Is It A Proper Role of the Government to Provide Healthcare to Its Citizens?

This is an essay based on a motion debate that I performed at in June 2017. My friend Chuck Braman and I defended the con side of the debate and argued that it is NOT proper for the government to provide healthcare for its citizens. This was another victory for the two of us as a team, but it was a lot closer than the previous debate on education. This time around, the same number of people shifted their vote on both sides, but because we came in with a far smaller percentage of the total, we were declared the winners.

The division of labor was the same as before: Chuck established the ethical context for our position and I supplemented it with economic and practical arguments. This essay has been lengthened to include some of Chuck’s arguments for the benefit of those that were not present.


America is obsessed with healthcare, and has been for nearly a century. In particular, activists and ideologues have led the charge with demands for government health guarantees, especially for those that are unable to afford it. The alternative, these people hold, is to simply allow children and elderly people to die in the street while well-fed elites enjoy the latest technology and treatments. It has been said that the free market has failed to provide Americans with adequate healthcare and that the government must now step in to correct the issue.

This view is entirely mistaken.

I’d like to disabuse the reader of a common misconception that is popular with both political parties: the idea that we have tried the free market in medicine and that it has failed to deliver results. The truth is that we currently do not have a free market in medicine in the United States today and have not for much of the 20th century. The US is a mixed economy with some freedom and some controls in the healthcare industry. Over time, the controls have continued to grow at the expense of Americans’ freedom.

Government intrusion into healthcare began with occupational licensing laws passed in the late 19th century. These regulations determine who can practice medicine by making it illegal to do so without a license. Medicine is already a demanding profession, as it requires considerable training and skill to become a doctor, yet these laws make that harder still. In the name of “high standards,” the state requires doctors to jump over regulatory hurdles in order to gain regulators’ permission to practice. Licensing laws overrule the independent judgement of dedicated doctors and savvy consumers and leave the market subject to the whims of the bureaucrats. The result is an artificially restricted supply of doctors, and therefore a higher cost for their services.

Licensing laws are only the beginning. The next step in the march towards more government in healthcare was the Stabilization Act of 1942, which froze wages nationwide during World War II. Employee benefits, such as health insurance, were not considered wages under the law and were therefore exempt from the freeze. Employers who sought to attract better talent were incentivized to offer health insurance during this period as part of their compensation packages. The practice was made permanent with the passage of the Internal Revenue Code of 1954, which enshrined the tax benefits for these compensation packages.

The Stabilization Act brought us the modern link between health insurance coverage and employment that is bemoaned by many of today’s unemployed millennials.

The beat goes on, as Medicare and Medicaid were passed in 1965. These two programs taken together implemented full-on socialized medicine for the elderly and low-income populations in the United States. Years later, President Nixon declared a “war on cancer” with the passage of the National Cancer Act. Bill Clinton later took the baton from Tricky Dick in the 90’s when he earmarked more federal funds to cure cancer. The spent dollars are gone, but cancer remains a potent cause of death in America.

In 1986, under the supervision of the allegedly capitalistic Reagan administration, Congress passed the Emergency Medical Treatment and Active Labor Act, also known as EMTALA. EMTALA mandated that hospitals could not reject emergency room care to any patient in need, and made doctors required by law to treat patients regardless of their ability to pay. In the 1990’s, attempts by the Clinton administration to further increase government involvement in healthcare were narrowly defeated by the Republican majority in Congress.

This victory was short-lived, though, as the later Obama administration succeeded in passing the Affordable Care Act. Known colloquially as Obamacare, this bill has made health insurance mandatory for American citizens. In one of the most shameful Supreme Court decisions in history, the bill was upheld based on the government’s power to tax. Despite promises to repeal Obamacare, President Trump has no intention of slowing the growth of government in this sector of our economy.

This gallop through healthcare history explains how we got what we have today: a bloated, chimeric, monstrosity bred by a mixture of cronyism and big government. Today’s health care industry was not birthed by the free market, but by the enemies of freedom. What are the consequences of such a system?

One is the creation of an enormous, unnecessary bureaucracy that would make even the protagonist of Brazil recoil in horror. In the healthcare industry, red tape is the norm as clerks that are responsible for processing payments and dealing with insurance forms outnumber nurses two to one. The same clerks outnumber the physicians by an outrageous nine to one! In case these figures make you think there may be too many nurses on staff, note that it is estimated that nurses spend nearly 35% of their time on documentation alone.

A typical hospital spends over 38,000 man-hours a year to deal with the billing requirements for Medicare. It is easy to see why: Medicare has over 130,000 pages of rules and restrictions that need to be applied whenever a patient uses it. Studies have found that for every 1 hour spent caring for a Medicare patient, ½ an hour must be spent on paperwork. Many doctors no longer accept Medicare and those that do are stuck with the high overhead cost it imposes. Meanwhile, the FDA prohibits the manufacture and sale of new medical devices and prescription drugs in order to perform tests that take an average of 16 years. In the interim, many who would otherwise have had early access to life-saving technology perish while awaiting the seal of approval from some Washington bureaucrat. Such facts are enough to warrant changing the meaning of the acronym “FDA” from the “Food and Drug Administration” to the “Federal Death Administration.”

American lives are not the only thing spent on the healthcare industry. In 2014, Medicare and Medicaid together cost the country nearly $1 trillion; that is nearly 20% of the annual federal budget. Medicaid alone is often the single most expensive budget item in most states. The trend indicates that this will only continue to get worse. It is estimated that in 2029, 20% of federal dollars will be spent on Medicare. The same statistic in 2041 is expected to be closer to 25%. Obamacare, the most recent legislation on healthcare, on its own cost taxpayers $3 billion in 2016. Was this due to a new advance in technology or perhaps a new line of miracle drugs? No, the costs were due to penalties for not having purchased health insurance.

Is so-called “single-payer” (read: full socialized medicine) any cheaper than the hybrid system that we have today? Let’s look at some example cases to find out.

California recently sought to enact a single payer healthcare system, with an estimated cost of $400 billion. The only problem was that the entire state budget was $183 billion at the time. Vermont also tried to implement a single payer healthcare system in 2014, but it also failed due to the high cost. Taxpayers would have been on the hook to fund a $4.3 billion program in that state. How did the government of Vermont propose they pay? An 11.5% payroll tax on all businesses, and an income tax as high as 9.5% for individual taxpayers on top of it. In Colorado, voters rejected plans for a single payer system in 2016 when it was revealed that a 10% payroll tax increase would be needed to meet the $25 billion price tag.

The facts speak for themselves. Is single-payer cheaper? Hell, no!

What makes it so expensive? People are misled to believe that healthcare which is allegedly provided by the government is free when it isn’t. Nothing that requires human effort and the use of man’s reason is “free,” someone has to produce it. Yet in America, customers are insulated from the true costs of healthcare and health insurance due to a looming, third party payer environment that is in cahoots with the government. If and when this colossus fails to deliver, left-wing activists say, what we need is a complete government takeover to eliminate the contemptuous “middleman.”

The truth is that even in single-payer government systems, government does not produce anything. All it can do is redistribute by force what has been created by successful, productive citizens. The healthcare industry in the United States is inspired not by socialism on the Bolshevik model (communism), but socialism on the German model (fascism). The former is a system wherein the government completely owns the means of production outright, and the latter is a system wherein the government forces people with nominal “property rights” to do its bidding. Both systems are opposed to laissez-faire capitalism and both systems obliterate private property rights.

The advantage of the fascist model is that by preserving the trappings of a capitalist system, it is more difficult to see its totalitarian nature. It also makes it that much more difficult to see the true costs, since government’s ability to borrow and print unlimited money serves to obscure what is really happening. People tend to spend more when they are not given the bill at the end to settle. Before Medicare, nearly 55% of healthcare spending was out of pocket, and by 2010 that figure dropped to just over 10%. For every 1 dollar of care that a patient receives today, on average he only personally pays 14 cents. Who covers the rest? The benevolent government, a.k.a “the public,” a.k.a the cash-strapped taxpayer.

The final and arguably most morally devastating sin I will attribute here to government meddling in the healthcare industry is the massive wedge that it drives between doctors and their patients. Under the free market, the focus is on individuals — individual patients treated by individual doctors. The standard is individualized care. Under socialized medicine, the focus is on collectives – a collective of patients that is owed the services of a collective of doctors. The standard is collectivized care.

Collectivized care holds that what matters is what the FDA thinks is good for all patients, not what an individual doctor thinks is good for his patient.

Collectivized care holds that what matters is overall spending, not what an individual consumer should spend to satisfy her healthcare needs.

Collectivized care holds that what matters is what people need, not what they have earned.

The activists will argue that healthcare is a right, and that the state has a responsibility to provide affordable healthcare to its citizens. But there can be no right to the products or services produced by others. Such “rights” only enslave the producers to the consumers. To see the absurdity of such an argument, apply the principle that doctors owe care to whoever claims a need to other industries that serve a vital need, say restaurants. What if restaurant owners were required to serve free meals to anyone that came in claiming to be hungry, regardless of their ability to pay? What about clothing stores being required to let anyone who has a need for a new pair of high heels or the latest swimsuit to come in and take it without compensation? Such a principle leads necessarily to the virtual enslavement of the doctors on the grounds that the products of their minds are owed to the first person who demands them.

But the doctors are not the only ones that are enslaved by government control of medicine; so too are the consumers who buy it. Once the premise that government ought to pay your medical bills is accepted, it follows logically that government has a stake in lowering the costs by whatever means it deems appropriate. This is done by controlling behavior, either by limiting “unhealthy” activities or “encouraging” healthy ones.

As an example of the former, consider the onerous taxes on smoking and soda. People genuinely get pleasure from these products and they are available at a price that even poor people can afford. In the name of public health costs, the government thinks is fitting that it make these things harder to buy. California has a “zero tolerance” policy on after school bake sales at schools on the grounds that the children are too obese. Such a message is clear: “you do not own your life, and the state has the authority to tell you what is good for you.”

Other countries in the world are further along the authoritarian road than the United States. They impose even more humiliating restrictions on their people and annihilate even a pretense of privacy. In Japan, the government checks the length of your waistline when you are over 40. If you are deemed too fat, the government dictates that you undergo “reeducation” and lose weight; otherwise, you pay stiff fines. Germany publishes an annual list of people with high health care costs and labels them “antisocial.” New Zealand has turned people away from its borders if they are obese, on the grounds that their healthcare bills would be too high. How is that for fat-shaming?

We do not need this nonsense in the United States; what we need is a free market in medicine.

There is ample evidence that markets lower costs and raise quality, even in the healthcare industry. While healthcare on the whole has risen in price, elective procedures like LASIK and cosmetic surgery have gone down in price and up in quality year after year, even though they are not covered by insurance. In 1998 LASIK cost $2,200 per eye and in 2014 it cost a mere $300 per eye. In the case of cosmetic surgery, the top three most popular procedures (botox, laser hair removal and chemical peel), have fallen in price since 1998 by double digits. For those procedures not covered by insurance which have seen increased spending, the increase averages 32% compared to the industry-wide 47.2%.

Advocates for government-run healthcare seem to believe that no matter how many regulations and controls they place on the healthcare industry, medical care will be readily available to all those that want or need it without regard to cost or the rights of the providers, but this is not true. Health care is not exempt from the laws of economics. It is not manna from heaven.

If you want everyone in society to have bread, your first priority would be to respect the rights of the bakers who toil in kitchens to bake it.

If you want everyone in society to have clothing, your first priority would be to respect the rights of the dressmakers who sit at looms to weave them.

If you want everyone in society to have iPhones, your first priority would be to respect the rights of the programmers who manufacture them.

The same reasoning applies to those that provide healthcare. Leave doctors free; it’s the healthy thing to do.

The Egalitarian In Chief

All about the philosophy that informs the Obama administration.

As the end of Barack Obama’s administration approaches, we ought to discuss the overall impact that it has had on the United States. While no president is perfect, I believe the overall legacy is a negative one; allow me to defend this position with a discussion of the philosophy of the Obama administration.

When discussing Obama, I am often reminded of the 1972 election when Richard Nixon won in a landslide against George McGovern. At the time, McGovern was the candidate of the far left, which had come to prominence in the wake of the Vietnam War. Nixon positioned himself as the experienced, establishment candidate against a pacifist who would have surrendered America to the Soviet Union. To many voters, Nixon was the man who would prevent the hippies from taking political control. Though we later learned that Nixon had serious ethical and political issues of his own, voters at the time awarded Nixon every state except for Massachusetts. The resulting landslide meant that the radical left was exiled from American politics for two full generations.

The only popular Democratic presidency after the ’72 election was the Clinton administration. Carter, the only other Democrat to be president during this era, was largely seen as weak and ineffectual, as well as economically destructive. The headlines of Carter’s reign spoke of “the misery index”. Economists were baffled when high unemployment appeared at the same time as high inflation, which was considered impossible under the standard Keynesian economic model. Despite the personal scandals, Clinton’s approach was animated by a moderate, “third way” philosophy that had earned respect from many of his political opponents, particularly in the economic realm with the passage of welfare reform. The  ideological left made a return to mainstream American politics with the election of Obama in 2008, who was the first “New Left” American president.

Conservatives took pains to portray Obama as a Marxist in the 2008 presidential campaign, but the truth is that he only appropriates the ideology and rhetoric of class warfare when it suits him in his true agenda, which is more aptly described as egalitarian and not Marxist. Egalitarianism is the view that equality is the most important standard by which we ought to evaluate justice and morality. For egalitarians, equality is a higher value than standard of living or individual achievement. As a self-styled “community organizer” Barack Obama is a philosophical poster boy for Harvard philosopher John Rawls’ theory of “justice as fairness”. Let’s examine some of the specific instances where Obama’s policies have supported his egalitarian philosophy.

To begin, Obama has ratcheted up the traditional Democratic rhetoric against Wall Street and the banks. Along with Senators Sanders and Warren, Obama has called for higher taxes on the wealthy so that everyone is paying their “fair share” though there is little explanation for what is truly “fair” in this context. The president has done his part to convince Americans that the financial sector is parasitical, taking care to ignore the crucial role that the financial sector plays in allocating capital throughout the economy where it is most profitable and therefore most valued. When asked by the New York Times whether he would raise taxes on “millionaires and billionaires” even if it would result in less overall revenue, Obama responded that he would do so, stating that its not a matter of revenue, but “fairness”. Obama truly seems to believe that if a person possesses considerable wealth, irrespective of how they achieved it, then the government is justified in taking the “excess” and redistributing it to those “in need”. If one could custom the presidential seal for each person who holds the office, Obama’s would likely read “you didn’t build that”.

Obama’s administration is also responsible for raising government spending on “clean energy” and seeks to further restrict America’s consumption of electricity and fossil fuels. The truth is that energy is the lifeblood of an industrial, capitalist society and without it, America cannot effectively produce the goods and services that make innovations in every other field possible. At this stage, so-called clean energy is not only “clean”, but overly expensive and ineffective in generating what our economy needs to grow and expand. Any cost-conscious entrepreneur would recognize the value of efficient, renewable energy and invest in it if they thought that there was a chance for profits. Some, like Elon Musk, do this now (albeit with government subsidies). On the other hand, the Obama administration is engaged in a sort of wishful thinking: even if clean energy can’t compete with fossil fuels in terms of efficiency or yield, we still ought to invest in it at the expense of established, proven energy sources because it is “the right thing”.

The question to ask is: right for whom? Eschewing cheap, abundant energy for clean, expensive and rationed energy is not “right” for humans that seek to travel the world, mass produce medicines, generate high crop yields, and expand the reach of telecommunications. The administration’s attitude seems to be that human welfare needs to take a back seat when compared with the environment, the climate, and the mating habits of any and all non-human species on the planet which have an intrinsic value simply because they exist and therefore belong on an equal footing with humans. In other words, energy is great and all, but if it comes down to humans or polar bears, we will just have to go without and sacrifice for the sake of the polar bears. Ayn Rand put it best when she described the American left as seeking “an anti-Industrial Revolution”. To this I would add that the Obamas of the world seek an egalitarian energy policy where the welfare of humans is considered on a par with the welfare of lakes, ferrets, and redwoods.

On the international scene, the Obama administration has consistently acted to diminish America’s stature by denying American exceptionalism. The president applies his egalitarianism consistently to nations of the world as well as individual humans only to conclude that each and every country should be treated the same as every other, irrespective of its actual values and customs. Rather than serve as an eloquent spokesman for the peculiar and unique American tradition of individual rights, separation of powers, free elections, and limited government, Obama has told young people in Argentina that “there is no essential difference between socialism and capitalism” and that they should choose “whatever works”. Rather than stick up for American interests, Obama is willing to subvert American interests to those of the United Nations, an egalitarian body that gives equal representation to all nations, whether they are authoritarian or free.

Mr. Obama has also enthusiastically breathed new life into the tyrannical Cuban regime by pushing the end of the US embargo. This act does a remarkable disservice to Cubans that fled the country and further damages the cause of Cubans that remain on their home island, trying to resist the communist dictatorship. For generations, Cuban refugees have orally transmitted the horrors of communism to their children and grandchildren; they explain that it was the United States that gave them hope and allowed them to prosper after painfully leaving their homeland. The message to young Americans is clear: if Mr. Obama thinks that the Castro family is kosher, perhaps Fidel and Raul are not all that bad after all.

Obama also lacks the moral courage to openly identify radical Islam as a threat to the United States. Like his predecessor, George W Bush, Obama refuses to recognize that what motivates ISIS is not anti-imperialism gone amok but ideas, specifically religious ideas. It is not true that all religions are equal in the effects of their dogma; to see this, note that we are not discussing the threat posed by radical Jainism. Many on the left will argue that Christianity is just as bad as Islam when it comes to fundamentalism, but this is an ahistorical claim. The fact is that Christianity and Judaism have been severely weakened politically in the West after the Enlightenment and the Industrial Revolution relegated them to superstition among the intellectual and business class. The Middle East, on the other hand, is rife with countries stuck in the Middle Ages culturally.

Obama saw the so-called “Arab Spring” through the rose-colored glasses of his egalitarianism and mistook the political machinations of committed Islamists as the rumblings of a native people rising up against their government for an equal voice in a democratic system. The two biggest exponents of Islamism are Saudi Arabia and Iran, a nation that has been in a de facto state of war against the United States since they took hostages from our embassy in 1979. Instead, the president has opted to appease Iranian posturing by kicking the can down the road with regards to their nuclear weapons program.

What about health care, which has been the flagship of Obama’s political legacy? President Obama led the charge to institute his health care scheme as a means of correcting supposed market deficiencies in allocating health care. From the beginning, the left has sought to use health care as a means of undermining confidence in the market by driving up costs and lowering quality. In reality, the health care “market” was heavily regulated and distorted by government intervention prior to the Affordable Care Act. It started with Social Security, a program borrowed from Bismarck’s Germany to placate the middle class at the behest of socialist agitators. It continued with more guarantees in the form of Medicare and Medicaid. Occupational licensing laws were put forth to regulate “legitimate” medical care and outlaw “illegitimate” medical care, making it difficult and expensive for new doctors to enter the market. Finally, it was under Ronald Reagan that federal law required all visitors to emergency rooms to be subsidized by the taxpayers if they could not pay their own bills. The “market deficiencies” that Obama sought to “fix” with his health care bill were a result of government action, not the free market.

Obama’s solution for health care was naturally derived by applying his egalitarianism to health care coverage. The Affordable Care Act put into effect an individual mandate that requires all citizens have health care coverage irrespective of their health and ability to pay. Furthermore, Obamacare decrees that the services rendered by all plans need to be identical, even if particular aspects of the plan are nonsensical or uneconomical. For instance, thanks to Obama, a young man in his 30’s can now have his pregnancy covered by his insurance plan, and anyone diagnosed with a preexisting condition will be covered even though there is a near certain chance that the health care firm will need to pay out heavily for treatment. If we compare auto insurance to health care insurance, the mandate states that one can demand an insurer cover them after they have totaled their vehicle. Rather than treat health care as a service provided by the market, with a variety of products and pricing commensurate with consumer needs, Obama has made it clear that it would be unfair that some go without health care coverage, and that this is prima facie unacceptable.

Finally, there is the deterioration of race relations and the proliferation of identity politics that have occurred under the Obama administration. Despite the fact that Americans voted in a black president, there is a widespread belief that the majority of white Americans are racists. Opponents of the Obama administration that have legitimate criticism are lumped together with white nationalists as racist by the mainstream media and various academics. It is often taken as axiomatic by educated Americans that Caucasians benefit from “white privilege” and there is need to address “institutional racism”. The police have been slandered by Black Lives Matter activists, who claim that there is a preference for jailing black Americans over all others. If someone points out that the incarceration rate of blacks is commensurate with the rate at which they actually commit crimes, they are also conveniently labeled as racists and apologists for oppression.

While Obama has not done much to stoke these flames, he has not done a thing to refute them, even though he can easily do so. Instead, he opts to take the approach that because all people are equal, it must be the case that all cultures are equal as well, and that it would be unfitting for anyone to point out differences, let alone claim that one is better than the other with regard to a given activity or problem.

Obama is the first president to take egalitarianism seriously. Apart from the 2016 election, the Democrats lost seats in Congress in 2010, 2012 and 2014 despite Obama getting two terms as president. Obama has stepped into the fray consistently with the message that even when he is personally not on the ballot, his policies are. Americans heard that message and voted accordingly to reject Obama and his egalitarianism. Though many Americans are not philosophical in their orientation, they are discerning enough to note that the effects of egalitarianism are destructive and harmful when they are implemented.