The supposed “cheering” of the hypothetical death of a man without health insurance in the recent CNN-Tea Party Republican Debate has reignited a discussion of government’s role in health care. Several pundits — Jonathan Cohn, Paul Krugman, Eugene Robinson, Alan Grayson — are denouncing conservatives and libertarians as being callous and uncaring when it comes to providing for the needy.
This is mistaken. It’s not that conservatives and libertarians don’t care. Rather, their position is a response to the fact that other people don’t care. As often as people say that “health care should be a right”, few of them — liberals and progressives included — believe it. At least, their actions don’t match their words.
When people advocate some sort of universal health care plan, they typically argue something along these lines: “The free market might work for a lot of things, but it doesn’t work for health care. Health care is different. It’s a right, not a privilege. Providing health care shouldn’t be about profit, it’s about people.”
But what are people are willing to do in order to make these plans function?
For instance, if you suggest to a “health care is a right” advocate that, as part of universal health care, they will volunteer at the local hospital every week in order to help provide health care for people, they’ll usually say “no”. They’ll reply that they don’t want to work in that industry. Or, if they do, they want to be paid in return, not work for free.
The rejoinder would be as follows: “No, you can’t demand that. You’re not allowed to refuse to work in health care, you’re not allowed to expect to be compensated for working at a hospital. Health care is about people, not profit. The free market doesn’t work for health care. You can’t just let the 30-year-old male Wolf Blitzer mentioned die. Health care is not a commodity, it’s a right. We have an obligation to provide it to you, and you have an obligation to provide it to others, either by taxes or — if you receive more health care services than you pay in taxes — by community service.”
The point is, you can’t reject the free market and then take refuge in it. And the idea that you have a right to choose what industry you work in, and to choose whether you work for free or for pay — those are free market principles. That’s where the word “free” in “free market” comes from: You are free to decide what goods and services you are going to offer to people, and how much you are going to demand in return for them. And others are free to do likewise, and free to decide what they’ll offer for your goods and services, resulting in the millions of negotiations and compromises that make up our economy.
Of course, being human, we tend to employ self-serving double standards. We’re not really inclined to reject the free market. Rather, we reject the parts of it we don’t like — e.g., you pay for your own health care — while holding on to the parts of it we do like — e.g., you get to decide (or at least negotiate) where you work and for how much.
People are a mixture of selfishness and altruism, and we often take the selfish side of altruism. People think more about what they can get out of an altruistic program than what they can contribute to it. Whether or not this attitude is good, it’s pervasive.
For instance, people will take a second job to feed their own family, as a matter of altruism and individual responsibility. But no one takes a second job to keep the food stamps program afloat. When providing food becomes a public responsibility of the government, “public” means “someone else, not me”.
Nobody takes a second job to make sure Medicare is adequately funded, either, just like people aren’t willing to volunteer at the local hospital in the name of universal health care. Health care, it seems, is not so different from food and other commodities in the free market.
The economy works best when people produce goods and services in exchange for the goods and services they receive (with currency as a middleman). Perhaps we create exceptions for those who truly can’t provide anything in exchange, either because they are elderly, sick, or very young. But, the moment you carve out these exceptions, people — being selfish — will portray themselves as someone who “can’t” be productive, when they really just don’t want to. Altruistic programs are taken advantage of by selfish individuals, as demonstrated by the recurring news of people defrauding programs — Medicare, Hurricane Katrina disaster relief, the 9/11 compensation fund, meals for preschoolers — intended to provide for the needy.
Free market advocates aren’t espousing such selfishness, they’re responding to it. Goods and services — health care or otherwise — don’t come from nowhere. They have to be provided by people. Even Marx understood that: “From each according to their abilities, to each according to their needs.” The best way to prompt people who don’t want to work in exchange for what they receive — and, let’s face it, who does? — is to tell them they won’t get anything if they don’t give something in return. If you’re going to have altruistic programs, they have to exist on the margins of a free market economy and be ruthlessly administered to counter fraud.
In the choice between a free market or a command economy, you either volunteer your services in return for what you receive, or they will be volunteered for you.