[Home] [Headlines] [Latest Articles] [Latest Comments] [Post] [Sign-in] [Mail] [Setup] [Help]
Status: Not Logged In; Sign In
|
Dead Constitution See other Dead Constitution Articles Title: The Right to Medical Care and the Causes of the Medical Crisis This is an excerpt from a longer article and analysis. The whole thing is worth reading but I thought this long excerpt covered some of the key issues and as such stands by itself. 2. The Right to Medical Care and the Causes of the Medical Crisis The causes of the present crisis in medical care, namely, its runaway cost, which the Clinton plan is intended to address, can all be subsumed under one essential heading: the government's violation and/or perversion of the individual's actual, rational right to medical care. I use the concept of "rights" in the sense in which Ayn Rand uses it, and in which, at least implicitly, John Locke and the Founding Fathers of the United States used it. (See Ayn Rand's essay "Man's Rights," which appears in two of her books: The Virtue of Selfishness and Capitalism: The Unknown Ideal.) That is, not as an arbitrary, out-of-context assertion of claims to things or to obligations to be filled by others, but as pertaining to the actions an individual must take in order to live – as moral principles defining and sanctioning his freedom to take those actions. The only way that the individual's freedom, and thus his rights, can be violated is by means of the initiation of physical force against him – that is, by the use of guns and clubs against him, in the form of the government's threat to dispatch the police if he does not obey irrational laws. This is what stops him from taking the actions necessary to serve his life. Rights are a moral injunction to the whole rest of society – including, above all, its government – not to interfere with the individual's freedom to take the actions that serve his life. They exist on behalf of the individual and are directed against the rest of the world. They are the means of subordinating the whole of society to the requirements of the moral law of each and every individual serving his own life. It should go without saying that in serving his own life, each and every individual is morally obliged to respect the right of others to be free from any initiation of physical force on his part. This is implicit in the right of each to be free from the initiation of physical force by the whole rest of the world. In exercising his own rights, therefore, the individual is not to violate the essential right of anyone else to be free from the initiation of physical force by him. This means that insofar as any individual's exercise of his rights entails the cooperation of other people, their cooperation must be obtained voluntarily. An individual has no right to exercise any alleged right that would entail the initiation of physical force against others and thus the violation of their rights. There is no right to violate anyone else's rights. The exercise of man's right to life means simply that he has the right to take whatever actions are necessary to sustain and promote his life or further it in any way. For example, in the simple conditions that prevailed on the American frontier in the nineteenth century, he has the right to clear land, build a cabin, hunt game, grow crops, and so on. In the more complex conditions of life in modern society, in which he is surrounded by other people, insofar as his taking any such actions entails the cooperation of others – notably, the use of their labor or property to serve his life – his proper and necessary means of obtaining their cooperation is to trade for it. For all practical purposes, this means that he obtains the cooperation of others by selling his labor or goods for money and then using the money to buy the labor and goods of others. Buying and selling become an integral part of the exercise of one's rights in any modern society. Buying is the means whereby one enlists the intelligence and skills and the wealth and property of others in the service of one's life. Selling is the means whereby one provides others with the benefit of one's own intelligence and skills and wealth and property in the service of their life and thereby obtains the means of buying. Thus, in the conditions of life in a modern, division-of-labor society, the right to free exchange, the right to the freedom of contract, becomes an essential aspect of the exercise of the right to life. It is at the base of the exercise of the right to life under conditions in which individuals mutually cooperate, to mutual advantage, in promoting their lives. It is at the base of the exercise of the right to life that enjoys the overwhelming advantages of life in a division-of-labor society. The right to free exchange and the freedom of contract becomes an essential aspect of all rational rights to things. Rights to things exist only in the context of the freedom of exchange and the freedom of contract. To take some examples, an individual has no such thing as a right to a job as such. He has a right only to those jobs voluntarily offered by employers. His right to employment is violated not when he cannot find an employer who is willing to employ him, but when he can or could find such an employer and is prevented from doing so by the initiation of physical force. His right to employment is violated when, for example, an employer who would otherwise choose to employ him is prevented from doing so by the government's imposition of a racial or sexual quota which compels the employer to hire someone else instead. His right to employment is violated by the government's minimum-wage laws and prounion legislation, which latter makes possible the imposition of artificially high wages for skilled and semiskilled labor. Every rise in wage rates above the free-market level serves to reduce the quantity of labor demanded below the supply available and thus to prevent people from being employed. The legislation that makes this possible thus represents a violation of the right to employment in the sense of the right to accept employment that employers would be willing voluntarily to offer. Similarly, no one has the right to such a thing as a house as such. What one has is the right to buy a house, or to buy the things necessary to build it. One's right to a house is violated not when one cannot afford to buy or build a house, but when one could afford to buy or build a house if one were not forcibly prevented from doing so. The right to housing is violated by such things as zoning laws, arbitrary building codes, minimum-wage and prounion legislation, protective tariffs on the import of construction materials or construction equipment – by any initiation of physical force that artificially increases the cost and price of housing and thereby prevents people from obtaining housing who otherwise could have obtained it from willing providers. In exactly the same way, the right to medical care does not mean a right to medical care as such, but to the medical care one can buy from willing providers. One's right to medical care is violated not when there is medical care that one cannot afford to buy, but when there is medical care that one could afford to buy if one were not prevented from doing so by the initiation of physical force. It is violated by medical licensing legislation and by every other form of legislation and regulation that artificially raises the cost of medical care and thereby prevents people from obtaining the medical care they otherwise could have obtained from willing providers. The precise nature of such legislation and regulation we shall see in detail, in due course. This then is the concept of rights, and specifically of rights to things, that I uphold. One's rights to things are rights only to things one can obtain in free trade, with the voluntary consent of those who are to provide them. All such rights are predicated upon full respect for the persons and property of others. This is the concept of rights appropriate to rational human beings living in a civilized society. Henceforth, I shall refer to it as the rational concept of rights. In sharpest contrast, the concept of rights held by the great majority of our contemporaries, especially the great majority of today's intellectuals, is a concept characteristic of savages, that is, of people who have not grasped the principle of causality and the fact that wealth must be produced, who believe instead that wealth appears as though by magic, and that they have a claim to it by the mere fact of needing it or wishing for it. This concept of rights I shall refer to as the need-based or wish-based concept of rights. It exists in full contradiction of the rational concept of rights and entails the complete violation of all rational rights. It is a concept of rights whose literal meaning is "I want it and therefore I'm entitled to take it." According to this concept, people do have rights to jobs, houses, and medical care as such, just by virtue of needing or desiring them. Since a job entails the payment of money by the employer to the employee, and typically the provision of the use of part of the employer's premises to the employee, the notion of a right to a job as such – that is, with or without the employer's consent – implies an alleged right to take an employer's money against his will and to occupy his premises against his will, that is, an alleged right to trespass on his property and to rob him. Similarly, since a house, or any other material good, is a product of human labor, the right to a house as such implies a right to compel other people to build one a house, whether they wish to or not. It is tantamount to claiming a right to forced labor on their part. Finally, in exactly the same way, the alleged right to medical care as such implies an alleged right to force others to pay for one's medical care against their will or to force the providers of medical care, such as doctors and hospitals, to provide it against their will. It thus implies an alleged right to medical care as a right to steal and enslave. All such alleged need-based or wish-based rights are a contradiction of genuine, rational rights, which exist precisely as a moral sanction of the individual's freedom from such outrages. I have said that the causes of the present crisis in medical care can all be subsumed under the heading of the government's violation and/or perversion of the individual's right to medical care. By this last, I mean its use of the alleged need-based right to medical care rather than the actual, rational right to medical care as the basis of various policies it has adopted over the years. Seen in this light, the origins of the present medical crisis go back all the way to the government's establishment of various forms of medical licensing as early as the nineteenth century, and the subsequent increase in licensing requirements it has imposed in the course of this century. The essential nature of medical licensing is forcibly to exclude from the market a more or less sizable number of individuals and organizations who otherwise would be willing providers of medical care. Such legislation violates the right to medical care by depriving the buyers of medical care of the services of these willing providers. It is both a violation of the freedom of competition of those providers and, by the same token, the bestowal of a monopoly privilege on those to whom the government grants licenses. It deprives the buyers of medical care of the benefit of the additional supply of medical care that would be provided by the excluded competitors and forces them to deal only with the government-protected medical monopolists. The inescapable effect of such legislation is to make medical care scarcer and more expensive. The principal victims of such legislation are necessarily those who can least afford any rise in prices, namely, the poor. (I will deal with the essential rationalization offered in favor of medical licensing later.) Ironically, the main driving force behind medical licensing has always come from within the medical profession itself, many of whose members have sought the monopoly privileges that licensing bestows and thereby the artificial rise in their own incomes that it makes possible. There is nothing that should be surprising in this. It simply means that physicians have often acted in the same mean spirit as carpenters or plumbers who form coercive labor unions, farmers who seek government subsidies, or businessmen who seek protective tariffs. It is an expression of the mentality that underlies most government intervention into the economic system, namely, the mistaken belief that it is possible to serve one's self-interest by means of the initiation of physical force against others, coupled with a willingness to serve it by such means. Such a policy is irrational and ultimately self-destructive. Indeed, its self-destructiveness is illustrated precisely by the plight of today's physicians. For what is ironic in the fact that physicians have been the driving force behind medical licensing legislation is that, in effect, they first sent around to others precisely what has more recently been coming around to them, namely, the violation of individual rights in the field of medicine. The effects of medical licensing have played a major role in encouraging demands for socialized medicine and the threat to the rights of physicians that socialized medicine represents. Medical licensing has played into the hands of the advocates of socialized medicine precisely by making medical care scarcer and more expensive, thereby reducing the amount of medical care obtained, particularly by the poor. Because the effect of medical licensing was greatly to increase the difficulties of poor people in obtaining medical care, socialized medicine was perceived as all the more necessary. It was a classic case of what von Mises describes as prior government intervention serving as the cause of problems used to justify later government intervention, this time against the beneficiaries of the prior intervention. The essential goal of socialized medicine is that the individual should be relieved of financial responsibility for his and his family's medical care. Medical care should be provided to him without charge by the government, paid for out of taxes. To this extent, allegedly, his life will be worry free, because the government will take care of him. Medical care will simply come to him according to his need, paid for by others, presumably according to their ability. It should be obvious that such an arrangement entails the utter perversion of the right to medical care. The right to medical care ceases to be the individual's right to take the actions required to secure his medical care – namely, to buy it from willing providers. Instead it becomes an alleged right to the fruits of others' labor and ability, with or without their consent, for that it is the only way it can be obtained if the individual himself is not to pay for it and yet is to have a right to it merely because he needs it. As I have shown, its existence is in direct contradiction of all actual rights, which center precisely on the individual's freedom from involuntary servitude. The first major direct step toward the establishment of socialized medicine in the United States came about in connection with World War II's price and wage controls. The price and wage control authorities typically refused to allow wage increases, just as they typically refused to allow price increases. In the case of wages, however, they made an important exception. They allowed employers to pay for medical insurance on behalf of their employees. Although the medical insurance constituted an additional labor cost to the employers and thus from their perspective was indistinguishable from a rise in wages, the price control authorities did not regard it as a wage increase and therefore allowed it. The income tax authorities also did not regard it as a wage increase and therefore did not tax it. The employees too did not regard it as an actual wage increase either. They regarded matters from what must be called the rather magical perspective of believing simply that their medical needs would be met and that they would not have to pay for it. After World War II, in the remainder of the 1940s and in the early 1950s, coercive labor unions made employer-financed medical insurance a standard part of their contract demands. Even most nonunion employers were compelled to provide it, in order to avoid giving their employees a reason to unionize. Thus, by the end of the 1950s, employer-financed medical insurance had become the prevailing method of meeting medical expenses throughout the American economy. This is how the system of medical insurance we know today came into being. Of course, not all medical insurance plans were or are exactly the same. Some require of the worker no out-of-pocket payment of any kind for medical expenses. Others have imposed some kind of relatively modest annual deductible, such as $100 or $200, which the worker has had to pay before payment by the insurance company begins. A common practice has also been that the employee pay some share of the medical expenses beyond the deductible, typically 20 percent of the amount of the expenses up to some rather modest maximum limit, such as, at present, $5,000 (which means a maximum limit of $1,000 as the employee's own additional contribution). It cannot be stressed too strongly that this system of medical insurance contains essential features of socialized medicine. And that, as we shall see, is why our problems in connection with medical care have gotten progressively worse since World War II, as the present system of medical insurance was extended and people became more and more acclimated to it. A leading socialist feature of the system is that the typical wage earner has been led to regard medical care as essentially free, either completely free or virtually completely free, or, at most, 80 percent free after a modest deductible and then completely free after a relatively modest maximum limit on his own outlays. Thus, the psychology of the average American worker in relation to the cost of medical care has become the same as if he were living under communism. For all practical purposes, medical care comes to him simply according to his need for it. This situation is both based upon and reinforces the perverted notion of the right to medical care as a right divorced from considerations of what one has earned and can afford to pay and of the willingness of suppliers to satisfy one's need out of regard to their own financial self-interest. As I say, under the system of medical insurance of the last forty years or so, medical care appears to come to the average wage earner almost as though by magic, on virtually no other basis than that he needs it. The present system also shares with socialism – with communism – the further, corollary feature that for all practical purposes the individual's burden (the actual financial cost of his treatment) is borne by a large group – a more or less giant collective. Thus, when an individual with medical insurance undergoes procedures with a cost of $10,000, say, he personally may pay nothing at all or, at most, perhaps $1,100 or $1,200; the entire rest of the cost is spread over the group as a whole. And if the individual undergoes medical procedures with a cost that is twice as great or ten times as great, the cost to him, if anything at all, will still be no more than $1,100 or $1,200, and the much larger remaining total will be spread over the group as a whole. This is a system of collectivism. For all practical purposes, it is the same as exists under communism or socialism. Although called medical insurance, it is actually a hybrid of insurance and collectivized medical costs. It is insurance only insofar as it provides for the meeting of extraordinary, catastrophic medical expenses. For the rest, it is a system simply of collectivized medical costs. True, this system exists for the most part in an environment of privately owned business firms and is financed for the most part by those business firms. But when one recalls how the system was started and how it was spread, namely, by price-control officials and by coercive labor unions, and that throughout the years it has been deliberately supported by a discriminatory tax policy in its favor, one must characterize the system as imposed and maintained by the government, and not as a product of the competitive processes of a free market. Furthermore, as will become apparent later on, additional forms of government coercion serve to maintain the system by making it financially prohibitive for most people to step outside of it. Thus, the system is socialistic in the further essential respect that it is the product of government coercion, not of voluntary choice. Now this collectivistic system of governmentally imposed "private" medical insurance is the leading cause of the continuous rise in medical costs that we have experienced. To help my students understand this point, I ask them to imagine that after class they all go out together for a meal somewhere, on the understanding that the check will be divided evenly, irrespective of what anyone orders. I explain how this will greatly affect what they order. I point out, for example, that someone who might be thinking of choosing between, say, a $3 hamburger and a $15 steak, will now be much more inclined to order the steak. This is because instead of the additional cost to him being the full difference of $12, which it would be if each student had to pay his own check, the additional cost to him will now be perhaps just 50¢, that is, it will be the additional $12 divided by 24 (which happens to be the usual number of students in my class). I point out that to the extent that the students behave this way, the size of the total check must increase. Obviously, if what all 24 students ordered were affected in this way, the size of the check that each of them would have to pay would end up being $15 instead of $3, because each of them would experience the effect of 23 other students shifting 50¢ of their additional costs to him. In other words, it would be a situation of mutual plunder, in which all would lose. I explain how even if things did not start out quite this bad, the dynamics of the situation would tend to make them end up this way, if such meals were made a regular event. I point out that because the students are a relatively small group and know each other to some extent, and probably have some personal regard for each other, many of them might be unwilling to take advantage of the others and thus would order as they normally would, perhaps even more conservatively than they normally would. But all it takes is that a few of them take advantage of the situation. In that case, at the next such outing, some of those who had shown restraint the first time will follow the lead of those who hadn't and also take advantage of the situation. Soon self-restraint will be regarded as serving merely those who are unwilling to practice self-restraint. Even if this kind of outcome might be avoided in a small group of individuals all of whom possessed both high regard for one another and high standards of personal responsibility, it is certain that in a group consisting of thousands, tens of thousands, or millions of total strangers, the only possible outcome will be a sharp increase in total costs. Here one can benefit oneself greatly at virtually no significant cost to any other single individual, who is anonymous in any case. In a group of a hundred thousand people, for example, an additional expense of $1,000 incurred on behalf of any given individual means an additional expense of just 1¢ to each member of the group. Indeed, in the context of today's system of medical insurance, the way most individuals seem to look at matters is that any additional expense incurred on their behalf is not an additional expense, however small, to other individuals, even anonymous individuals, but merely an additional expense to a rich insurance company, which, they believe, is growing continually richer and can well afford any additional expense. By the mid-1960s, the collectivization of medical costs imposed by the government had created severe new problems. The rising demand for medical services it had created was pricing medical care more and more beyond the reach of the poor and the elderly. At this point, the government added further intervention to its earlier intervention, namely, the Medicaid and Medicare programs. These programs, of course, represent a more extreme collectivization of costs for the particular groups they cover. The medical costs of the poor and elderly are charged to the account not of a collective representing the membership of a given private insurance plan, which may range from the thousands to the low millions, but to the account of the country as a whole, that is, a collective representing more than a hundred million taxpayers. The collectivization of medical costs, both under government-imposed "private" medical insurance and under Medicaid and Medicare, raises medical costs in a variety of ways, each of which deserves consideration. In each instance, the perverted notion of the need-based right to medical care – that is, an alleged right to medical care that entails a claim on other people's wealth or labor, which must be met with or without their consent – is what underlies both the collectivization of medical costs and the concomitant loss of the individual's personal financial responsibility. In this way, it is a perverted notion of the right to medical care that is fundamentally responsible for the rising cost of medical care. The following are the specific ways in which this is the case. LINK TO FULL ARTICLE: The Real Right to Medical Care versus Socialized Medicine
Post Comment Private Reply Ignore Thread
|
||
|
[Home]
[Headlines]
[Latest Articles]
[Latest Comments]
[Post]
[Sign-in]
[Mail]
[Setup]
[Help]
|
||