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How the Free Market Would Handle Quarantines

July 16, 2007

Tags Free MarketsHealthInterventionism

On July 3, doctors announced that Andrew Speaker, the tuberculosis patient who sparked an international outcry when he flouted orders and boarded a jet for Canada, might not be so dangerous after all. The CDC confirms that Speaker's TB, though difficult to treat, is not nearly as drug-resistant as officials thought when they tracked down Speaker on his honeymoon.

For those familiar with the case, the latest wrinkle is par for the course. What follows is a brief summary for those readers who may not have heard all of the (outrageous) details:

  • In January Andrew Speaker was diagnosed with TB (which he thinks he contracted while doing charity work in Vietnam), yet was told he wasn't contagious. He continued to practice law, eat at restaurants, see his fiancée and her young daughter, and all with the knowledge of his doctors.

  • Health officials knew of his plans to get married overseas in May, and they told him (according to Speaker) that they preferred he not travel, but reiterated that he wasn't contagious. For what it's worth, Speaker's new father-in-law, believe it or not, is a CDC expert on tuberculosis, and he and his wife (as well as both of Speaker's parents) also traveled overseas to be at the wedding and watch Speaker kiss his new bride. (I have tried but could not confirm whether the four parents flew on the same plane to Europe as Speaker and his fiancée.)

  • Health officials contacted Speaker while he was still on his honeymoon overseas. They told him that he had XDR-TB, a highly drug-resistant strain that made his case much more serious. They urged him to turn himself into an Italian facility for treatment, where they admitted he could be held "indefinitely." Because they had earlier told him that treatment in Colorado was his one shot for survival, Speaker was reluctant to possibly sign his death sentence by obeying. (The CDC told him he could charter a private jet at his own expense, which would have cost $100,000.) He asked if anything had changed about his being contagious, and they (according to Speaker) wouldn't answer this question. So he and his new wife decided to fly into Canada to avoid the US no-fly list, and then drove a rental car over the border. They claim that they never faked their ID, and that the customs agent let them through because Speaker looked healthy.

  • As the scandal broke, the CDC and Fulton County health officials maintained that they had never told Speaker he wasn't contagious or a risk to others, and painted it as if he were a selfish rebel who bolted. Yet Speaker's father released a hidden recording he had made where the director of the Fulton County health department tells Speaker (before the trip), "because of the fact that you actually are not contagious, there's no reason for you to be sequestered," and "As far as we can tell, you are not a threat to anybody right now." In other words, at this point the authorities are clearly caught lying about what had happened.

  • Speaker is taken into custody as the first patient to be put under federal quarantine since 1963.

  • Now, after all of the above, with online polls asking, "Should Speaker be prosecuted?" and writers calling for more government funding and power, the CDC confirms that its alarmist diagnosis was a mistake, and that Speaker's TB can be treated with antibiotics. (In fairness, I admit that I don't know whether Speaker's new diagnosis would have been grounds for the authorities to track him down on his honeymoon.)

A VOLUNTARY ANALOG TO THE CDC

Despite the typical government screw-ups and cover-ups in the Andrew Speaker case, most people would say, "Yeah I know it's not perfect, but contagious diseases are definitely one area where we need the government. The free market works for TVs and laptops, but not for containing epidemics."

As with other arguments for government programs, this one too suffers from a lack of imagination. If the government relinquished its role in handling contagious diseases, the public would be far safer.

First and most obvious: the government restricts freedom of association, and more specifically, the freedom of property owners to exclude whomever they desire. In the current legal environment, it would be pointless for airlines, bus carriers, amusement parks, hotels, etc. to maintain their own list(s) of people with contagious diseases. If these people weren't considered health risks by the government, then they could sue if (say) Disneyworld refused to let them into the park.

But suppose the government did act as if owners really had the right to control who used their property. What voluntary institutions would spring up to help a free society cope with the problem of contagious diseases?

There are two competing principles that we need to consider. On the one hand, it's bad for business to exclude potential customers for health concerns, especially if it turns out that the exclusion was based on mistaken information. On the other hand, it's really really bad for business if a bunch of customers contract a contagious disease from another customer because of lax oversight.

Since business owners are in no position to make these judgment calls themselves, they would gladly pay for independent health experts to advise them on how best to run their operations and minimize the risks to their employees and customers. Through such consultations and (as always) the profit and loss system, over time an efficient portion of resources would be channeled into disease prevention. For example, salad bars would have sneeze guards, critical employees would wear gloves, and bathrooms would have soap dispensers.

But beyond these fairly obvious safeguards, more sophisticated ones could emerge. For example, specialized consulting firms could assemble teams of medical experts to monitor the world, and identify individuals for the airlines who are at risk for contagious diseases. In order for these flagged travelers to buy tickets and board the plane, they would first need to be checked by the medical consultants (or by their own physicians, if the airlines recognized their competence).

The great difference between voluntary mechanisms versus the monopoly CDC is that the former would have every incentive to do a good job. If an airline turned away certain customers because Ace Medical Consultants said they had TB, when in fact they didn't, this would be horrible for business. Ace's competitors (who had a better track record) would advertise this fact in their brochures and the airline would switch if it thought the rival could do a better job.

In contrast, what will happen to the CDC in light of the Speaker case? Will its budget be slashed? Will heads roll? Of course not, just the opposite: when government agencies botch the job, proponents consider it proof that they're underfunded.

WHAT ABOUT QUARANTINES?

The possibility of quarantines is just a specific application of the above ideas. In a free society where pieces of property are all assigned ownership to specific individuals, there would be no such thing as a person having his "right to walk around" revoked — because there's no such thing as a "right to walk around" in the first place. Rather, what could happen is that someone is considered so dangerous that all of the reputable health agencies place him at the top of their lists, and they hold news conferences, send out emails and faxes, etc. to alert the relevant owners to look out for this person. Major property owners would probably have prearranged agreements on how to deal with cases like this, so that the response could be coordinated.

Private businesses aren't stupid; they don't need the government to order them to keep lepers away. And if a particular church, say, wants to open its doors to such a person, that's perfectly within their rights. (As a matter of courtesy, we would hope this policy would be announced to others who might not want to visit the same building.) Indeed, the final repository for such people would be buildings where the owners thought they could safely contain the disease. And the common name people would use for these buildings is "hospital." In a free society, to be "quarantined" would simply mean that most owners (of roads, sidewalks, malls, hotels, factories, etc.) would refuse access, and so a contagious person would have few choices outside of treatment facilities.

In any event, the bogeyman of a self-centered fugitive carrying a highly contagious disease is a bit unrealistic. As Andrew Speaker himself has said, he was furious when he was told that he might be a danger to others — because had he known that, he wouldn't have been in the same room as his fiancée's young daughter! Those with communicable diseases are people too, and they don't want others getting sick. On top of that, if they want to be treated, they need to go to the hospital anyway.

CONCLUSION

The free market could deal more effectively with contagious diseases, just as it beats the government when it comes to computers, cars, and crops. The very idea that we should give the government the right to lock somebody up because it classifies him or her as a health risk sounds pretty sick to me.

 


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