[ExI] Yet another health care debate

[Lee Corbin]

Damien S. writes

> Another take:
> communism doesn't work because it assumes away the high-frequency bits
> of human nature where we're greedy and looking out for ourselves,
> friends, or family, and out to get stuff without working for it.

That's one reason. But having read Hayek, you will recall that he
was keen to advance the notion that central planning cannot take
into account the myriads of small decisions that must be made.
The commissars simply *cannot* know what price to set for shoes
or exactly what kind to make. The feedback provided by the free
market alone can do it (so far in history).

> libertarianism doesn't work, or rather doesn't last, because it assumes
> away the high-frequency bits of human nature where we like taking care
> of each other *and* don't like being the only ones to take care of
> people.

Libertarianism on this narrow aspect did work for quite a number
of years: when government was small (and still shrinking) in 1855
people in America understood that they needed to lookout for
themselves and for their friends, families, and neighbors. There was
no overweening state to take away this actually vital part of community
living.

> More exactly, most people don't like seeing members of their in-group
> die, especially preventably.  There's some flexibility here: who's in
> our in-group, would we rather help our or avoid knowing that someone's
> in need, will we hope that someone else will step in before we have to.
> But when we're clearly the only ones who can, at low cost to ourselves,
> keep someone else from dying, most of us will rise to the occasion.

Yes.

> The generalized version of this is that most of us don't like people
> starving or dying due to lack of cheap medicine, even without the
> thought that that might be us some day.  So we want people helped... but
> we also don't want to be suckers, helping all the poor by ourselves.

No, most poor people figure that the government should make
the rich pay for it. The rich figure that the corporations should
pay. The costs skyrocket when it's OPM.

> Absent a really powerful social reputation system that can reward
> charity, that means taxes, in this case a draft of the rich, or the
> non-poor.
> 
> Thus public granaries, tithes to church charities, alms tax, welfare
> systems.  Thus also, in the US, the mandate that emergency rooms can't
> turn people away.  We don't have a pure free market in health care for
> many reasons, but *that* is among the most fundamental.  When you're
> sick, there's somewhere you can go that'll help you.
> 
> Thing is, giving food to the starving is pretty effective.  Giving
> medicine to the sick... is actually kind of inefficient, compared to
> preventing them from getting sick in the first place.  Once we accept
> the moral commitment to help the sick, it then becomes cheaper to
> support the whole process, not just the endpoint.  Vaccines and checkups
> and cancer screenings, rather than waiting for cancerous pneumonia
> patients to stagger their way into ER.  Let alone dealing with people
> using ER for their less urgent needs because they can't afford more
> regular channels.
> 
> So the sensible economic choices are full universal health care, or
> laissez faire and let them die on the streets.

They wouldn't generally die on the streets. This is *not* what
laissez-faire leads to. Again, it leads to allowing the people close
(in one way or another) to those in need (and who therefore
have the most knowledge) to take charge.

But what really riles some of the idealists on this list, evidently,
is the *possibility* of starvation, freezing, or some other form
of death. I dare say that fewer people starved to death in
19th century America per capita than in almost all other nations.
Why? Simple. It was because America was so rich. I strongly
suspect that if the U.S. had resisted socialism (which it has not,
whether it's social security, the government wrecking of the
financial system, the enormous debt, billions and billions of
wasted dollars due to over-regulation), then today America
would be so *much* richer than it is now, that even fewer
people would have a hard time of it. Really---nothing works
like freedom, and it is unfortunate that most Americans no
longer realize that. 

Lee