Free Medicine

by William Dale

Nearly every reform proposal offered to fix “the health-care crisis” calls for increased governmental control of medicine. These proposals are the logical result of the belief that there is a “right” to medical care.

But there is no such right. Rights, properly understood, do not include an entitlement to the services of others.

Recall the Declaration of Independence. Thomas Jefferson referred to a right to the pursuit of happiness, not an entitlement to happiness. People possess a right to be left to guide their lives in the manner they choose, so long as they do not impose by force their will on others. Interactions with others must be voluntary.

The opposing view, so prevalent in America today, is that human beings are entitled, by right, to certain goods and services—and, thus, that others are required to provide them. Advocates of this view argue that people have a right to such things as food, shelter, clothing, education and, now, health care. Other people should be forced, by law, to provide these things, they say; relationships should be coerced.

The fact that certain conditions must exist for one to pursue one’s goals does not give one a right to force others to satisfy those conditions. If it were otherwise, the right to liberty would disappear. For if a person is given, by law, a right to the services of another, then the person who is forced to provide the services is no longer free—his right to liberty is gone.

Medicare and Medicaid

Why is there a health-care “crisis”? We must go back to the year 1965 for the answer. For it was in that year that Medicare and Medicaid were enacted.

The first result of these two programs was dramatically rising health-care prices. According to Health One Corporation, between 1940 and 1960, health-care spending rose modestly from 4 percent of gross national product to 5.2 percent. According to the Health Care Financing Administration, since 1960, the percent of gross domestic product spent on health care has almost tripled—to 14 percent in 1992.

Medicare and Medicaid paid on a fee-for-service basis-the more services provided, the more fees generated. Thus, patients no longer needed to consider the price of services when treated. And doctors, who generally opposed Medicare and Medicaid when they were being considered, found them to be financial gold mines, as generous amounts of tax monies flowed into their pockets for care the physicians used to provide—voluntarily—for free or at reduced prices.

Rising prices pushed the cost of medical treatment beyond the range of more and more people. But, unfortunately, the original culprits—Medicare and Medicaid—were not identified as the cause. The blame, instead, was placed on “the greed” of doctors and hospitals. People’s “right to health care,” it was said, was being violated by the medical profession.

Not only did prices rise dramatically as a result of Medicare and Medicaid, they rose in unpredictable ways-ways which distorted incentives for doctors and hospitals. Harvard sociologist Paul Starr, in his Pulitzer Prize-winning book, The Social Transformation of American Medicine, observes:

The incentives that favored hospital care promoted the neglect of ambulatory and preventive services; the incentives that favored specialization also caused primary care to be neglected. The same reimbursement practices that encouraged. . . hospitals in wealthy areas to expand caused financial difficulties for hospitals in poor neighborhoods.
Thus, as a result of these distortions in incentives, the very people who were supposed to be helped by Medicare and Medicaid, i.e., the poor, were actually the people being hurt the most.

Blaming the free market

Despite the fact that governmental policies have caused the health-care “crisis,” public officials instead place the blame on “the free market.” Here is how one Congressman—Representative Robert Wise—put it: “The American myth is that free markets and laissez faire will take care of the health-care problem. It will not, and clearly that’s been demonstrated.”

But Representative Wise is wrong—it has not been demonstrated. In fact, what has been demonstrated is the failure of governmental intervention in health care. And why has governmental intervention in health care failed? Because it is based on the fallacious notion that people have a “right” to health care.

Moreover, as Dr. Maurice Sislen pointed out in the January 10, 1991, issue of The Wall Street Journal, “A huge, complex and ineffective policing system. . .has taken the place of what used to be the doctor’s responsibility to his patient. Probably only a practicing physician can fully appreciate the magnitude of the economic waste and moral degradation involved.”

The solution to the so-called health-care crisis is to rid ourselves of the cause of the problems—to dismantle governmental involvement in health care, especially Medicare and Medicaid. Only a complete separation of the state and the health-care market can permanently solve the problem. Instead of asking for free medicine from the state, we should be asking to free medicine from the state.

Chapter 9
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