[Originally posted at TheDailyFuel.com on January 28, 2007]
Last night I happened to catch an episode of a local PBS program called Independent Thinking. The host is John Caldara, President of the Independence Institute, a think-tank which, though non-partisan in theory, is ostensibly dedicated to advancing libertarian to conservative principles, depending on the issue. (Perhaps that's how the adjective Independent found its way into the name of the think-tank: you can be a conservative on some issues and a libertarian on others.) This particular installment of the show was a celebration of the work of Milton Friedman, the Nobel Prize-winning economist who was the principal advocate of laissez-faire capitalism. To discuss Friedman's ideas and influence, and perhaps to reinforce the idea that people should think independently (of what? of whom?), the three-person panel was entirely composed of members of the Independence Institute. Evidently, in the host's view, independent thinking does not require a variety of viewpoints being considered; rather it should rest on a homily made of the viewpoints we should all subscribe to in the host's opinion.
In addition to John Caldara, the panel included two women, one of whom was Linda Gorman. I recognized the name it from my marginal participation in the activities of Health Care For all Colorado, a group which advocates single-payer healthcare system for Colorado. Linda Gorman, as it happens, represents a conservative/libertarian point of view on the Blue-Ribbon Commission for Health Care Reform established in 2006 by the Colorado Senate to examine possible solutions to Colorado's health care crisis. She believes in the freedom of the individual to choose what kind of a health care he or she wants to receive. A convenient corollary of such a belief is that the free market should be left to its own devices and that hospitals should decide how much they can charge for services rendered, how much insurance companies can charge individuals for policies, what is and is not covered, who received benefits and who does not. In Linda Gorman's world, the free market is a self-adjusting organism, so the government should just act as a referee, without ever trying to run things.
Let's consider the implications of Ms. Gorman's beliefs for a moment, gauged against reality. The concept that the free market is a self regulating environment is wonderful in theory, but it should come with obvious stipulations. For example, we can agree that the free market works reasonably well in the realm of goods and commodities: you buy what you want at the price you can afford. You want a plasma TV but cannot afford it? Just wait until the price is affordable. Or, if you cannot wait, you can finance the purchase and do without other things that you can live without. That stipulation behind us, everyone should see why health care is quite different: your needs, not your wishes, should dictate what you get. You don't wish for a new heart, unless you need one. You don't choose to take asthma medication, a doctor prescribes it for you, so you can go on living a normal life. It seems to me that advocates of the free market fail to recognize this simple, basic fact of life and of economics: health care is not a commodity, nor is it a choice. Should it be a right? I believe so. But if it is a right, how far does that right go? Should everybody get everything the system can provide, with no spending limits? How do you prioritize access to services and treatment? Who makes final decisions that affect people's health? As you see, viewing health care as a right is not devoid of controversy, but the fact remains that any controversies pale in the face of the decision of a health insurance company to grant or deny policies or services to an individual, or to the impossibility of an individual to afford adequate health care.
Proponents of free market health care would have you believe that the free market is the best of all possible systems, that everything works just fine the way things are, and that the government would bring fewer choices, higher costs, and more complicated processes. Things are quite different from the way proponents of paint them. Even people like John Caldara and Linda Gorman, who believe that governments should referee things, not run them, should know that administrative costs for services provided by the U.S. government (for instance Medicare and Medicaid or in the VA Administration) are 3 cents on the dollar, compared to anywhere between 15% and 35% for private health insurance companies. They should also know that in Colorado, for example, the number of people without health insurance approaches 800,000 (and the number of the uninsured nationwide approaches 50 million.) It is possible, of course, that some of these uninsured choose not to have health insurance only to spend their money on something else. (The typical example that free-market advocates make is that a twenty-something in good health may prefer to waive health insurance costs and spend the money on a new Jetta or a vacation in Cancun.) In reality, though, most of those without health insurance simply cannot afford it. And many of the insured are under-insured, which they are not even aware of until something goes awfully wrong. And while health care per-capita expenditures in the U.S. are now more than twice as high as those of the next nation, the World Health Organization ranked the U.S. 37th in the world (in 2000) in terms of health care per capita.
If you believe people like John Caldara or Linda Gorman, or even their idol, Milton Friedman, the free market is the best possible system, under all circumstances, and in all walks of life, regardless of context and real-life evidence to the contrary. We should make no concessions, or very few, to government intrusion in the lives of citizens (for instance in matters of law and order) and anyone who says otherwise must be misguided, a commie, or incapable of "independent thinking." Free-market fundamentalists, such as Caldara and Gorman, will not waver in their defense of free-market health care even when all available evidence flies in the face of their preconceived position. What's worse is that their defense allows those whose true motive is greed to keep the miserable status quo by dressing it up as the principled defense of valid economic policies.
I am not against private health insurance in a nation's health care system, even when it does not make economic sense. If that's what some people want, they should be allowed to have it. I am saying that private health care should be in addition to, not instead of, a single payer, government-run system. In other words, everyone should have the reassurance that help will be there when their health is not. The richest and luckiest could then buy an insurance policy to ensure that they would have optional access to more expensive, specialized, or prompter care, without breaking the (fatter-than-average) bank.
My support for public funding of certain fundamental social services applies to another one of Linda Gorman's pet peeves: education. Just like she believes that people should have freedom of choice in health care matters, Ms. Gorman believes that people should not be forced to send their kids to a public school where they will be taught inconvenient beliefs in things their parents disagree with; oh, I don't know... like the Theory of Evolution. On this, I agree with Linda Gorman: people should not be forced to send their kids to a school whose teachings they disagree with. In fact, they are not forced to do so today. They can, if they choose, send their kids to private school, or even—alas—to home school them. That does not mean, however, that public financing of schools should be at the mercy of the whims of any special interest group. Public schools do not have to cater to the various tastes and preferences of mothers and fathers. Their curricula do not have to be shaped by the will of a minority, or even of the majority, enlightened or otherwise--if that were the case. Their only obligation is to provide students with the best possible education, based on generally accepted and proven scientific theories and academic principles. Parents who are not satisfied with the education provided by public schools can send their kids to private schools, if they can afford it, or get engaged to improve the way public schools work.
Where Linda Gorman and I (and hopefully you) disagree in our view of the education system is whether parents who wish to give their kids a different education should be subsidized by the government in the form of school vouchers (basically a rebate on the school taxes which everybody pays to local governments.) I don't believe they should be. Even though I do not have any children, I do not resent the fact that I must subsidize the education of other people's kids, because the portion of my taxes that goes toward public education benefits society as a whole in the long run, including me, my family, and everybody else on this planet. Good education allows people to make better choices (at least in theory), and perhaps even to think not just independently, but also intelligently and critically, so that they may recognize the fallacy of bad ideas, even when are masked by an attractive label, such as Independent Thinking. I'll take critical thinking any day.