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Home > Basic Issues > American Health Care: Essential Principles and Common Fallacies
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American Health Care: Essential Principles and Common Fallacies

By Richard E. Ralston

Virtually all discussion of health care policy today avoids explicit reference to underlying principles. In the United States, any reference to uniquely American values—including the inviolability of the individual—is particularly avoided. Indeed, while the discussion consistently and studiously neglects to mention any fundamental ideology, it invariably takes for granted the standards of altruism and collectivism. Outwardly, the mantra is "practicality."

Even within the terms of pragmatism, socialized medicine is not practical—it does not work. When policy proposals from pragmatic arguments are offered (always as a litany of concretes, and often based on erroneous information), they should be addressed in the full context of the ideological causes such proposals routinely ignore. And it must be established that the reason socialized medicine (or any application of socialism or collectivism) does not work is because it is immoral.

The first task in proper health care policy formulation must therefore be to turn the discussion to its necessary roots. A foundation must be built by establishing the proper political and moral principles: the distinctly American values of freedom, individualism and the right to life, liberty, property and the pursuit of happiness.

Political Principles

One economist who is a tireless advocate of medical socialism has written that the only obstacle to universal health care is "ideology and personal choice." Eliminate those and we can have universal health care. Of course, that is quite correct, and it is seldom that the advocates of such policies are so explicit. Although the writer obviously is talking only about ideologies other than his own (which is easy to identify), elimination of such ideologies as freedom and individualism, and such concepts as personal choice, are a sure foundation for collectivism.

Individualism must be at the heart of health care policy. Life, liberty and the pursuit (or practice) of happiness is the proper basis for policy. That must include property rights, and no right to property is more important than one's ownership of his own body. Failure to maintain this foundation opens the door to the most common attacks on freedom in health care.

It is important to recognize that advocates of medical socialism are not primarily trying to apply the principles of collectivism in order to promote better health care. They are using the issue of health care in order to promote collectivism. In 2007 Senator Clinton proposed the expansion of an expensive and wasteful federal and state program to expand government health care from poor children to families of four with incomes up to $82,000. The proposals became law in 2009. The goal is obviously not to help the poor but to move as many children as possible—eventually all children—into a government health care system. This is another "slice of the sausage" that Senator Clinton promised when the Clinton administration's proposals for national health care were defeated in 1994. When she could not get the whole sausage of national health care, she promised to deliver it one slice at a time.

The objective of such paternalism extends far beyond the nationalization of health care. We and our children must all become dependent on government as the only source of our health care. Most children already must depend on government for their education (i.e., their indoctrination). Ideally these advocates of government would also like children to rely on government for food and housing. The motive may or may not be an ideological commitment to socialism; it is certainly an avid commitment to a political spoils system. The enemies of such a system are autonomous individuals pursuing their own happiness and deciding how to live their own lives. Like the corruption of the client system that helped destroy the Roman Republic, citizens are inculcated into a system that destroys personal freedom and choice through dependence on government for the needs of daily life. That is the ultimate goal: the abdication of freedom by citizens in exchange for a government that will take care of them. "It takes a village."

Without a foundation on the principles of individualism, the door is open to anti-concepts such as the "right to health care." Those who proclaim the "right" to health care usually mean its opposite, i.e., that no one has the right to any health care at all unless they get it from the government. When private health care is criminalized and everyone is forced into a government system with nowhere else to go, we are at the mercy of the political powers that administer such a system, whether it actually delivers health care or not. (This perversion of the concept of rights into goods and services, which you must be forced to provide to others, is described by Ayn Rand in her article "Man's Rights" in The Virtue of Selfishness.)

Is the objective really to criminalize private health care? To some extent that already has been achieved. The federal regulations governing Medicare were 130,000 pages long, until the Medicare Prescription Drug Bill added another 1,300 pages. No one can understand them. No one can read them. No one can even lift them. It is not possible to comply with some of these regulations without being in violation of other provisions. Yet physicians and hospitals can be held criminally liable for violating many of these provisions. What can be the purpose of such confusion? It is the ability to subject physicians and the rest of us to the arbitrary and capricious application of these regulations by any random bureaucrat. These regulations have grotesquely distorted and set the standard for the way private insurance companies pay for medical expenses.

Does this currently affect us on a daily basis? Most definitely. If you are 65 years of age or older, after a lifetime of paying Medicare taxes you are stuck with it. But if you want or need a procedure that Medicare does not allow, and if your physician accepts Medicare patients, he is forbidden by law to provide it even if you choose to pay for it yourself.

Medicare and Medicaid expenses have increased exponentially over the last 40 years and are a primary contributor to increased spending on health care. Federal programs now account for about 50 percent of medical spending. Federal tax policy has provided strong incentives for third-party payment of medical expenses, divorcing most of the costs from those who receive services. That is another primary factor in increasing costs. Heavy regulatory regimes of insurance and medical licensing by 50 state governments have greatly inflated the cost of both insurance and health care itself. State regulations prohibit the purchase of insurance from other states—thereby eliminating the possibility of a competitive national market for insurance and further increasing the cost of insurance. Insurance commissioners and other regulators in every state have united in opposition to legislation allowing their citizens to buy insurance from other states. Presumably they each must believe that consumers are endangered by the regulatory environment in the other 49 states. Affordable health insurance is thus often impossible for consumers to find because it is forbidden by law.

The strongest advocates of medical socialism want Americans to believe that what we have today is a free-market health care system based on principles of laissez-faire capitalism, and that we need to replace it. What we actually have, of course, is an essentially fascist system of highly complex and government-financed health care manipulated by interest groups with political pull.

America's health insurance and medical care system is an overregulated, bureaucratic monster that is the creation of government. It is in need of major reform, and the status quo should not be defended. But reform of the system must not take the form of more of the government poison that has been killing it.

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