Health care slaves? “Public goods” versus private exchange

Posted: Aug 17, 2009 12:00 AM

Conservative public policy is often attacked because it fails to “fix” human nature. But liberal public policy usually fails because it ignores human nature. A conversation I had at a business law conference I attended two weeks ago drove this point home to me anew.

Having served on a well-attended panel entitled “Conservatism in Academe,” early on in the conference, I was fair game for anyone wanting to challenge conservative principles and policies. Later in the week, a colleague chatting with me over cocktails tried to defend single-payer health care. “I believe in having a civil society,” she explained pleasantly, “and in a civil society, I think health care should be a ‘public good.’”

Saying that health care is a “public good” sounds wonderful – the kind of statement with which no intelligent and compassionate person could disagree. But, as with so many blanket statements made by liberals, it does not hold up under scrutiny, and in fact the infrastructure necessary to deliver on such an apparently compassionate policy inevitably results in disappointment, failure, and – if the latter is not acknowledged – oppression by the very government it was hoped would be the solution to all human ills. Why is this so? Three basic reasons, all inarguable:

1. No one “owns” another human being’s work.

A “public good” ought to be something that everyone needs access to, but no one should own, like air or water. Although human beings might unlawfully pollute or otherwise make these public goods unavailable or unusable for their fellow creatures, humans did not create nor do they own these things, which preexisted us.

Unlike air or water, “health care” does not exist in the absence of another human being’s endeavors. If someone decides to be a nurse, a pediatrician, an oncologist, or a neurosurgeon, he will spend (or borrow) the money, and devote months and years of study to acquire the necessary expertise. Someone else could get an engineering degree and invent a new stent, an MRI technology, a CT scan machine, or ultrasound. Still another could pursue her education in chemistry, and develop a compound that eventually becomes drug therapy for cancer, autism, diabetes, hypertension, or chronic obstructive pulmonary disease. Groups of people get together, raise the necessary funds, and build offices, clinics, and hospitals. Multiply this activity by hundreds of thousands of people over decades, and you have a health care “system.” (Although even the term “system” is a misnomer here, since there is no single unifying power behind the development or delivery of the care). But none of these goods or services would exist without human beings’ creating, building, or deciding to deliver them.

To say that “health care” is a “public good” is to say that everyone has an equal right to these people’s time, their efforts, their energy; the services they choose to deliver, or the things they have devoted their lives’ work to developing. The unfairness of this assessment and the impossibility of its implementation is surely obvious: none of us “owns” anyone else’s time or creativity, and none of us have the right to demand free access to it. To claim otherwise is a form of indentured servitude. A free society depends upon free exchange: we request goods or services that another provides, and we must offer something that person views as having equal value. Which brings us to the second point.

2. If people think it is “free,” they will demand more of it than can be provided.

Characterizing health care as a “public good” is another way of saying that demand for it is potentially unlimited. This exposes the single largest flaw in the single-payer plans. Single-payer advocates like Barack Obama, Nancy Pelosi and Barney Frank ignore human nature, and then hide behind their intentions when human nature rears its head: “We don’t have any intention of ‘rationing’ health care,” they claim. OK, let’s assume they don’t. But it won’t be their “intentions” that cause it to be rationed; it will be the fact that everyone will want more of it than they can have, because they have been told that it is their “right,” and that it is “free.”

A simple analogy should demonstrate this. Food is even more essential to human existence than health care, and yet we don’t argue that we have a “right” to “free” food. If your local supermarket was ordered to announce “Free food today!” would people casually stroll over and pick up a few items they needed? More likely, there would be a run on the store that would empty the shelves within minutes. Imagine that happening at every store, every day. How long could that system last?

The only thing tempering insatiable human demand is the fact that the person providing the wanted item expects something of value in exchange – usually money. As much as liberals love to denounce the profit motive, it is precisely the insistence upon an exchange of value that keeps what would otherwise be limitless human demand in check.

Government purports to be “above” mere money-grubbing profit motives, and people assume this is an improvement. But it is actually the problem. Government “income” from tax dollars is not unlimited, despite perception to the contrary. Yet history is replete with instances of entities charging the government more than they would if they were billing a private entity. (Medicare fraud, anyone? Or perhaps you remember $500 toilet seats?) In point of fact, the costs of the goods and services after the government decides to provide them will be pretty much what they were before the government took over. Only now, the customers/recipients/patients think that they no longer have to pay for them. Without the checks and balances inherent in the “my-wants-versus-your-profit-motive” dynamic, demand will skyrocket, supplies will shrink, and shortages will occur. Why must supplies shrink? Because the government cannot command doctors to work more than 24 hours in a day. It cannot command that complex surgeries take less time. It cannot command the chemical reactions in pharmaceutical manufacturing to occur faster. All it can do is ration what there is.

3. There is no such thing as completely “equal” care, anyway

If demand for health care is limitless, governments’ pursuit of absurd and impossible results, seemingly, is not. And that pursuit has been the cause of untold misery. It is a very small step from saying that “health care is a ‘public good’” to saying that “equal quality health care is a ‘public good.’” After all, if I have a “right” to neurosurgery, then do I not also have a right to neurosurgery that is as good as that which someone in Los Angeles, Cleveland or Boston would get?

This, too, is untenable. Human beings may be “created equal” in the eyes of God, but they are certainly not created equal in terms of talent, skill, acuity, tenacity, or ability. The government cannot say, “Surgeon X must be of equal quality and skill as Surgeon Y.” Plenty - like the former Soviet Union, Cambodia, China and Cuba (note the pattern there) - have tried and failed. More recently, countries like Sweden have actually forbidden the private purchase of health care that is not paid for by the government, arguing that for some to get “better” care simply because they can afford to pay for it, is “unequal.”

The primary problem with the delivery of health care in this country is not the model of private exchange, it is a cost structure that is making it increasingly difficult for the average American to pay for the care they receive. The correct model of reform is one that addresses unnecessary costs, not one that takes our most talented, productive and needed citizens, and makes them – and us – slaves to an unworkable and ultimately doomed government health care system.