“Figures, right? The libs wanna give handouts to people who don’t have health insurance.Instead they want to make hardworking Americans pay for their medical bills. Hey, life ain’t fair. You wanna get health insurance? Getta job. I work hard for my money. Why should I have to pick up the tab for a bunch of sick moochers?”
If this sounds like someone at a family gathering, an uncle perhaps, you might be interested in giving him an answer that could be persuasive, at least more persuasive than shaking your head and rolling your eyes. Maybe you could try to appeal to both his patriotism and to his wallet.
The first question is why he, and we, have to pay, and the second question is, even if this is so, what’s the cheapest way to honor that obligation and why.
First up is why we’re on the hook for universal healthcare. Is it because we should be generous or charitable or humane. All of those are good reasons, of course, but not the answer. Instead it’s because healthcare’s not just a human right, like the freedoms of speech or press or religion, it’s one of our three inalienable rights. Yep, it’s one of the big three: it’s the LIFE part of “life, liberty, and the pursuit of happiness.”
And according to our Declaration of Independence, those were the most important reasons we rebelled against George III in the first place. As Thomas Jefferson put it, not just our government, or some governments, but all governments everywhere “are instituted among men” to “secure these rights.” And not just for some of their people but for all of them, because “all men are created equal.” In short, these three self-evident rights provide the institution of government with the moral foundation for its very existence.
If all of this is true, if your uncle agrees that ethical governments are obligated to secure these three inalienable rights for all of the people that they govern, then the second question is how. How should they do it? How can our government, or any government, provide the highest quality healthcare at the lowest possible cost?
Well, the USA is a capitalistic democracy, and our first, natural inclination must be to let Adam Smith’s invisible hand take care of it. After all, out economy is rife with examples of how corporations and entrepreneurs benefit our society by providing their customers with state-of-the-art products and services at reasonable prices. Hey, we deregulated the airline and telecommunications industries (remember Pan Am and Ma Bell?), and look at what’s happened to air travel and long distance phone calls over the last forty years. Yep, capitalism works.
Why? In one word: competition. If companies don’t give their customers the best products at the cheapest prices, then their competitors will.
If the American economic paradigm has one principal axiom, it’s that competition forces people and companies to produce the highest possible quality at the lowest possible cost. Every American knows that competition is great at providing consumers with high-quality goods and services at low costs in virtually every major industry. From cars to computers, from machinery to movies, from algorithms to agriculture, from real estate to restaurants, American capitalism is still the envy of the world.
If so, then why shouldn’t we use that method to deliver our healthcare, too? If we can make healthcare more competitive, then the dynamics of marketplace capitalism will improve the quality of care and reduce its cost, right? If not, why not? What makes healthcare different?
The short answer to that question may be too obvious, too evident, for your uncle to see it. It’s simply because the phrase “healthcare marketplace” is an oxymoron. It doesn’t exist because it can’t. But why is that so? Health insurance companies compete, hospitals compete, pharmaceutical companies compete, hell, even doctors compete, at least subtly, right? So why can’t we create an efficient healthcare marketplace?
And the answer to that question can be found in our old pal: the dynamic of supply and demand. The capitalistic model breaks down when you remove the freedom of choice from the purchasing decision. No one ever WANTS healthcare, they either buy it because they need it or they don’t. Their demand, their degree of desire, doesn’t fluctuate based upon cost because healthcare is either worthless when you’re healthy or priceless when your sick. At the risk of being too obtuse, pricing is irrelevant when something is priceless. It’s kinda right there in the word itself, and it’s that “pricelessness” that makes capitalism a terrible provider of healthcare, or any of our other inalienable rights for that matter.
Perhaps the best way to demonstrate this fact is to compare how our government provides us with our healthcare in order to secure our inalienable right of life to how it provides us with our protection from criminality and conquest in order to secure our inalienable right of liberty. In other words, maybe we should compare how our society pays for the doctors and drugs that protect our lives with how it pays for the cops and prosecutors that protect our liberties.
So maybe your uncle should help pay for a doctor to fix my broken arm for the same reason that I should help pay for a cop to arrest someone who breaks into his house. I have a vested interest in his safety because it enhances mine, not because I need that protection now, but because I might need it in the future. On the other hand, he has a vested interest in my health because it enhances his, not because he needs that protection now but because he might need it in the future.
If that’s not true, what would a “law enforcement marketplace” look like? How could we use the invisible hand of capitalsim to secure our domestic liberty from the tyranny of criminality? How could we harness the power of the “free market” to prevent crime and provide punishment in the same way that we use it to cure diseases and heal injuries. In other words, what would happen if I didn’t pay taxes so that your uncle can get his law enforcement and criminal prosecution services for “free”?
I’m guessing that we would quickly create a robust “crime insurance” industry.If you want police protection, you should pay for it out of his own pocket when he needs it, or else he could buy “crime insurance” just like we buy health insurance today. Can’t you just see it now? “This game is brought to you by The Good Handcuffs People at …”
And how would this kind of private crime insurance work? Pretty much the same way that the health insurance companies do, IMO: you pay them to pay for your protection against accidents and attacks. Let’s say that you hear a burglar downstairs in the middle of the night. So you call 911, and the first thing that the operator does is ask you for is the name of your crime insurance provider. With it, the cops are on their way. Without it, or a valid credit card to pay them for their house call, you’re on you own, buddy. Hope that the gun in your nightstand is loaded.
But that’s the beauty of capitalism, right? It’s his money, so according to the free marketeers, not only should he have the ethical freedom to decide how to spend it, but he’ll spend it smarter and better than some faceless bureaucrat in DC or City Hall. And if he can’t afford to pay the cops or buy crime insurance, well, that’s how the cookie crumbles. If his kid goes missing, it’s his problem; if my kid goes missing, it’s my problem, right?
Crazy? Not according to Jefferson and the rest of our Founding Fathers. Hell, the Declaration of Independence was already nearly seventy years old before New York City created the country’s first local police department in 1845. Before that, you either protected yourself, or you hired someone else to do it.
And it wasn’t just the arrests. When it came to the private prosecution of criminals:
“Privately prosecuting a crime continued as a common practice throughout much of the United States into the nineteenth century, despite the growing trend of using a public prosecutor. Although many state courts continued to permit victim-retained private prosecutions throughout the nineteenth century, some jurisdictions prohibited the practice.”
Bottom line is that fair-market capitalism is great fulfilling self-interest by creating and supplying markets with high quality goods and services at low costs, but it’s terrible at providing people with their fundamental with human rights. That’s why we pay more than twice as much as most other industrial democracies for our mediocre healthcare system: when the pricing mechanism does not effect the purchasing decision, either individually or collectively, the concept of a competitive healthcare “marketplace” becomes as deceptive as a competitive “law enforcement marketplace” would be.
When a buyer’s demand is fixed at absolutely necessary in order to sustain human life (or to protect human liberty), its cost becomes superfluous to the purchasing decision, and price competition as a cost-control mechanism flies out the window, and this characteristic prevents capitalism from operating efficiently. A hungry man will pay more for a sandwich than a sated one, but a starving man will pay anything.
So if your uncle likes competition, tell him not to think of it as competition among healthcare insurance or pharmaceutical drug companies within a country because private companies sustain inalienable rights expensively and inefficiently. You can’t send a corporation to do a government’s job. Since there’s no marketplace for human rights, competitive pricing is largely immaterial to their efficacy.
Instead, you can tell Uncle Freemarket that he should look at it as a competition among the countries themselves, and any way you slice it, we’re getting our asses kicked. By everybody, everywhere.
When American healthcare is compared to every other nation in the world, every single one of them can say, “We do it cheaper,” and according to the WHO, thirty-six of them can say, “Not only do we do it cheaper, we do it better, too” because it ranked the quality of our national healthcare system as only the 37th best in the world, snuggled comfortably between Costa Rica and Slovenia.
Costa Rica and Slovenia? How bad is that? Try it this way: if Costa Rica, Sovenia and the United States were all tourists instead of countries, and they were visiting Las Vegas at the same time and staying at the same hotel in the same kind of room on the same floor, then the Costa Ricans would be spending $100 per night for the room, the Slovenians would be spending $216 per night, and the we’d be spending $741 per night. So much for buying those tickets to Cirque de Soleil.
Yes, it’s that bad. Costa Rica has a healthcare system that’s slightly better than ours, and they pay nearly SEVEN AND A HALF times less per person than we do. For every dollar we pay, they pay 13.5¢. Couldn’t get much worse than that, IMO, and when you mention this to your uncle, you should remind him that you don’t gotta be AOC to know that serving your customers booze from the well and then charging them top shelf prices for it ain’t no way to tend a bar.
So if your uncle wants you to get behind a capitalistic, pay-for-play healthcare system, ask him to show you a marketplace. The next time he’s sees a hospital running a “buy-one-get-one-free” ad for liver transplants, or a “we will not be undersold” TV commercial for colonoscopies, ask him to send it to you. Until then, he, and we, have the illusion of a healthcare marketplace, not the reality of it.
Finally, if he doesn’t think that the bureaucrats in Washington are sufficiently competent to manage the delivery of our healthcare goods and services, suggest that you ask him to take a gander across the Potomac at a little office building that he might have heard of named “The Pentagon.” Just like our military protection is a state-run monopoly that provides us with a our human right of liberty from foreign subjugation, healthcare could become a state-run monopoly that provides us with our human right of life that’s as free as possible from debilitating injuries, chronic maladies, and deadly diseases.
And to put these two institutions into a relative perspective, our military spending comprised 3.4% of our GDP in 2019 while our healthcare spending comprised 17.7% or greater than FIVE times more of our GDP that year. Looks like Eisenhower’s “military-industrial complex” from 1960 has become quaintly anemic compared to our robust “medical-industrial complex” today.
So I guess that the lack of a capitalistic military marketplace has produced disgruntled soldiers, bungling sailors, defective weapons, and dilapidated military bases, all of which demonstrate that our inept Armed Forces are an international scandal and a national embarrassment. Hmmm. Wait a minute. I thought that our military proficiency was pretty good, even though it’s not run by private companies that compete with one another. Coulda fooled me.
Instead, tell your Uncle Free Market that he should have more pride in our monopolistic military, like you do, and in its phenomenal capabilities despite the absence of a marketplace, including its ability to provide “free” healthcare to our servicemembers, of course.
If your uncle’s still in the dining room and not off sending an email to his Senator demanding that he or she support an American National Health Service, then you can end your conversation by telling him that there ain’t no mystery to decreasing the costs and increasing the efficacy of American healthcare. We don’t need no magic wand. We can do both.
No, there ain’t no such thing as free healthcare just like there ain’t no such thing as a free lunch. Public or private, somebody’s gotta pay, but when it comes to the securing our inalienable right of life, we all deserve an equal chance to make it as long and healthy as possible, and that chance shouldn’t bankrupt us individually or collectively.
It’s simply a question of national will.