A Libertarian argument in support of government healthcare and regulatory oversight.

on Saturday, October 8, 2011

Obamacare, will lower per capita insurance costs by forcing everyone to be part of the system. It avoids the risk that only sick people will purchase health insurance, and allows companies to price insurance based on actual disease rates without calculating the probability that a new customer is already sick. This is one reason that group insurance for companies is cheaper per person.

Many people feel it is immoral to force people into the group system, but this is somewhat strange; they often don’t feel it is immoral to force everyone into military-protection “insurance.” We are all forced to pay for universal military protection, and the cost is lower, per capita, because we are all forced into the plan.
If each citizen were able to choose to purchase protection or not (ignoring the free-rider problem), military “insurance companies,” would have higher per person costs to defend its customers. People living in areas more susceptible to enemy attacks would be more likely to purchase protection, just as people more likely to get sick are more likely to purchase health insurance. The same “self-selection bias” problem exists in pricing insurance against international violence.
Additionally, if one is against universal health, one should also be against universal police forces, because people with larger families or more assets enjoy more benefits relative to people who don’t own anything, have no children, and live in safe neighborhoods. If each of us should pay individually for health insurance, surely we should all pay for police and courts based upon how many of our children and assets they are required to protect.
If one claims that he should be free to choose to live with the risk that he may be hospitalized, without insurance protection, should he not similarly demand that he be free to choose life without the protection of police? Should he not be free to select the level of police protection he desires, so that he is free to avoid paying for services and accept the risk that his home may be burgled? If one is in favor of a public police force, one should also favor universal healthcare for the same reasons.
My opinion is that the only legitimate function of government is the military protection of its citizens, and that army services cannot be privatized, because a company with profits as its primary goal would necessarily engage itself in conquest and slave-trading, if motivated by profit and nothing else. Military and governance must be motivated by something other than the desire for material gain; if we must trust someone with enough power to defend the nation, we must also trust them to avoid enslaving the nation.

This is why ancient civilizations separated the merchant class from the nobility; aristocrats were expressly forbidden to engage in any form of trade at all. Trading was to be shunned completely and rulers were raised from birth to be disgusted with the very thought of trading for material gain. Income of royalty was to be donated, citizens were to pay “tribute,” to their leaders who so honorably and nobly protected the kingdom from invasion, unmotivated by the desire for mutual exchange. Rulers and royalty were to be motivated only by honor and and the duty to defend.

If the physical protection of citizens is a government’s only purpose, what difference does it make if invaders are men and machines, or diseases and viruses crossing borders undetected? If it is government’s legitimate duty to protect our physical bodies against damage from bullets and bombs, should it sit idly by if the damage is caused by an infectious agent? What is the difference between an invading army of men, and an invasion by an army of viruses and bacteria? If an alien race were to invade the nation, and each extraterrestrial were no bigger than an atom, would the military be absolved of any duty to defend us? 
If a horde of walking sharks suddenly emerged from the sea, killing millions and leaving a swath of bloody terror in their wake, would it be the responsibility of private citizens to have adequate insurance coverage for their own hospitalization, and enough weapons to fend off the sharks? I don’t see a fundamental difference between an invasion by man-eating sharks, hijacked planes hitting tall buildings, and an army of men with guns crossing the border. Why are citizens asked to pay for a private defense and elimination of intruders when a life-threatening invasion is of one type, but rely on government for protection from another?

To be logically consistent, if one recognizes the necessity of a military entrusted with the duty to defend its people from physical harm, one must also recognize that the size or shape of the invaders does not matter. A person who falls ill at the hands of a virus, hell bent on destroying his body, is no different than a person attacked by an enemy soldier.
Protecting other human beings with powerful weaponry, be they bullets or drugs, is a business of honor and duty, and cannot be operated as private enterprises without encouraging ruinous corruption. A guard must be trusted to refuse bribes, and a general must be trusted to never rent the services of his army, and soldiers must never sell sensitive information, no matter how high the price. 
In the same way, a doctor must be trusted to offer the best advice, drugs, and procedures that are in the patient's best interest. He must be driven by a duty to protect his patient's body from disease, not a desire for profit. A doctor who knows that a $4 drug will be more effective, and have less side effects, must avoid recommending a $100 drug that will earn him a higher commission. He must be trusted to avoid unnecessary procedures and tests, even though he knows they will be profitable for him or his hospital.
The problem in both businesses (doctoring and soldiering) is that customers are powerless to negotiate in good faith. A citizen does not know how much to spend on military, does not know enough about  the stability of international governments to know how dangerous or likely invasion may be. And a patient does not know enough about medicine to know the risks and benefits of various drugs and procedures. Customers are forced to trust doctors and military leaders.

We must trust soldiers to avoid abusing their power by enslaving us tomorrow at gunpoint, or entering our homes to steal our assets, or accepting bribes from those that would do us harm. Soldiers must separate their duties from the desire to profit by trading some of the power they hold for material gain. And doctors must do the same, keeping their duty to their patients separate from their desire to profit by recommending more expensive treatments.
If guarding our borders is a legitimate function of government, medicine should logically be included as a legitimate function as well. Both are jobs best left to men who are motivated not by pecuniary incentives, but instead live to uphold their honor and duty to the citizens that they protect and serve. Both military and doctors must depend upon the profit-driven manufacturing of the private sector, to create weapons and medical equipment, but perhaps a return to the old methods would be best. Perhaps doctors and generals should have no direct access to negotiations, as was done with the aristocracy of the middle-ages. All trading was done at arm’s length, with middlemen and servants engaging themselves in the "nasty, lowly and dishonorable" business of negotiation and trade, so that rulers were free to protect the kingdom from harm without any danger of corruption (trading power for money.)

Guardians and doctors are necessarily in the same business; they both protect people from harm, and both must avoid the temptation to trade power for money at the expense of their customers. 
This is the purpose of regulators. A patient is unable catch a doctor prescribing more expensive or less effective drugs, or performing harmful or useless surgeries. A regulator is designed to know as much as a doctor, and to audit the actions of physicians and insure that they are not taking advantage of patients for profit. They are needed only because patients are incapable of judging a doctor's quality without knowing as much as the doctor (removing the need to hire a doctor).
In any business where one party agrees to care for the other, using superior firepower or knowledge, regulation is needed. One party has agreed to act in good faith, but absent any oversight, is free to abuse the other party without risk; without oversight, the abuse would never be discovered.

A case could be made in support of a private, voluntary regulatory system, where doctors agree to be audited by private-market regulators, but the source of the regulator is not important, per se, because his job is in both cases an honorable duty, and by that I mean to say that he must be trusted with a power to protect us from harm that is unmatched by his salary. A soldier is not driven to fight, or driven to risk his life because of the money he receives. He is driven to protect because he enjoys being “selfless,” he enjoys being viewed as a good man, a hero worthy of respect and honor. He would certainly prefer to avoid a salary in the first place, and instead be showered with enough material gifts to sustain him in a lifestyle befitting a man who risks his life for the well-being of others.

The same can be said of both doctors and regulators, and even professional investment advisors, who require regulation for the same reasons -- they have superior knowledge and have the ability to agree to invest a client’s money in the best way possible, but can secretly invest in vehicles that offer the largest kickbacks and commissions. Again, a business that agrees to care for its clients by using superior knowledge or physical force is a morally dangerous situation that is ripe with opportunities for corruption.

Societies have, in the past, tried to separate trade and protection with caste systems and morality, and today we try to separate them with regulation. It is likely in our best interest to focus not on how "free" or "regulated" markets should be, or on how large government becomes, per se. We must concentrate on separating the duties of guardianship from the business of efficient production. One requires men to faithfully serve those they have sworn to protect, and the other requires an unending willingness to shift from one supplier to another and constant adaption to create the best products possible at the lowest cost. They are fundamentally incompatible processes.