Why Are We Moving Toward Socialized Medicine?
By Dr.
Yaron Brook,
Executive Director, The Ayn Rand Institute
Government intervention in
medicine is wrecking American health care. Nearly half of all spending on health
care in America is already government spending. Yet President Obama’s “reforms”
will only expand that intervention.
Prior to the government’s
entrance into medicine, health care was regarded as a product to be traded
voluntarily on a free market--no different from food, clothing, or any other
important good or service. Medical providers competed to provide the best
quality services at the lowest possible prices. Virtually all Americans could
afford basic health care, while those few who could not were able to rely on
abundant private charity.
Had this freedom been allowed to
endure, Americans’ rising productivity would have afforded them better and
better health care, just as, today, we buy better and more varied food and
clothing than people did a century ago. There would be no crisis of
affordability, as there isn’t for food or clothing.
But by the time Medicare and
Medicaid were enacted in 1965, this view of health care as an economic
product--for which each individual must assume responsibility--had given way to
a view of health care as a “right,” an unearned “entitlement,” to be provided at
others’ expense.
This entitlement mentality fueled
the rise of our current third-party-payer system, a blend of government
programs, such as Medicare and Medicaid, together with government-controlled
employer-based health insurance (itself spawned by perverse tax incentives
during the wage and price controls of World War II).
The resulting system aimed to
relieve the individual of the “burden” of paying for his own health care by
coercively imposing its costs on his neighbors. Today, for every dollar’s worth
of hospital care a patient consumes, that patient pays only about 3 cents out of
pocket; the rest is paid by third-party coverage. And for the health care system
as a whole, patients pay only about 14 percent.
Shifting the responsibility for
health care costs away from the individuals who accrue them led to an explosion
in spending. In a system in which someone else is footing the bill, consumers,
encouraged to regard health care as a “right,” demand medical services without
having to consider their real price. When, through the 1970s and 1980s, this
artificially inflated consumer demand sent expenditures soaring out of control,
the government cracked down by enacting further coercive measures: price
controls on medical services, cuts to medical benefits, and a crushing burden of
regulations on every aspect of the health care system.
As each new intervention further
distorted the health care market, driving up costs and lowering quality,
belligerent voices demanded still further interventions to preserve the “right”
to health care: from regulations mandating various forms of insurance coverage
to Bush’s massive prescription drug bill.
The solution to this ongoing
crisis is to recognize that the very idea of a “right” to health care is a
perversion. There can be no such thing as a “right” to products or services
created by the effort of others, and this most definitely includes medical
products and services. Rights, as the Founders conceived them, are not claims to
economic goods, but to freedoms of action.
You are free to see a doctor and
pay him for his services--no one may forcibly prevent you from doing so. But you
do not have a “right” to force the doctor to treat you without charge or to
force others to pay for your treatment. The rights of some cannot require the
coercion and sacrifice of others.
Real and lasting solutions to our
health care problems require a rejection of the entitlement mentality in favor
of a proper conception of rights. This would provide the moral basis for
breaking the regulatory chains stifling the medical industry; for lifting the
tax and regulatory incentives fueling our dysfunctional, employer-based
insurance system; for inaugurating a gradual phase-out of all government health
care programs, especially Medicare and Medicaid; and for restoring a true free
market in medical care.
Such sweeping reforms would
unleash the power of capitalism in the medical industry. They would provide the
freedom for entrepreneurs motivated by profit to compete with each other to
offer the best quality medical services at the lowest prices, driving innovation
and bringing affordable medical care, once again, into the reach of all
Americans.
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