You’ll be treated in an emergency room even if you don’t have health insurance, but you’ll be presented with a bill for your treatment. If you don’t pay it, you’ll lose your credit. The same is true for ambulance service. I’m sure Triumph knows this, and I wish he/she would stop posting his/her nonsense about this topic.

  48. anjin-san says:

    how many times do I have to repeat that the fact that we already have a certain level of abuse of our rights in the system

    Are you actually arguing that taxation to provide police and fire services is some sort of abuse of your rights? (perhaps I misunderstand, I am on my first cup of coffee.)

    It that is your position, suggested reading for you is “Coventry” by the noted socialist Robert A. Heinlein

  49. Jeez anjin-san, how many more times are you going to peddle the same lame meme that because the government takes money from me today to do something we can all agree on the government has the right to keep taking more money for whatever else those in power think I ought to be paying for? Take a breath and at least make an effort to read what Dodd writes before responding.

    You are free to think my money isn’t really mine but there for the government to spend in whatever manner it deems more worthy. The fact that the bastards are so dishonest as to not actually take my money but instead borrow it makes them even more contemptible, but I digress. Please, don’t be surprised or insulted because not everyone else agrees with you.

  50. wr says:

    Steve Verdon: “One can be in favor of civilized behavior and against coercive taking of other peoples property and wealth. In fact, I’d say the a person who holds such a view is probably more civilized than you.”

    Fascinating. I wrote about civilization, and you responded by coming out in favor of “civilized behavior,” as if the two were the same thing. They are not.

    Civilization is a state of being in which large groups of individuals have banded together in the knowledge that working together — and yes, sacrificing together — will lead to a better standard of living for the vast majority.

    Civilized behavior is a code of conduct laid out by the upper classes to maintain their surperiority over the lower classes.

  51. M1EK says:

    As Dodd says in the beginning, more government involvement is not the answer. Zero government involvement is not the answer either. It’s got to be in the middle and I think more to the free market end by far.

    Which is ridiculous in this instance since every health care system with better outcomes than ours has a lot more government involvement than we do; every single one.

    Also, re Medicare and Medicaid, their sustainability problems are arguably LESS serious than those facing the private health insurance ‘market’.

    But this is what passes for modern Republican thought; massive government interventions which subsidize ME (roads, highways) = GOOD; massive government interventions which subsidize OTHERS = bad.

  52. M1EK, your assumption that all these other systems are better than ours is flawed in many respects. Just curious, but is Cuba’s health care system one of the systems you prefer to ours?

  53. Raoul says:

    Austin- Cuba? Is that all you got?

  54. Steve Verdon says:

    ptfe,

    @Steve: It’s good to know that hospitals aren’t profit-based. And since Medicare and Medicaid apparently make up a majority of our health care system, moving to one that’s even more public won’t have much effect.

    I agree, but I don’t think you realize what you are saying. Going 100% non-profit will likely have no effect…at reducing costs, the real problem with health care. In other words, you are advocating a non-solution.

    You raised “public good” as a dissimilarity. We were talking about the legalities (Constitutionality, actually) of the situation.

    And I used an economic argument to show that while maybe you have some legal grounds on which to stand it wont help the problem. Sure legally we can regulate stupid stuff like backyard gardens, but do we really want too and to what end? As for health care, it is a private good and treating it as a public good is a recipe for overuse and sky-rocketing costs…which is what we have, thanks in part to things like Medicare which treats the good like a public good.

    Or to put it bluntly, the law is an ass.

    Typically, what we do when we’re making a shift from the legal to the economic arena is….

    You were the one making an appeal to the publics good argument, I was pointing out the flaw in said argument. The rest is just you obfuscating.

    wr,

    Civilization is a state of being in which large groups of individuals have banded together…

    …to use the force and coercion to obtain compliance of those members who don’t agree with the ruling class. Whether the ruling class is a marjority of the electorate, representatives of the majority, or even a dictator is irrelevant in that all such States end up using coercion and force against the members of the State. I find the use of coercion and force to be distasteful and to be avoided when at all possible.

    As for the rest of your post it is just nonsense. You seem to value civilization, the use of force and coercion, yet look down on the notion of civilized behavior as a means of the elites for controlling the masses.

    You are so utterly confused it is shocking.

    M1EK,

    Which is ridiculous in this instance since every health care system with better outcomes than ours has a lot more government involvement than we do; every single one.

    You are too smart to be putting forward a sh*t brained argument like this. You argument basically says that medical outcomes are solely a result of how health care is provided: private or public. That is stupid beyond belief. It may be a factor in some instances, but it is not the only one. For example, we keep hearing how fat Americans are. Would obesity be a determinant in health outcomes. Do we drive more? Could that play a role? How about smoking and possibly some cultural factors.

    Raoul,

    Austin- Cuba? Is that all you got?

    But according to M1EK that should be sufficient to generate better health outcomes in all cases than the U.S. Cancer survival rates should be higher, infant mortality lower, life expectancy higher, heart attack survivability rates higher, etc., etc., and so on and so forth. The only determinant is whether it is public or private provision of health care. M1EK made the claim, Charles is merely pointing out, by example, why the claim is false. You know the claim is false, and come back with this lame response.

    Try being honest next time.

  55. Stan says:

    “…is Cuba’s health care system one of the systems you prefer to ours?”

    Well Charles, if I were carrying for small children and if my income was too high to get help from Medicaid but too low to pay for their medical care without bankrupting myself and losing my home, I would certainly prefer Cuba’s system to ours. What would you do? Or is it too difficult for you to conceive of being in such a situation.

  56. Jody says:

    Anyone that equates essentials such as health care with luxuries like big screen TVs needs to stop drinking so much paint. Talk about a willfully ignorant and insulting analogy…

  57. Stan, I understand that you are willing to trade your freedom for health care, but I’m not willing to allow you to trade my freedom for your healthcare, your personal situation notwithstanding.

    Every time I see one of these hypotheticals putting forth another Dickensian false dichotomy it just seems to me that you think you can play God (or let the government play God) and eliminate bad things from happening to people, ever. It just isn’t possible.

    Maybe I shouldn’t have just watched The Lathe of Heaven again.

  58. Stan, but directly to your point, considering that I would have to take the rest of Cuba along with its Michael Moore endorsed health care, then no I would not prefer Cuba’s system to ours. I realize this is hard for some to grasp but I believe that caring for my family is my responsibility, not yours.

    I contribute to charities and via taxes to provide help to the less fortunate. I owuld hope that were I down on my luck I could find a local charity that would help. What I wouldn’t do is demand that the government take money from my neighbors for no other reason than they have it and I need it.

  59. wr says:

    Mr. Verdon — I think it’s quite refreshing to see a libertarian actually admit the truth about libertarianism — that it loathes the very concept of civilization. I wish more of you were willing to admit that, so that those whose belief systems consist of adolescent fantasies of living like Tarzan or Conan would be finally excluded from serious policy discussions.

  60. Herb says:

    Even leaving aside your inapposite conflation of insurance with health care, you honestly can’t think of any examples of one person being forced to pay for another’s health insurance? Really?!?

    Depends on how you define “being forced to pay.”

    I don’t want to hear you whine about how your tax dollars might be misappropriated by providing healthcare to the poor and elderly.

    I want the name of the guy who’s forcing you to pay for his healthcare.

    So I ask again, where are these healthcare thieving thugs? Point them out to us, so that we can pelt them with rocks.

    I think what you’re getting at is that no one has the right to use your tax dollars in a way that you don’t agree with. And to that I say, get over it.

  61. Steve Verdon says:

    Mr. Verdon — I think it’s quite refreshing to see a libertarian actually admit the truth about libertarianism — that it loathes the very concept of civilization. I wish more of you were willing to admit that, so that those whose belief systems consist of adolescent fantasies of living like Tarzan or Conan would be finally excluded from serious policy discussions.

    Not quite there, your thinking is akin to that of a dolt who has just had a frontal lobotomy. Libertarians loathe coercion and as such want to minimize its application in society. Minimize does not necessarily mean eliminate (which maybe impossible). Some of the the most radical libertarians think the State should be eliminated to achieve this end (anarcho-capitalists), some believe in a minimal amount of government (minarchists). Then there are those libertarians who want to return to an interpretation of the Constitution prior to the 1930’s reinterpretation of the Commerce Clause. In other words, damn few want to live like Tarzan. Even the anarcho-capitalists think that there can be a legal structure that is privately provided.

    Only your own retarded strawman is what needs to be excluded from serious policy discussion.

    Stan,

    Well Charles, if I were carrying for small children and if my income was too high to get help from Medicaid but too low to pay for their medical care without bankrupting myself and losing my home, I would certainly prefer Cuba’s system to ours. What would you do?

    Are you aware that you cannot get care like this in the U.S. because of the government? The government mandates that quality of care can not be reduced due to income. Yet here you are saying, that is precisely what you’d prefer.

  62. Stan says:

    charles austin, I have no doubt that you’re a decent fellow, but I feel that you’re unable to grasp the predicament people are in when they nowhere to turn. In my personal case I’ve always had a secure, well-paying job, and if I were in financial trouble somebody in my family or my wife’s would help. Many people are not in this situation – they’re alone and they’re scared. They’re my fellow Americans, and on this basis alone they deserve help, and more help than private charity can provide.

    There’s another reason besides the ethical one for why we have to do more for people in need. Our economy depends on having a financially secure middle class with enough money to afford necessities and an occasional luxury, and our democracy requires people with a strong stake in our system and a willingness to defend it. At present our level of inequality is the highest since the late 20’s, and I see no sign that the divide between haves and have-nots is decreasing. How much inequality can a democracy stand? I wish you’d ask yourself that question once in a while.

  63. Stan says:

    “The government mandates that quality of care can not be reduced due to income.”

    Steve Verdon, is there some law that I don’t know about? What the Hell are you talking about?

  64. Stan, I don’t regard wealth inequality as the great evil you do. I am familiar with real poverty and worry that the plans of great men with pure hearts trying to do good actually do more to perpetuate poverty than to solve it, but that is a whole ‘ nother topic.

    As to grasping predicaments, all I can say is that I have certain principles I believe in, and if pushed I hope I can stand by them rather than sacrificing them just because things got difficult, and I am not saying you don’t have principles or that you wouldn’t stand by yours, only that perhaps our core principles are different.

    I do think you discount the help private charity can provide. Now if we can get the government out of the way and empower charities again I think they can do a much better job of delivering locval services than the federal government, but YMMV.

    As for the, ahem, non-ethical economic considerations, well, I think the people being free to make their own choices and improve their own lots is more important than achieving some artifical equality or holding some down to enable others to be pushed forward. It’s funny, to me at least, that a rather large amount of the inequality you complain about isn’t created by free markets but by privileges and corruption enabled and abbetted byt the government and corporate interests — which are decidely not the free market.

  65. anjin-san says:

    I owuld hope that were I down on my luck I could find a local charity that would help.

    So thats your plan care of your family, if say, God forbid you lose you health, can’t work and find yourself in dire financial straits?

    “Well gang, we will be homeless in 45 days, but I am hoping a charity will help out”.

    And I have no doubt at all that a man of your standards would refuse that evil government help and watch his kids go hungry before taking food stamps, welfare, section 8 & so on…

  66. Stan says:

    I don’t mean to be contentious, charles, but I really think that businessmen in the US are killing the goose that laid a golden egg. The goose is the American consumer. If he/she doesn’t have disposable income, our consumer economy collapses. For the last 30 years the median income in real dollars has stagnated. The economy has kept going because women have entered the work place and because people, very unwisely in my opinion, took on more debt than was prudent. I think the stagnation in real wages is at least partially responsible for the present hard times. I also think that the trend in American society towards greater inequality is not wholly due to economics, since there has been no comparable trend in Japan and in the EU, apart from Great Britain. Real wages have stagnated here because businesses have figured out a way to divert a larger share of the profits to their executives and stock holders. As Warren Buffett said, the US is in a state of class warfare, and his side is winning. I’ve benefitted from this. Nevertheless, I think it’s bad for the country in terms of our economic and social stability. Obviously I disagree with you. In our conversations I’ve learned your point of view. I hope you’ve learned mine.

  67. anjin-san, I’ve made my plans already. Sacrificing my principles at the first sign of difficulty isn’t amongst them. But hey, If President Obama gets his way, perhpas we’ll get to test that theory soon enough.

    Stan, neither of us can do justice to the complexities of the problem or any proposed solutions in the space available here. I would put the stagnation in wages more to the rest of the world catching up to the US and the effects of globalization. It was inevitable. I’m not sure what women entering the workplace has done in isolation unless you also factor in the significant levels of illegal immigration on the lower end of the wage scale. I wholly concur on the problems of assuming too much debt and we will be paying the price for that folly for quite some time. Most of the economic problems we see today are a direct result of that and, sadly, assuming more debt, as seems to be the preferred policy approach these days, isn’t going to help.

    Anyway, I appreciate the civility and will leave it at agreeing to disagree.

  68. anjin-san says:

    I’ve made my plans already

    Yes, you’ve told us. You are going to “hope” a charity helps out. What are you going to do at the second sign of trouble? Or when you find out that the trouble ain’t going to get any better? I have several relatives who have had catastrophic health problems. I subsidize them pretty heavily, but it is a drop in the bucket, I assure you.