Thursday, July 19, 2007

Libertarian market extremism and health care in the US

Andrew Koppelman at Balkanization:

"I’m writing today in a foul mood, having learned from an old friend with whom I’ve recently reestablished contact that he is going to be moving to Canada because he’s quite ill, has no medical insurance, and will not receive the extended treatment he needs if he stays in the United States...

A frequent trope that the libertarians used, in our conversations, was the invocation of the terrible abuses that existed under Soviet communism. The idea that these exhaust the options on the table is weird. The following is an attempt to explain the weirdness.

Think about the question of treatment of illness – just on the individual level, as the individual decides what to do about his disease. One can imagine analogues to the communist and libertarian offering him advice. One advisor, let’s call him Dr. Frankenstein, suggests the following: “The problem with your body is that it operates by chance natural processes, without human direction. What you need to do is let me completely dismantle your body and put it together again in a completely different way, following a logic that I have carefully worked out, sitting here at my desk.” The other advisor, Christian Scientist, responds: “Your problem is that you haven’t got enough faith in the natural processes in your body. No intervention of any kind is appropriate, other than the prevention of basic physical trauma and starvation. Your body is a wonderfully self-regulating mechanism, which obviously takes care of itself most of the time without any medical intervention at all. It’s a mistake ever to try to interfere with its natural operation.”

Both Frankenstein and Christian Scientist are, not to put too fine a point on it, insane. The person needs medical intervention. The hard question is what kind of intervention he needs. There are sane presumptions that bear a family resemblance to both of these crazies: one can think that illness is evidence that intervention is appropriate, and one can also notice that, given the body’s capacities for self-regulation, intervention can sometimes do more harm than good. But both of these presumptions must await empirical testing, and each can be convincingly refuted in particular cases.

The communist and the libertarian are both loony for similar reasons. Economies are, for the most part, self-regulating, and the desire to micromanage them is crazy for the same reasons that Frankenstein is crazy. But the libertarian is no better. Our free market in medical care has created a state of affairs in which a large chunk of our population is vulnerable to easily preventable diseases, and in which the United States has become uninhabitable for some of its citizens, as my friend’s case illustrates. The faith that the market will fix this is as daft as the faith that prayer will cure my appendicitis."

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