Kevin D. Williamson, writing on the question of the right to health care, offers a thought experiment: you have 3 apples but 4 kids, and you would like for every kid to have an apple, and you manage to have apples declared a human right… but nothing has changed. You still have 3 apples but 4 kids and are going to ration those apples, one way or another.
Declaring a right in a scarce good is meaningless. It is a rhetorical gesture without any application to the events and conundrums of the real world. If the Dalai Lama were to lead 10,000 bodhisattvas in meditation, and the subject of that meditation was the human right to health care, it would do less good for the cause of actually providing people with health care than the lowliest temp at Merck does before his second cup of coffee on any given Tuesday morning.
Health care is physical, not metaphysical. It consists of goods, such as penicillin and heart stents, and services, such as oncological attention and radiological expertise. Even if we entirely eliminated money from the equation, conscripting doctors into service and nationalizing the pharmaceutical factories, the basic economic question would remain.
We tend to retreat into cheap moralizing when the economic realities become uncomfortable for us. No matter the health-care model you choose — British-style public monopoly, Swiss-style subsidized insurance, pure market capitalism — you end up with rationing: Markets ration through prices, bureaucracies ration through politics. Price rationing is pretty straightforward: Think of Jesse James and his “Pay Up, Sucker!” tattoo on his palm. Political rationing is a little different: Sometimes it happens through waiting lists and the like, and sometimes it is just a question of money and clout. American progressives love the Western European medical model, but when Italian prime minister Silvio Berlusconi needed a pacemaker, he came to the United States to have it implanted.
Rich people always get better stuff. That’s what it means to be rich. And money is only one resource: Political connections matter enormously in some places, as might a good family name or employment in a powerful firm. If you live in one of the poorer corners of the world, you may have “free” health care, meaning that if you should become infected with HIV, you will get a free aspirin. On the other hand, the Coca-Cola Company distributes antiretroviral drugs, free of charge, to employees around the world being treated for HIV.
That may seem unfair to us. That may be unfair. It may be unfair that you have four kids and three apples. After we are done lamenting the unfairness of it all, what do we do?
Ideally, we’d plant some apple trees. We would find ways to invest in medical care with an eye toward making it more effective and less expensive. There is no substitute for abundance. And the great enemy of abundance is the bias against profit. There is something deeply rooted in us that instinctively thinks we are being abused if someone else makes a profit on a deal. That is a dumb and primitive way of thinking — our world is full of wonders because it is profitable to invent them, build them, and sell them — but the angel is forever handcuffed to the ape.
A different piece, by Michael Tanner, offers 6 “hard truths” about health care. Here are three:
1. Health care is neither a right nor a privilege; it’s a commodity. Worse, it’s a finite commodity. There are only so many doctors, so many hospitals, and so much money, and there are limits to how much these things can be expanded. That’s why no health-care system, outside Bernie Sanders’s fantasies, provides unlimited care to everyone.
Every health-care system in the world rations care in some way, either through bureaucratic fiat (Scandinavia, the U.K.), waiting lists (Canada), or price (that’s us). One can argue about which of these rationing mechanisms is fairest or most efficient, but let’s not pretend that it won’t occur.
3. The uninsurable are uninsurable. Let us remember that the definition of “pre-existing condition” is: someone who is already sick. It’s a little like driving your car into a tree and then trying to retroactively buy auto insurance. It won’t work. Insurance is the business of spreading risk. But for someone who, say, has cancer, there’s no risk to spread, just cost. That’s not insurance, it’s paying for health care.
Obamacare tried to square this circle by mandating that young and healthy people buy insurance to offset the cost of providing care to those already sick. It turns out that didn’t work. Not enough healthy people signed up to pay for the influx of sick people. Insurance companies either dropped out of the market, cut back on high-quality providers, or raised premiums. All of this forced more healthy people out of the insurance pool and threatened an adverse-selection death spiral.
Republican proposals to keep the popular pre-existing-condition protections while jettisoning the mandate for coverage is only going to make the adverse-selection problem worse. It may have sounded like a moderate compromise, but it is like trying to be a little bit pregnant. It’s not going to work. The only realistic approach to dealing with pre-existing conditions is to take those people out of the insurance pool altogether and somehow pay for their care directly. There are several options for doing so, from state insurance pools to a revamped Medicaid program.
4. Medicare is not a success. Faced with the wreckage of Obamacare, Democrats are increasingly embracing the once controversial idea of “Medicare for all.” Most of them would start slowly, with a Trojan-horse “public option,” a taxpayer-subsidized plan that would undercut private insurance, but the result would still be a government-run national health-care plan based on Medicare.
Medicare is undoubtedly popular, especially with its beneficiaries. It should be. The average two-earner couple pays about $150,000 over their lifetime in Medicare taxes and premiums, while collecting almost $450,000 in benefits. Jackpot! But that disparity is one of the reasons why Medicare is running some $58 trillion in the red, after totaling all projected future liabilities. A program facing more long-term debt than most countries probably isn’t begging to be expanded.
Moreover, almost everything that people complain about with our health-care system is even more evident in Medicare. Medicare is inefficient, spending lots of money without evidence of better results