American Health Care: Essential Principles and Common Fallacies
By Richard E. Ralston
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Michael Moore's comedy-drama Sicko (it was hardly a documentary) was only tangentially about health care. The clear underlying theme of the movie was the inferiority of American society and culture to almost all others. Name a country, and Mr. Moore makes the case that its culture, education, politics, economy and health care are superior to America's to the degree that they embrace collectivism.
That is the foundation for the frequently heard statement that all other industrialized countries have a government-financed health care system. (That is, incidentally, not true.) Americans should, in this view, be embarrassed by their lack of collectivism and outmoded commitment to free markets. Collectivist systems ruled by enlightened intellectuals are obviously superior in every respect. If only Americans would discard such parochial curiosities as the Declaration of Independence, the U.S. Constitution, the Bill of Rights, and the very concepts of individualism and life, liberty and the pursuit of happiness, we could freely embrace the benefits of government micro-management of our health care. Of course, a government that pays for all of our health care ultimately acts as if it owns our bodies, but anti-American elitists tell us that we should not be concerned with such ideological considerations.
Obviously we must vigorously defend American values as a necessary precondition of health care policy. We must recognize that disdain and contempt for American values is often the motivation for collectivist policies. This is the current manifestation of a very old trend in America. In the 19th Century many intellectuals began to look to Europe for validation of their abandonment of the reason-based world view of the Enlightenment and justification for replacing free institutions with various forms of state tyranny. Americans must recognize these intellectual roots, best expressed in the surprisingly accurate popular term "Health Care Nazis." The only appropriate American response to such health care folly is individualism and a free market.
Many people cannot afford comprehensive health insurance—especially with current government regulations. Many people need medical care they cannot afford. These unfortunate facts are used as the basis for the argument that others must be forced to supply them with both insurance and health care. The context of proper political principles and American values is ignored and replaced with the implied moral context of altruism. Even if the existence of individual rights is acknowledged, it is trumped by altruism and collectivism.
Because health care is so important, we are told, issues of freedom and individual rights must be set aside. The need of patients requires that government sweep away the rights of all individuals in order to seize and distribute medical care to others. Of course, the truth of the matter is that it is precisely because health care is so important that the individual rights of patients and physicians must be vigorously defended.
It is appropriate for defenders of individual rights to point out that the government action that would in fact help make affordable health care more widely available is not more government controls and regulations, but the elimination of most current controls and medical programs. (Government-funded medical care for active-duty military personnel and injured veterans is of course appropriate, but in the case of veterans could be best managed by reimbursement to them for private care.) But that should never obscure a defense of self-interest as the only moral foundation for health care. The moral issue is also often clouded with the notion that even if socialism is immoral and inefficient in most cases, it is somehow appropriate in others—such as for children or the elderly. That assumes that the most precious value or gift that can be given to children is socialism or paternalistic fascism.
Across the entire political spectrum, altruism is the common element that clears the way for both the right and the left to devastate freedom and individualism. Socialists, welfare-state paternalists, Christian conservatives, public employee unions and politicians seeking to make their constituents dependent on them for all of their needs unite under the banner of altruism. There is no principle of political philosophy, no economic law, no proven efficiency of free markets or proven incompetence of government, no American value, that is not trumped by altruism. Any government action purporting to be a sacrifice for the good of others is generally sanctioned—even when in fact the proposal will help kill those it is supposed to help while making life miserable for everyone else. That is why supporters of reason, freedom and individualism should always take altruism on directly.
Michael Moore has remarked that socialized medicine should more appropriately be called "Christianized medicine." This extreme opponent of free markets and American values has thus been inspired by the success of some Christians in using the power of government to force Christian morality on American citizens. While Mr. Moore's piety may be highly selective, it is a symbol of what pandering to the religious right by conservatives has made possible.
Specific Policy Development
Health care based on the foundations of individualism—uniquely expressed through American values—requires free markets to work effectively. Self-interest requires a principled defense of free-market health care.
Because the transition from the current regulated mess governments have created will be long and difficult, it is also necessary to take notice of not just the unprincipled and immoral foundations of the present corrupt system, but of the huge amount of misinformation in circulation about current needs and realities.
In this context, while policy options must always refer back to correct principles, in any given instance it is the direction of policy that often should be considered. Is the direction more government controls, regulations, bureaucracy and spending, or less? If less, a proposed reform might be appropriate if it is not proposed in conjunction with regression to more government.
For example, the Medicare Prescription Drug legislation of 2003 was a horrible expansion of government health care—the largest in 40 years. It did include a pitiful few helpful features such as the expansion of Health Savings Accounts and some paltry choices for private insurance options within Medicare. Neither of those features justified passage of the legislation. But now that we are burdened with the program, it is appropriate to build on those features to push in the direction of more private options in health care and to build a constituency for free markets. Exempting individual health care expenses from income tax is fine, but of course not ultimately a reason to maintain income taxes at all. We can take advantage of limited opportunities for progress on the road back to freedom in medicine only if our goals remain firmly rooted in the right principles.
In this context it can be useful to review the most common misinformation and fallacious reasoning about the current policy situation and suggest rhetorically effective replies. Recourse to correct principles is the best response, as there is no limit to the false information and irrationality that can be manufactured. Nevertheless, some things should not be allowed to go by without comment and need to be specifically refuted. A mantra of commonly accepted misrepresentations has developed that is endlessly chanted to the exclusion of any rational discussion of the real issues. They must therefore be challenged.
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