By happy coincidence, shortly after I’d scoffed at Democrat Congressman David Cicilline’s childish and ignorant declaration that “Higher education should be a right” and then written about the point of view that suggests, in essence, that lovers of local farms have a right to have those farms continue to exist no matter how little economic sense it makes, I came across Megan McArdle’s explanation for why “Health Care Is a Business, Not a Right,” wherein she begins:
… Almost everyone feels that there is something fundamentally wrong about making money off of someone else’s illness.
Why do we feel this way? No, don’t sputter and tell me that it’s obvious, that people need health care. People need a lot of things. You’ll die without food long before you’ll die without health care, and yet few people say we need to “take the profit motive out of farming”. (There are some, to be sure, but this was never a widespread sentiment even when food was a lot scarcer and more expensive). Why is health care special?
McArdle describes two types of economic transactions. Because health care involves a complex balance of values among strangers, it must operate according to “market exchange,” wherein prices are set by the market, and anybody wishing to procure a product or service must come up with the dollars corresponding to the value that society at large has placed on it. But because we find it unseemly for people to profit from others’ illness, and because we don’t like the implication that somebody’s life doesn’t measure up to the value of a particular treatment, we allow there to be a patina of “reciprocal altruism” in our health care system.
Reciprocal altruism is essentially a system of bartering in which no tally is actually kept. One person helps another and it’s understood that the latter will at some point return the favor, with abuse being loosely enforced by one party’s unwillingness to help again. Obviously, such a system requires direct interactions and familiarity, such that participants can keep their own general tally of feelings.
A number of movies or TV shows involving country doctors show how we like to think about health care. The doctor appears to operate without being paid — as if in no need of income — and the grateful rural folk bring him produce or even livestock in an unrequested (maybe unwanted) expression of gratitude.
Applying another point of McArdle’s to that cliché shows the problem with using it as the basis for a health care system. Imagine the doctor knows of a treatment that his patient simply couldn’t afford or (tsk! tsk!) that would take more time and risk than the doctor is willing to contribute, given other obligations. With advancing information technology, even a backwoods pig-keeper might learn of the treatment and fault the doctor for withholding it. Unless the market has priced in the work and investment that the doctor has made to become a doctor, the value of every other way he might spend his time, and the scarcity of doctors in the area, he’ll have a hard time making the case to his neighbors that he can’t set the precedent of such broad altruism.
In other words, as our economy becomes more intricate and information technology becomes more pervasive, we need to grow up as a society and recognize that money is just a way of assessing value. There’s nothing untoward about it; it just allows the calculation of unseen factors and forces two parties to be explicit about value.
What progressives want to do instead is to invest the government with the aura of reciprocal altruism (with the assumption of well-meaning “public service”) while giving it the power to calculate and impose prices in the place of the market. As I suggested this morning, this approach simply applies the values of the ruling elite across the entire society without really having to acknowledge to the public that that’s what’s going on.