I Demand the Right to be Free of Economic Ignorance

by Don Boudreaux on September 30, 2006

in Health, Myths and Fallacies, Reality Is Not Optional

Today’s New York Times has several letters-to-the-editor expressing inanely quixotic notions about health care.  For example, Professor of Psychology Marcus Tye writes that

We should stop thinking of health care as a benefit to be earned from work and bought through middlemen (private insurers), and start treating it as a human right and a universal entitlement.

Sounds nice.  Rights are good, right?  So if some rights are good, more rights are better.

Wrong.  Bart Hinkle, columnist at the Richmond Times-Dispatch, very admirably summarizes (at the TimesDispatch.com blog) the reasons why health care is not, and cannot be made to be, a right.

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Brad September 30, 2006 at 4:29 pm

I submitted a comment and they published it! I am so honored. Here is what I wrote in response to a commenter…
Margie asks: "I don’t see any difference between mandating health care and police, fire, or any other service provided for the common good. Educate me."

Margie, first, I respect that you've had a tough time. Nobody can take that away from you in this debate. All of the services you mention above cost money. Universal health coverage, "class equity" for health expenses if you like that better, costs money. People have to provide the service. People have to be paid if they aren't going to be slaves and if you'd like them to be adequately prepared and do a good job. I don't want a slave laborer advising me about whether to have my arm amputated.

The United States spends 15% of its GDP on health care today. We don't spend 15% of GDP on fire and police protection. If fire and police protection were terribly inequitable, we could raise the bottom significantly without making a dent in % of GDP spent on those services. To do the same with health care and not control costs somehow would cost A WHOLE LOT OF MONEY! It's like if you said everyone should be able to go to the moon, just like everyone has fire and police protection. Well, the cost proportion of your demand is not THAT bad, but it's not like saying everyone should have 2 pounds of subsidized, printed bills and junk mail per day (a proportionally affordable service provided to every American by USPS).

A significant portion of the uninsured and "underinsured" are young, healthy people who choose to divert their earnings elsewhere because health insurance isn't a good deal for them. Massachusetts style universal coverage is more about getting these people into the system to offset the (expensive) sick than it is about making sure everyone has this important right.

Sadly(?), whether we can get what we wish for all boils down to economics. The best current discussion of the economic realities of the American health care system is Arnold Kling's "Crisis of Abundance". Forget "rights' for a moment. Kling pretty much shows that if you do what you want to do, you'll just ADD misery to the health care situation because our economy can't structurally absorb that without creating misery. And he shows you the mechanisms (such as "premium diagnostic care") that will do it.

Chris Meisenzahl September 30, 2006 at 9:21 pm

>> "We should stop thinking of health care as a benefit to be earned from work and bought through middlemen (private insurers), and start treating it as a human right and a universal entitlement."

Wow, that crosses over into the arena of "scary-stupid".

As usual. Dr Williams nails it:

Chris Meisenzahl September 30, 2006 at 9:23 pm

Another thought on this. Let's suppose for a moment that no one decided to go into the medical field and there were no doctors. If everyone had healthcare as a "right", where would it come from? Would the govt. force some people at gunpoint to become doctors?

Brad September 30, 2006 at 11:40 pm

Chris, there are lots of doctors who would do it for free because they really like being doctors. They'd be terribly overburdened, but I think they'd survive.

The thing about this argument is, we can win it without getting all philosophical. We won it in 1993 against Hillary without getting all philosophical. The health care system is so damned huge that any attempt to regulate or takeover more of it is going to cost an unfathomable amount of money or restrict freedoms we are used to within the context of the current system so much that it can't pass. We're finally on the offensive — coming up with non-cliche market solutions (think any reform that isn't spelled "MSA") that can improve the system. We ought to be promoting such reforms as non-radical ways to get incremental improvement rather than debating Old Lefties over whether health care is a "right".

Tim Worstall October 1, 2006 at 6:48 am

There's one simple and very good reason that US health care will not (or perhaps should not) become a single system managed from the centre.

Anyone know how to co-ordinate the actions of 13.3 million people without markets?

Trumpit October 1, 2006 at 10:27 pm

If dirt poor Cuba can do it, so can we. If our northern neighbor Canada can do it, so can we. If Great Britain can do it, so can we. If Denmark can do it, so can we. If Sweden can do it, so can we. If Norway and France can do it, …

P.S. Just who do you think you are kidding?

Russell Nelson October 2, 2006 at 2:09 am

Trumpit: So …. why do Canadians travel to the US for medical care?

Andrew October 2, 2006 at 9:29 am

If one defines a right as an action one may take without fear of reprisal as opposed to someone providing a service, then a right as applied to health care would not mean the right to use other people's money to pay for one's health care, but the right to determine a course of health care that is best for them, rights one would certainly lose the more socialized and managed a health care system becomes.

Gianluca October 5, 2006 at 10:11 am

Dear U.S. friends,
as italian citizen, let me explain why you absolutery should be careful to go in a public centered health care system.

In Italy, since XIX century, until 1973-1978, we had a health care system well grounded on privates, chatolic associations, and municipalities (I dont' know exactly, but it is possible that early religious associations for health care were established in XI-XII centuries, I should see on a history book).
In the last century, the core of this system was a network, singularly spontaneous, of private insurances, becomed only last years mandatories (by parliamentary bills). In any case, every municipality traditionally provided (as established by the 32.2 1947 Constitution, but it was yet so in every region from middle age) for the cost of the health care for the poor. The other part of the population (wealthy, middle poeple and not so poor) was more or less protected under private insurances (mandatory or not mandatory).
Please note that, until recent years, we never had a "Minister of health care" in the national government, but sometimes a direction in the Ministry of Interior, sometimes an undersecretary with very little administrative powers.

In '70, associations and some parties claimed that this system was "ineffective" and "unequal". In 1973-1978, the parliament passed the Bill for the "Universal health care system".
Since now we have a health care system almost entirely expensive, ineffective, and seriously corrupted.

In Italy, since last years we call "i viaggi della speranza" – "the travels of the hope" – the trip of sick poeple from fully disastred regional system to yet more or less functional, or from public health care enterprise (free of charge!) to private health care enterprise in the north or outside. In fact, in most part of Italy we pay for the health care system two times, with taxation, and when we are seriously obliged to use private facilities. More than half of the budget of regional government are locked on health care, in some regions more than 60%. It is very difficult to change anything, and even to return to the past in some regions, because strong public medical lobbying, and because the complexity of the administrative and legislative proceedings (divided in three levels, municipal, regional, and national).

Last years some region is trying to enact legislation on "Buono sanità", literally "Health care voucher", a credit given to poeple to enable them to choose freely the health care facility, private too. This is the case of some first bills of the Lombardia or Veneto Legislatives (two northern regions). I dont' know if it will works. In any case, funding for this program is very little, because public facilities absorb more and more money.

So, I should pray you, for the respect of human rights, to be careful, really CAREFUL in front of proposals to high the public presence in your health care system.

I really apologize for the lenght of this post and for my undoubtely bad english.

Harold Henderson October 6, 2006 at 10:02 pm

Seems to me the level of discussion would be higher if people distinguished between two questions:

(1) Is some kind of socialized healthcare desirable?

(2) Is it a right?

As for (2), I don't understand the original post. Isn't Hinkle's point that establishing something as a right has a cost, one that is rarely articulated or presented as such? He didn't show that health care couldn't be a right, only that to deem it so would be quite costly, perhaps in unexpected ways. Did he forbid making that tradeoff? (Aside from whether it would be a wise one to make.)

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