Posts Tagged ‘single-payer’

Spurious Invocations and Socialized Medicine

Sunday, 19 March 2017

Advocates for funding or for in-kind provision of medical services through the state — some degree of socialization of medicine — frequently assert that there is a basic human right to health or to medical services. But there is invariably a bait-and-switch, because health cannot be provided as a right, basic or otherwise, universal to human beings or even held by all members of a large, naturally formed community such as a nation; and a right to medical services gauged in terms other than consequences for health would be grossly implausible and otherwise unappealing.

It should be immediately obvious that there cannot be a basic right to medical services, because a basic right exists in any context in which there is a person, even when that person is in isolation. One cannot make a claim to the services of others if there are no others, nor can one make a claim to the use of technologies that simply don’t exist. That’s why genuine liberalism understands that basic rights aren’t claims to the services of others, but instead are claims to be free from various sorts of interference by others. Robinson Crusoe cannot see a doctor when he is alone on the island, yet can speak his mind whether he is alone or has neighbors.

Derived rights are another matter. Derived rights are founded upon basic rights, but may emerge in a social context and be informed by the available resources, including technology. And there might even be a derived right that, though only emerging in some context, were universal to some population and involved positive claims to goods or to services. To provide an argument that health or medical care were just such a right, advocates of socialized medicine would have to identify and explain a process of derivation. While some persons making the assertion that there were instead a basic right to health or to medical care are simply swept-up by emotion, doing so also short-circuits a recognition of responsibility for that identification and for its explanation.

There are advocates who speak and write of the social contract and propose to find support thereïn for socialized medicine at present levels, and perhaps at still greater levels. But what is here called the social contract is not the contract that Hobbesians or liberals once imagined to be adopted at the beginnings of civil society; rather, a set of expectations held by some members of a society is being called a contract, as if such expectations alone could somehow contractually bind everyone within that society. The need to identify and explain the derivation of an ostensible right to medical care remains unmet by the use of the misleading metaphor of a contract. (Perhaps Mr Crusoe expects Friday to begin studying medicine upon arrival, but what of it?) It might also be noted that reference of this sort to a social contract is profoundly conservative — in the original sense of conservative — because the principal informant of expectations about social outcomes is tradition. And, if such expectations did have the sort of moral force that is imputed to them by the invocation of the social contract, then practices such as the subordination of women in various societies could be defended by reference to the social contracts of those societies. Even if such defense is somehow progressive, it is utterly illiberal.

In any case, health itself cannot be delivered as a right universal to human beings nor within some smaller but still large and naturally formed community. Some people have dire medical conditions for which there is no effective treatment, so there is no right to health itself. One might acknowledge that indeed there is no right to health yet assert that there were still a right to medical care; but others have conditions that could be corrected only by diverting resources that would otherwise be used to provide medical treatment to different people; and it is incoherent to speak of rights as things that may be in conflict — indeed, the point of insisting that health or medical care were a right (as opposed to a lesser desideratum) is to make an over-riding claim. One might finally punt to an assertion that everyone simply had a right to medical care regardless of need; but, thus unlinked, there is no more reason to suppose an entitlement to some allotment of adhesive bandages and of aspirin tablets than to suppose an entitlement to an allotment of bubble gum.

The actual provision of medical goods and services under socialized medicine cannot be about rights, and so it isn’t about rights; it is instead a matter of politicized collectivist calculations. Essentially, popular opinion is motivated by a naïve and incoherent utilitarianism — trying somehow to maximize an implicitly quantified sum of human well-being (with perhaps odd lexicographical properties), but making exceptions here and there driven by pity or by respect for some people and enabled by blindness to the costs to others; and officials of various sorts try to keep some share of the public happy but more generally pursue their own interests. Those who are not served under the programme or who find their access to medical care reduced or even effectively ended by socialism are waved-away as unfortunate victims of practical limitations, previous talk of rights not-withstanding.

I’m not at all a fan of collectivist calculations; typically they assume quantifications that don’t hold, and otherwise they seem arbitrary in what they seek to maximize. But, if those calculations truly made sense, then one would want to consider the long run, to include the well-being of people in the future in one’s aggregation; and thereïn lies the rub. Unless one assumes that humankind is fairly soon to come to an end, there are more people yet to be born than are alive to-day. If there truly were a collective aggregate to maximize, then anything done to-day that impaired economic development in the future would be counter-indicated. If people in the future were generally wealthier, then they would enjoy better medical care and almost surely better health. If we allow for considerations beyond the medical, the case for economic development is greater still. And, because it cannot allocate resources with economic efficiency, socialized medicine is ultimately a drag on economic development and thus on medical progress.

Socialized medicine doesn’t deliver a basic right; it doesn’t deliver a derived right; in the long run, it means that more people suffer (though suffering itself has no aggregate across persons) and that at any given age a greater share of people die. Refusing to face these points doesn’t make one a nicer person; accepting the truth doesn’t make one uncaring. Forcing the innocent to swallow bad medicine is not kindness.