In a recent GOP debate, the moderator posed a hypothetical situation to presidential candidate, Dr. Ron Paul: A healthy 30 year old chooses to forgo health insurance and then suffers an expensive, life-threatening medical event. Who pays? Dr. Paul replied, “That’s what freedom is all about, taking your own risks,” adding that people need to assume responsibility for themselves. Applause of agreement erupted from the audience.
So far so good.
Then came the follow up question: “Are you saying that society should just let them die?” Dr. Paul’s emphatic “No.” was an appropriate but regrettably incomplete response to this crucial question. Many others quickly fell prey to the implicit false alternative presented to Dr. Paul. Two woefully misguided individuals in the audience cried out “Yes [let them die]!” which prompted a storm of accusations from commentators condemning Republicans as cruel and disrespectful of life. The logical fallacy underlying both these reactions is that our only choices are to either (1) force hospitals and doctors to provide care and citizens to purchase insurance, or (2) “Let Them Die.” This erroneously limited view fails to consider the existence of humane, liberty-preserving alternatives. It also ignores the history of increasingly intrusive government actions which have seemingly left us with only these two equally unacceptable choices: government coercion or Let Them Die.
Innumerable regulatory and legislative requirements have artificially boosted demand and restricted supply while simultaneously increasing the cost of health care. Rising prices put affordable healthcare out of reach for more and more people. The following are just a few of the more expensive interventions. Licensing laws provide a legal monopoly for physicians on the “practice of medicine,” outlawing less expensive alternatives. In order to sell health insurance policies, companies are mandated by state and now federal law to include long lists of mandated benefits. In addition to further increasing the cost of insurance, these mandates restrict competition and prevent price-lowering innovations. Price fixing within Medicare results in market distortions such as the paucity of primary care physicians, the preference of institution-based hemodialysis over the cheaper home-based peritoneal dialysis, or hearing aids over the more effective cochlear implants—and a myriad of other examples of delayed or aborted innovations in medicine, technology, and even health care delivery systems.
In the name of consumer protection, these government interventions increase costs and decrease choices. Market concentration is encouraged, further increasing costs. Health care providers are blocked from competing on price, and consequently cannot compete on quality. Instead of offering valuable advice, centrally-controlled boards of experts are given increasing authority over the private and personal health care spending decisions of individual patients and physicians, and the business decisions of all healthcare providers.
This false alternative, Government Control or Let Them Die, arises from a misplaced confidence in government and the erroneous belief in a fixed quantity of available healthcare resources. It is bolstered by the lingering remnants of the Marxist belief that profit-seeking requires exploitation and that because physicians know more than patients, an “asymmetry of knowledge” leaves patients too vulnerable and incompetent to make their own healthcare judgments. These errors are held by Democrats and Republicans—which results in both parties crafting “solutions” that require ever more government involvement in the provision and funding of healthcare.
But a system of voluntary exchange creates wealth by increasing the availability of resources. Competition drives affordability by increasing efficacy and decreasing cost. Profits are not the result of exploitation but simply the reward justly earned for providing patients with what they want, while losses are the correcting and cleansing consequence of failing to do so in a cost-effective manner.
Freedom does demand the responsibility of living with the consequences of one’s choices. That still does not inevitably lead to “Let Them Die.” Continued and increasing government interference is what makes healthcare unaffordable, steadily eroding the ability of people to remain self-responsible and independent. Eliminating the artificial, government-created obstacles which hinder innovation and prevent competition, while allowing the free market signals of profit and loss to accurately reflect supply and demand, will maximize the number of people able to afford basic health care and health insurance. For the remnant of individuals with medical needs beyond their personal means, the additional wealth created through greater economic freedom will enable charitable organizations to provide adequate assistance. Americans are compassionate and generous. At our core, we value the lives of individuals and will voluntarily do what we can to help.
Our only options are not “Government Control or Let Them Die.”
Restoring our freedom will Let Us Live.
Beth Haynes, MD, Founder and President of The Black Ribbon Project for health care freedom and the doctor-patient relationship; Senior Health Care Policy Analyst, Docs 4 Patient Care; formerly board certified in Emergency Medicine and Family Practice; currently concentrating on health care economics and policy.