Making Economic Sense
Making
Economic Sense
by Murray Rothbard
(Contents
by Publication Date)
Chapter 35
The Health Plan's Devilish Principles
The standard media cliche about the Clinton health
plan is that God, or the Devil,
depending on your point of view, "is in the details." There is
surprising agreement among both
the supporters and all too many of the critics of the Clinton health
"reform." The supporters say
that the general principles of the plan are wonderful, but that there
are a few problems in the
details: e.g., how much will it cost, how exactly will it be financed,
will small business get a
sufficient subsidy to offset its higher costs, and on into the night.
The alleged critics of the Clinton Plan also hasten
to assure us that they too accept the
general principles, but that there are lots of
problems in the details. Often the critics will present
their own alternative plans, only slightly less complex than the
Clinton scheme, accompanied by
assertions that their plans are less coercive, less costly, and less
socialistic than the Clinton effort.
And since health care constitutes about one-seventh of the American
output, there are enough
details and variants to keep a host of policy wonks going for the rest
of the their lives.
But the details of the Clintonian plan, however
diabolic, are merely petty demons
compared to the general principles, where Lucifer really lurks. By
accepting the principles, and
fighting over the details, the Loyal Opposition only succeeds in giving
away the store, and doing
so before the debate over the details can even get under way. Lost in
an eye-glazing thicket of
minutiae, the conser vative critics of Clintonian reform, by being
"responsible" and working
within the paradigm set by The Enemy, are performing a vital service
for the
Clintonians in snuffing out any clear-cut opposition to Clinton's Great
Leap Forward into health
collectivism.
Let us examine some of the Mephistophelean general
principles in the Clintonian reform,
seconded by the conservative critics.
1. GUARANTEED UNIVERSAL ACCESS. There has been a
lot of talk recently about
"universal access" to this or that good or service. Many "libertarian"
or "free-market" proponents
of education "reform," for example, advocate tax-supported voucher
schemes to provide "access"
to private schooling. But there is one simple entity, in any sort of
free society, that provides
"universal access" to every conceivable good or service, and not just
to health or education or
food. That entity is not a voucher or a Clintonian ID card; it's called
a "dollar." Dollars not only
provide universal access to all goods and services, they provide it to
each dollar-holder for each
product only to the extent that the dollar-holder desires. Every other
artificial accessor, be it
voucher or health card or food stamp, is despotic and coercive, mulcts
the taxpayer, is inefficient
and egalitarian.
2. COERCIVE. "Guaranteed universal access" can only
be provided by the robbery of
taxation, and the essence of this extortion is not changed by calling
these taxes "fees, . . . .
premiums," or "contributions." A tax by any other named smells as
rotten, and has similar
consequences, even if only "employers" are forced to pay the higher
"premiums."
Furthermore, for anyone to be "guaranteed" access
to anything, he has to be forced to
participate, both in receiving its "benefits" and in paying for them.
Hence, "guaranteed universal
access" means coercing not only taxpayers, but everyone as participants
and contributors. All the
weeping and wailing about the 37 million "uninsured" glosses over the
fact that most of these
uninsured have a made a rational decision that they don't want
to be "insured," that they are
willing to take the chance of paying market prices should health care
become necessary. But they
will not be permitted to remain free of the "benefits" of insurance;
their participation will
become compulsory. We will all become health draftees.
3. EGALITARIAN. Universal means egalitarian. For
the dread egalitarian theme of
"fairness" enters immediately into the equation. Once government
becomes the boss of all health,
under the Clinton plan or the Loyal Opposition, then it seems "unfair"
for a rich man to enjoy
better medical care than the lowest bum. This "fairness" ploy is
considered self-evident and
never subject to criticism. Why is "the two-tier" health system
(actually it has been multi-tier)
any more "unfair" than the multi-tier system for clothing or food or
transportation? So far at
least, most people don't consider it unfair that some people can afford
to dine at The Four
Seasons and vacation at Martha's Vineyard, whereas others have to rest
content with
McDonald's and staying home. Why is medical care any different?
And yet, one of the major thrusts of the Clinton
Plan is to reduce us all to "one-tier,"
egalitarian health care status.
4. COLLECTIVIST. To insure equality for one and
all, medical care will be collectivist,
under close supervision of the federal Health Care Board, with health
provision and insurance
dragooned by government into regional collectives and alliances. The
private practice of
medicine will be essentially driven out, so that these collectives and
HMOs will be the only
option for the consumer. Even though the Clintonians try to assure
Americans that they can still
"choose their own doctor," in practice this will be increasingly
impossible.
5. PRICE CONTROLS. Since it is fairly well known
that price controls have never
worked, that they have always been a disaster, the Clinton
Administration always keen on
semantic trickery, have stoutly denied that any price controls are
contemplated. But the network
of severe price controls will be all too evident and painful, even if
they wear the mask of
"premium caps, . . . . cost caps," or "spending control." They will
have to be there, for it is the
promise of"cost control" that permits the Clintonians to make the
outrageous claim that taxes
will hardly go up at all. (Except, of course, on employers.) Tight
spending control will be
enforced by the government, not merely on its own, but particularly on
private spending.
One of the most chilling aspects of the Clinton
plan is that any attempt by us consumers
to get around these price controls, e.g., to
pay higher than controlled prices to doctors in
private practice, will be criminalized. Thus, the Clinton Plan states
that "A provider may not
charge or collect from the patient a fee in excess of the fee schedule
adopted by an alliance," and
criminal penalties will be imposed for "payment of bribes or
gratuities" (i.e. "black market
prices") to "influence the delivery of health service."
In arguing for their plan, by the way, the
Clintonians have added insult to injury by
employing absurd nonsense in the form of argument. Their main argument
for the plan is that
health care is "too costly," and that thesis rests on the fact that
health care spending, over recent
years, has risen considerably as a percentage of the GDP But a spending
rise is scarcely the same
as a cost increase; if it were, then I could easily argue that, since
the percentage of GDP spent on
computers has risen wildly in the past ten years, that "computer costs"
are therefore excessive,
and severe price controls, caps, and spending controls must be imposed
promptly on consumer
and business purchases of computers.
6. MEDICAL RATIONING. Severe price and spending
controls means, of course, that
medical care will have to be strictly rationed, especially since these
controls and caps come at the
same time that universal and equal care is being "guaranteed."
Socialists, indeed, always love
rationing, since it gives the bureaucrats power over the people and
makes for coercive
egalitarianism.
And so this means that the government, and its
medical bureaucrats and underlings, will
decide who gets what service. Medical totalitarians, if not the rest of
us, will be alive and well in
America.
7. THE ANNOYING CONSUMER. We have to remember a
crucial point about
government as against business operations on the market. Businesses are
always eager for
consumers to buy their product or service. On the free market, the
consumer is king or queen and
the "providers" are always trying to make profits and gain customers by
serving them well. But
when government operates a service, the consumer is transmuted into a
pain-in-the-neck, a
"wasteful" user-up of scarce social resources. Whereas the free market
is a peaceful cooperative
place where everyone benefits and no one loses; when government
supplies the product or
service, every consumer is treated as using a resource only at the expense
of his
fellow-men. The "public service" arena, and not the free market, is the
dog-eat-dog jungle.
So there we have the Clintonian health future:
government as totalitarian rationer of
health care, grudgingly doling out care on the lowest possible level
equally to all, and treating
each "client" as a wasteful pest. And if, God forbid, you have a
serious health problem, or are
elderly, or your treatment requires more scarce resources than the
Health Care Board deems
proper, well then Big Brother or Big Sister Rationer in Washington will
decided, in the best
interests of "society," of course, to give you the Kevorkian treatment.
8. THE GREAT LEAP FORWARD. There are many other
ludicrous though almost
universally accepted aspects of the Clinton Plan, from the gross
perversion of the concept of
"insurance" to the imbecilic view that an enormous expansion of
government control will
somehow eliminate the need for filling out health forms. But suffice it
to stress the most vital
point: the plan consists of one more Great Leap Forward into
collectivism.
The point was put very well, albeit admiringly, by
David Lauter in the Los Angeles Times
(September 23, 1993). Every once in a while, said Lauter, "the
government collectively braces
itself, takes a deep breath and leaps into a largely unknown future."
The first American leap was
the New Deal in the 1930s, leaping into Social Security and extensive
federal regulation of the
economy. The second leap was the civil rights revolution of the 1960s.
And now, writes Lauter,
"another new President has proposed a sweeping plan" and we have been
hearing again "the
noises of a political system warming up once again for the big jump."
The only important point Mr. Lauter omits is
leaping into what? Wittingly or unwittingly,
his "leap" metaphor rings true, for it recalls the Great Leap Forward
of Mao's worst surge into
extreme Communism.
The Clinton health plan is not "reform" and it
doesn't meet a "crisis." Cut through the
fake semantics, and what we have is another Great Leap Forward into
socialism. While Russia
and the former Communist states are struggling to get out of socialism
and the disaster of their
"guaranteed universal health care" (check their vital statistics),
Clinton and his bizarre Brain
Trust of aging leftist
grad students are proposing to wreck our economy, our freedom,
and what has been, for all of the ills imposed by previous
government intervention, the best
medical system on earth.
That is why the Clinton health plan must be fought
against root and branch, why Satan is
in the general principles, and why the Ludwig von Mises Institute,
instead of offering its own
500-page health plan, sticks to its principled "four-step" plan laid
out by Hans-Hermann Hoppe
(TFM April 1993) of dismantling existing
government intervention into health.
Can we suggest nothing more "positive?" Sure: how
about installing Doc Kevorkian as
the Clinton family physician?
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