Health Care Rationing
Arnold Kling
Ezra Klein writes,
Britain and Canada control costs in a very specific fashion: The government sets a budget for how much will be spent on healthcare that year, and the system figures out how to spend that much and no more...
American healthcare controls costs in another way. Rather than deciding as a society how much will be spent in the coming year and then figuring out how best to spend it, we abdicate collective responsibility and let individuals fend for themselves.
He is right about Britain and Canada. He is wrong about America. In America, about 90 percent of health care spending is paid for by third parties--most individuals do not fend for themselves. He also writes as if those who [don't] have health insurance do without health care. They do with less than other Americans, but it is not accurate to say that they do without. [Freudian slip corrected]
My view of the American health care system is that it hardly rations health care at all. That is why we spend so much more than other countries. I wish we put more responsibility on individuals. Instead, we have this delusion that we cannot possibly afford health care if we pay for it individually, but of course we can afford it if we pay for it collectively.
econlog.econlib.org
Some Libertarian Basics
Arnold Kling
In the comments on my health care rationing post, I received many standard attacks as being cold-hearted and willing to deny health care to people who need it.
From a libertarian perspective, your generosity is reflected in what you do with your own money, not in what you do with other people's money. If I give a lot of money to charity, then I am generous. If you give a smaller fraction of your money to charity, then you are less generous. But if you want to tax me in order to give my money to charity, that does not make you generous.
I believe that some health care ought to be provided collectively. I would like to see people who are very poor or very sick receive health care. Are taxes required in order to get this result? Perhaps. But perhaps not.
Think of government as a charity. From a libertarian perspective, it is a charity run by the Mafia, which will break your knuckles if you don't make your donations. It is also a badly mismanaged charity. It funnels lots of money into questionable causes, and even when the causes are good the programs that it funds tend to be very wasteful.
I would like to see government have to compete with other charities on a level playing field. I often say that government should have had to fund the financial bailouts by holding a bake sale.
In an environment with a level playing field, perhaps charities that provide health care to the very poor and the very sick would be better funded and more effective than the existing government programs. If that did not happen in practice, then I might support the Mafia-run charity that we call government.
But being libertarian does not mean you have to have a cold heart. You can be a bleeding heart, but you show it by what you do, not what you advocate forcing other people to do.
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