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May 09, 2005

I Care for Health Care

QandO shows us what being a libertarian is all about:

Let's talk about health care for a minute. Health care is certainly a need, but it is not a right. And all the high sounding rhetoric in the world that says otherwise is baloney.

And just like that, the right to health care is disproven. Except, in Western Europe, health care actually is a right, no matter what QandO says. It's a right because the citizens and government have decided it's a right, easy as that. Whether McQ and his libertarian brethren are so callous as to keep a straight face while denying the transcendental importance of health care is their own issue, but this flip dismissal of "high sounding rhetoric", which is to say, compassionate speech, is simply, obviously, wholly, wrong.

From there, McQ argues for taking health care away from employers and out of the government's purview:

The immediate benefits of making health insurance an individual responsibility?

1. Portability. It now no longer matters where you work or for how long (or if you work at all) your insurance travels with you. And that means ...

2. No more preexisting conditions.

3. Pool cost averaging. No longer limited to the pool of those who work at your business, like car insurance it now is extended to the pool of those insured by your insurance company.

Funny, those are exactly the same arguments that, in saner contexts, are leveraged in favor of government-run health care. Funnier yet, they actually work better when run through the state. The exciting pool cost averaging of McQ's plan simply enters you into the pool cherry-picked by your insurance company (for more on how well that works, read this post), government-run health care puts you in a national pool that doesn't allow cherry-picking. Insurance companies have a list of preexisting conditions long as your arm, government provided health care has none. As for portability, well, you know what I'm going to say.

The right's wrong on this one and, while I don't say this often, the libertarian-right is even wronger. Pulling the plug on government involvement would be a mess. This time, it's the private sector that flouts efficiency and kowtows to perverse and immoral incentives, and the state that's been proven, again and again, to provide better health outcomes for less money. And any high sounding rhetoric lauding the vaunted private sector's ability to deliver health care is, if you'll excuse my libertarian, baloney.

Update: Whoops! McQ feels wronged by my post! Apparently, since he wrote "rights don't involve, involuntarily, the assets of others", I was mistaken in saying he'd blithely dispensed with the idea that health care is a right, and the reality that it's a right in Europe. Or something. You guys can decide. His response then devolves into a series of non-sequiturs about how our economy can't sustain a "right to health care". Of course, we spend almost double -- per capita -- what other countries spend to cover their entire populations, but hey, I wouldn't want to interrupt that pleasant libertarian perspective with facts. He also accuses me of believing there's no program that couldn't be done better by the government. SIlly stuff, but then coming from a guy who think the world's richest country can't afford to provide health insurance for its population, it's par for the course.


May 9, 2005 in Health Care | Permalink


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» The Cherry-picking left on health care from QandO
zra Klein "cherry picks" my post on medical insurance with a partial quote in order to set up a false premise: [Read More]

Tracked on May 9, 2005 6:18:01 PM

» Health Care Values from QandO
I usually hesitate to disagree with people I like, so.....wait, no I don't. In fact, I rather enjoy it, so let me wade into the ongoing dispute between McQ and Ezra [Read More]

Tracked on May 10, 2005 12:34:12 AM

» Gerber's is an affront to my political beliefs from August J. Pollak - xoverboard.com
Ezra links to a (rolls eyes) libertarian blogger who complains that Ezra didn't use this quote from his argument about health care: Rights don't involve, involuntarily, the assets of others. Any 'right' to health care would make exactly that sort... [Read More]

Tracked on May 10, 2005 2:22:04 PM


I think the biggest problem here is that while we have a mound of empirical evidence, we have no good theory to account for it. I mean, why should it be that the Canadian Government’s healthcare bureaucrats are 300% more efficient than American Corporate healthcare Bureaucrats? Why does that make sense?

Since the theory really does look good, and the empirical evidence is not well known, combined with the fact that you are asking people bet their health on a single point of failure people are scared to death of trying...

Posted by: Andrew Cory | May 9, 2005 5:54:29 PM

With such keen political understanding, it's hard to believe that Libertarians regularly get less than one percent of vote when they run for public office.

Posted by: FMguru | May 9, 2005 5:57:36 PM

Actually, it does make sense. Compare Wal-Mart's administrative costs to those of a hundred or a thousand individual retailers. Wal-mart, despite serving the same (hypothetically) sized market, will have far lower costs than its atomized counterpart. Why? Redundancy. Economies of scale. When you have many, many organizations all trying to do the same thing, you have redundant positions. One organization doing the same thing at the same efficiency level will be, in sum, much more efficient.

That's what's happening with Canada and the US. Think, for instance, of all the insurance company employees whose jobs are simply denying claims, figuring out ways to deny claims, and figuring out how to price out or peel off the sick from their plans. Those folks don't disappear, they're just shunted into more expensive plans or Medicaid. It's wholly inefficient because profit is the wrong incentive for health insurance.

Posted by: Ezra | May 9, 2005 6:01:44 PM

Ok, works for me.

Now, the trick is to give that explanation loudly, on as many different channels as possible and using “Wal-Mart” in the middle but “Costco” on the coasts. Never ever use the phrase “economy of scale” (the phenomenon you’re describing), as it will cause everyone’s eyes to glaze over...

Indeed, it occurs to me that American healthcare companies make their money on the bureaucracy side of things, rather than the healthcare side of things. Which might be something else worth mentioning. I mean, would you rather have a bureaucrat’s job performance measured on how much healthcare you received or on how little?

Posted by: Andrew Cory | May 9, 2005 6:19:41 PM

Also remove redundant... have a folksy synonym or euphemism for that?

Posted by: TJ | May 9, 2005 6:30:11 PM

I'm guessing he doesn't have any health problems to speak of, currently. But if diagnosed with, say, high blood pressure and suddenly forced with the prospect of paying hundreds of dollars a month for medince that prevents his veins from exploding, he'd change his tune real quick.

Posted by: Keith | May 9, 2005 6:41:54 PM

I can see a series of ads that break the phenomenon down. Staring in the Midwest and working towards the coasts. 30-60 second spots talking about how sure the Canadians have to wait a while to get breast implants, but that’s because the doctors are all so busy helping honest folks get over the flu. Perhaps end each spot with the tagline “America—together we’re healthier”

Maybe another spot would feature someone filling out a bunch of HMO paperwork while bleeding at the hospital (this has happened to me). The you see the Doctor is unable to help him right away because the doctor is also filling out paperwork. Finally someone does a voiceover detailing exactly how many hours each week American doctors spend doing paperwork compared to how many each week Canadian Doctors do the same. “No wonder Canadians get to spend X amount more time with their doctors!”

This would be followed by an Astroturf opinion page campaign where people keep using the line “I don’t care if it’s the government or the HMO, I just want the bureaucrats out from between me and my doctor.”

Perhaps: Americare—It’s all taken care of


Posted by: Andrew Cory | May 9, 2005 6:42:51 PM

Ezra, you might be interested in this tidbit from mark schmitt:

"I'm steeped enough in the tradition of negative liberty that I don't speak of health care as a "right." (Rather, it is a positive benefit that, by democratic processes, a society can choose to allocate or guarantee -- and as a citizen in that process, I would argue for broad allocation.)"


Posted by: Electoral Math | May 9, 2005 7:24:37 PM

"It's a right because the citizens and government have decided it's a right, easy as that."

Re the Schmitt quote above:Ezra, you do understand this is a fairly radical statement, with possibly radical consequences?

I tend to agree, but I also tend to say things like: "It makes no sense to say the Chinese people have a right to a free press."

Posted by: bob mcmanus | May 9, 2005 7:42:47 PM

I don't think health care is a right that anyone is entitled to demand from society. But I don't think gun ownership, or the amassing of astronomically-large fortunes, are rights, either. I do think that a society that allows children to suffer, or people in the prime of life to die, because they can't pay the doctor, simply doesn't deserve to be called civilized or decent. And decency is a quality I value more highly than liberty, let alone 'liberty' (i.e., the libertarian notion of liberty).

Posted by: ktheintz | May 9, 2005 8:36:56 PM

Let's talk about education for a minute. Education is certainly a need, but it is not a right. And all the high sounding rhetoric in the world that says otherwise is baloney.

Posted by: David W. | May 9, 2005 9:38:22 PM

"Education is certainly a need, but it is not a right."

Oh cmon.

1)As an interesting foundational premise, the Lockean right to dispose of the fruit of your labor without coercive interference has its uses for Liberalism and Libertarianism.

2)"Life, Liberty, and the Pursuit of Happiness" as "inalienable" rights are refuted in their consistent alienation.

3)So as Ezra says, the only "rights" are social and political constructs. If Congress, the President, and SCOTUS say you have a right to Cinemax, then the rest of us have to pay your cable bill. Women have no "right" to an abortion outside of law and practice. The right to an abortion was fullborn into existence at Roe v Wade. There are not rights hidden in the Constitution waiting to be interpreted into existence. Nor are there rights denied because of bad interpretation.

God or natural law or the Easter Bunny ain't gonna save you if you don't fight for some measure of political power.

Posted by: bob mcmanus | May 9, 2005 10:34:40 PM

To add to Bob's point, nowhere in the D of I or, more importantly, in the Constitution, does it say that just becuase something is not thereby enumerated as a right, that it can't be one. They merely state what ARE in fact rights - it doesn't logically follow, nor do they say, that there can't be other rights.

And most of the rights explicitly enumerated in the Constitution are in the Bill of Rights. The main body of the document is primarily a granting of powers and delegation of responsibilities to the government by its patron, the people.

Posted by: Lewis Carroll | May 9, 2005 10:48:41 PM

Re the Schmitt quote above:Ezra, you do understand this is a fairly radical statement, with possibly radical consequences?

Radical? As Bob McM points out, it goes right back to Locke's Second Treatise, and especially the odd little tricks he plays with temporality in the origin of societies.

Heck, following McQ's line of argument, you can say 'the right to keep and bear arms is a need, but not a right'. Then watch the libertarians implode.

Posted by: ahem | May 9, 2005 11:00:51 PM

Consider that we pay twice as much as other countries for health care and shortly government programs will be paying half of the total bill.

The private companies are trying to insure the healthiest people, while the government programs, especially, Medicaid, Medicare, and the VA, have extremely ill people.

A single-payer system combines everyone, healthy and sick, eliminates advertising costs, reduces the paperwork of different forms and codes, allows for bulk purchase discounts, etc. Every advantage of two businesses merging works when you shift to a single payer system.

In addition it reduces the costs of corporations that now provide health insurance through employment. Private health insurance drives up the cost of American business, which is why Ford and GM would both like to see a single payer system.

Posted by: Bryan | May 10, 2005 12:03:06 AM

"rights don't involve, involuntarily, the assets of others"

That's tautological. What the assets of others *are* depends on what rights one has.

Posted by: Tyrone Slothrop | May 10, 2005 12:13:42 AM

Tyrone --- excellent point.

On another, OT note...Ezra, any chance that you spent the weekend with Jesse in order to pave the way for your return to Pandagon? Amanda is stinkin' up the joint over there. OTOH, I do like your new digs here.

Posted by: collin | May 10, 2005 12:35:36 AM

why should it be that the Canadian Government’s healthcare bureaucrats are 300% more efficient than American Corporate healthcare Bureaucrats?

Because the American Corporate healthcare bureaucrats are trapped in the throes of moral hazard and adverse selection, while while the Canadian Government's bureaucrats are not. We have plenty of theory which fully explains this. Most folks are just ignorant of it.

Posted by: Kimmitt | May 10, 2005 3:06:20 AM

Doctors and nurses come from all over the world to America because they know they can make huge amounts of money here. How many times have you heard of doctors going to other countries for opportunity?
While I am loathe to endorse a large government one-payor system, I don't see any way out of it. Socialized medicine will be a reality, not because it is the best system, but because at this point in the medical community's greedy grab, they have left us no other path.

Posted by: Robert Zimmerman | May 10, 2005 9:05:54 AM




Posted by: jake | May 10, 2005 9:43:01 AM

The "libertarian right" is just selfish greedy bastards that know it's not cool to be sitting with the fundies. But they vote republican anyway, because its all about the $$$$$$. Anyone with more than a few brain cells can see that National Health Care is more efficient - just standardizing the paperwork could take the $30 it costs to process a medical claim down to less than $1. The people against it are not looking at facts and making judgements, they are repeating lies force-fed to them. It is no coincidence that both sides of the right (the fundies and the greedy bastards ) both believe strongly in things that cannot be proven. That's why they're not "reality based".

Posted by: fasteddie | May 10, 2005 9:45:25 AM

A libertarian doesn't want the government taking his (her?) money for the benefit of other people! Sun rises in the east! The Pope is Catholic! Dog bites man!

What I'm wondering is, how trustworthy insurance companies could survive under a laissez-faire economy. How can I know that the company that sells me totally-free-market health insurance isn't going to go bankrupt the day before I get socked with a seven-figure hospital bill?

(Yeah, yeah, there are private agencies that rate insurance companies. What kind of incentive do those agencies have to do a good job, when they're being paid by the people looking for good ratings and when the consequences of an inaccurate rating might not be felt until decades later? And if two competing agencies rate two competing insurance companies, how can I tell which one to believe?)

Posted by: Seth Gordon | May 10, 2005 10:31:16 AM

I sometimes think that liberals ought to devote their energies to improving the DMV, because that's the example we'll always hear in opposition. You want your healthcare to be run like the DMV? (And rather than explaining why Medicare is not like the DMV, I'd rather be able to smile and say "yes.")

Posted by: Abby Vigneron | May 10, 2005 11:25:50 AM

I posted on this over on pandagon, kind of to no avail, but here goes,

"rights" are not just a social contruct. If we woke up tomorrow and decided to revoke the right to free speech for certain blogger types, would that mean that Ezra had no right of free speech? If its just a social construct, then why not, but I think "the right to free speech" means something different. Like, government may not impinge on your speech, ever. (yes I know about certain enumerated exceptions under the case law) It means that impinging on speech is just plain wrong, period. Its not a matter of what society feels like or feels it can afford at any given time. Its not contingent, its absolute, and on and on.

It may be theoretical, hypothetical or aspirational, but there is something unique about "rights". Watching people deprived of their rights should inspire horror and rage. Like how I feel when people try to take away a women's right to an abortion. I simply cannot say that lack of government healthcare evokes the same response. I don't even think it should evoke the same response.

Liberals think they will trick Americans into feeling horror and rage about lack of healthcare if they say there is a "right" to it. What is far more likely is that Americans will lose whatever respect for "rights" that they ever had as a result of the terms widened meaning. As the word "rights" gets over used its power is diminished not expanded. I hesitate to quote this person, but Ayn Rand wrote about this some 50 years ago in an article called "rights inflation." You may not have any interest in what Ayn Rand has to say, whatever. I will simply say that we live in a world where old-fashioned rights like speech and privacy are treated more callously with each passing day. We don't need to contribute to the watering down of the respect that the word evokes.

I think we should have gov't healtcare for all the reasons people have listed, as well as the ones advanced by Ezra previously. I do not think declaring a "right to healthcare" is the proper way to get there. I well understand that advocates of gov't healthcare would like to use the most powerful rhetoric they can to get where they want to go. I just think the work "right" should be reserved for a narrower range of issues.

Posted by: Neil Paul | May 10, 2005 11:53:32 AM

What Neil Paul said.

Posted by: Lewis Carroll | May 10, 2005 1:31:39 PM

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