[NOTE: This is an Addendum to the previous post, “The Principles of Freedom and Medical Care.”]
Back on the January 17th, The Atlantic ran a article by Ronald Brownstein called “The Trumpcare Conundrum,” which dwelt at some length with the basic insurance problem of finding healthy people to pay the premiums to support the unhealthy ones. I posted a comment which read,
The article assumes health insurance and medical care are one and the same, as does Obamacare. But they are really different, and if we want to move to a free-market solution they must be separated. I explain how this can be done in a post called “The Principles of Freedom and Medical Care,” here:
[referencing the previous post, an unabashed plug]
“How to to make free choice and free markets work in the increasingly complex world of contemporary healthcare.” In this piece I introduce a novel system of ‘Medloans’ that can work to solve the problem of high risk (both financial and medical). Read it and see what you think.
My comment elicited several responses, and led to a lengthy discussion with a very well-informed individual calling himself ‘smarticat’ (in this day and age I suppose one must say ‘himself or herself’, but in English ‘he’ and ‘him’ are the default neutral pronouns, and my Spidey sense tells me my virtual correspondent is male). I won’t reproduce our back-and-forth; if you’re interested, you can find it here: Change the Comment order to ‘Newest’, scroll down a bit, and you should see my first comment, and all the responses.
I was disappointed that Smarticat (I’m going to capitalize his handle, to distinguish it in the flow) did not see fit to post his comments here, but then The Atlantic gets a lot more ‘eyeballs’, so that’s understandable. The upshot is that I learned a little about points I could have made better. Smarticat is in favor of what we used to call ‘Socialized Medicine’, but is now, perhaps in deference to the insurance tradition in America, called ‘Single Payer’. I recalled that a Medicare for the entire population would magnify the evils of third-party payers—pages and pages of regulations—immeasurably, and quoted a couple of sentences from Ronald Reagan’s Farewell Address; here’s an expanded selection:
When you’ve got to the point when you can celebrate the anniversaries of your 39th birthday you can sit back sometimes, review your life, and see it flowing before you. For me there was a fork in the river, and it was right in the middle of my life. I never meant to go into politics. It wasn’t my intention when I was young. But I was raised to believe you had to pay your way for the blessings bestowed on you. I was happy with my career in the entertainment world, but I ultimately went into politics because I wanted to protect something precious.Ours was the first revolution in the history of mankind that truly reversed the course of government, and with three little words: “We the People.” “We the People” tell the government what to do; it doesn’t tell us. “We the People” are the driver; the government is the car. And we decide where it should go, and by what route, and how fast. Almost all the world’s constitutions are documents in which governments tell the people what their privileges are. Our Constitution is a document in which “We the People” tell the government what it is allowed to do. “We the People” are free. This belief has been the underlying basis for everything I’ve tried to do these past 8 years.
But back in the 1960’s, when I began, it seemed to me that we’d begun reversing the order of things—that through more and more rules and regulations and confiscatory taxes, the government was taking more of our money, more of our options, and more of our freedom. I went into politics in part to put up my hand and say, “Stop.” I was a citizen politician, and it seemed the right thing for a citizen to do.
I think we have stopped a lot of what needed stopping. And I hope we have once again reminded people that man is not free unless government is limited. There’s a clear cause and effect here that is as neat and predictable as a law of physics: As government expands, liberty contracts. [my emphasis]
At this point the divide between me and Smarticat became crystal clear. He responded, “I simply don’t agree with Reagan, or any supporter, who believes that ‘limited government’ is necessary for ‘freedom’. I think there is a chasm of interpretation within those buzzwords that can mean entirely different things to different people, depending on their stake and perspective.” He cited Medicare in particular:
I’ve made mention of Medicare in several posts because the existence of the program has enabled healthier old age that also enables a wealthier and more independent old age. Those are “freedoms” that are just as real to the average person, perhaps more real than ideological arguments about the role of government needing to remain similar to what it was in the 1700’s when the US was 1/10th its current size and population and mostly an agrarian society. . .
Here is the New Deal idea of ‘Freedom from Want’; it is the basis of twentieth-century liberalism, and it is not without merit. Where it fails is with the role of government. The government can address Freedom from Want, but it is in the nature of government to define what your ‘want’ really is, or should be, and then it becomes Control, which is another word for the force that energized the American Revolution: the prospect of Tyranny.
Smarticat quite astutely pointed out that we really had very different goals in mind: he wants to ensure that everyone in the country has ‘healthcare’, and he apparently thinks that an expansive Federal government is a price worth paying; I want to ensure that we preserve, or rather restore, the free market in providing that ‘healthcare’. I’m with President Reagan: Liberty means not having a massive government bureaucracy intruding into our medical care, and thence into every aspect of our lives.
This is the main point I learned from Smarticat: We have to argue from first principles, from fundamentals. If you don’t agree with our Founders, and with President Reagan, that “As government expands, liberty contracts,” and if you don’t agree that the first priority has to be Liberty, not ensuring that everyone has Freedom from Want, then the principles I outlined in the preceding post will make little sense to you. Liberty is undisciplined, disorganized, messy, uncertain—and the outcomes are not equal. Tyranny makes the trains run on time, but it is intolerant of error—your error that is, not that of the bureaucrats who, it is averred, are always looking out for your welfare. The liberals never thought the Soviet Union was all that bad, did they?
We can’t eliminate Government entirely, of course. Health Savings Accounts were created by the Congress, and will have to regulated by a small (we hope) department. Third-party insurance has to follow certain rules, either State or Federal. And a system of Medloans will have to be funded and administered at either the State or Federal levels (or both). But like anti-trust laws, this is Government functioning as referee and scorekeeper, not marching the players around on the field like marionettes.
The other point I learned is where I started, with my one-sentence critique of the Atlantic article: we have to distinguish among basic medical services, which are individually directed; ‘catastrophic’ third-party insurance, which competes for the individual’s dollar; and Medloans to deal with the ‘uninsurables’. Not sure if I made this clear enough in my ‘Principles’ post, but I’m not sure if Smarticat ever read it, either. I hope you will. /LEJ