Tag Archives: care

The Politics of Need

Out of all the comforts and joys we reap in life, none are more crucial to the attainment of our wellbeing than the satisfaction of our basic physical human needs. Human health is so important that without maintaining it, all other desired states—whether social, economic, spiritual, and mental—become unreachable. It is impossible to ponder the nebulous teachings of science and philosophy, for example, when the growls of your empty stomach incessantly drown out the voice of your own mind.

Our preoccupation with satisfying basic human needs, albeit a noble one, has spurred the implementation of markedly ignoble redistributionist public policies. We used to hold capitalism in high regard as a system for alleviating human need, but the massive economic growth it caused, ironically, seems only to have ballooned our intellectual bankruptcy. Alas, the extra time and comfort with which capitalism endowed us has yielded few intellectual rewards besides the various rationales for undermining it (e.g., Marxism, progressivism, social democracy, etc.). As Walter Williams once noted,

“Free enterprise is threatened today in our country not because of its failure—it’s threatened because of its success. That is, capitalism has been so successful in eliminating the traditional problems of mankind, such as disease, pestilence, hunger, and gross poverty, that all other human problems appear to us, to be at once, inexcusable and unbearable. The desire by many Americans to eliminate these so called ‘unbearable and inexcusable’ problems has led us away from the basic ideals and principles upon which our prosperous nation was built.”

The desire to eliminate “unbearable and inexcusable” problems underlies almost every American redistributionist policy, from free/reduced school lunches for children to Medicare and Medicaid. It is exceedingly difficult to fight against this rationale, as the advocates of these policies invariably label any contenders as uncompassionate brutes vying to deny their fellow man of food and medicine. A libertarian would generally respond that supporting or opposing the government provision of a good or service is unrelated to whether or not that good or service is provided at all. But then the question becomes not whether a particular good or service is needed, but whether one thinks human need justifies the use of force to obtain it. Before we can answer that question, however, we must first explore the concept of need itself.

The Emergency Medical Treatment and Active Labor Act (EMTALA) gives an illustrative exposé of how Americans view “need.” Enacted in 1986, EMTALA forces hospital workers to provide emergency screening for anyone who requests it—regardless of that person’s ability to pay—and then either treat that person or transfer him to a proper treatment facility. The rationale for this law is the familiar argument from human necessity, that it is the responsibility of a compassionate people to provide for the basic needs of other humans, despite any and all costs incurred in meeting that obligation.

Setting aside momentarily any arguments from morality or efficiency, we can already see one obvious problem with the politics of need: Before you can claim that humans require a thing to live, you must first define what that thing is. For the purposes of political expediency, it has in this case been defined as emergency care provided by anyone working within a hospital, but there have been many kinds of health care other than purely the services of professionals within hospitals. Comprehensive freshwater and sewer systems, healthy diets, good hygiene, abstaining from alcohol and tobacco, regular exercise, animal therapy, and even feng shui can all be considered forms of health care—and those are just examples of physical health care! There are also many forms of mental health care, such as study, meditation, and reading, which the law doesn’t deal with. If health care is such an amorphous concept that it could encompass just about every aspect of life, then is there anything that we as a society cannot demand from individuals with such “health”-related resources and expertise? There can be no logical limit to the sense of entitlement on which the law is based.

Claiming that health care is required to live also requires defining what it means to live. This is not some mere esoteric quibble. The treatments for some incurable diseases do nothing more than marginally improve the quality of life for the afflicted, blurring the boundary between life-saving health care and quality-of-life health care. Equally obscure is the boundary separating quality-of-life health care and other quality-of-life items that we would not normally consider tools of health care, such as therapy furniture or pets. If the former can be demanded on the basis of improving quality of life, cannot the latter also be demanded on the same basis?

The inconsistencies in these concepts are not only frustrating, but also ultimately exploitative and immoral. Forcing private individuals or hospitals to provide for someone’s health care without compensation destroys any and every notion of individual property rights we have. I imagine that the proponents of EMTALA would balk at this assertion; they would emphatically reject, for example, the forced redistribution of jewelry or leaf-blowers—“individuals still have the right not to provide those to the poor” they would say—but then they are just being inconsistent. As health and nutrition gradually improve in this country (despite our government social safety net; not because of it), and as our “unbearable and inexcusable” problems fade into the distance, we will see the emergence of new problems to take their place. The “[X] is a necessity” rationale can theoretically, with enough logical finagling and patience, be applied to any good and service, such as education, housing, clothing, or even automobiles, and we can expect to see the politics of need envelop these as well, until there is ultimately no good or service to which anyone can justifiably deny provision to another. We used to call those without any rights to their property “slaves.” Now we call them “well-off.”

EMTALA needs to be repealed because of its immorality and its inconsistency. Moreover, we should abandon any sense of entitlement based on notions of necessity, and re-employ the concepts of property rights that gave us the societal wealth we have, and that will propel us into the next age of prosperity.

Advertisements

Mandating Failure

The recent decision by U.S. District Court Judge Henry Hudson striking down the “individual mandate” component of the Patient Protection and Affordable Care Act poses an interesting question regarding access to affordable health care in America which has generally gone overlooked: do we even want everyone to be covered under health insurance?

In a segment for ABC’s show 20/20, John Stossel exposes some of the lesser known costs incurred by consumers and health care providers as a result of health insurance.

Insurance is effective when it protects patients from unforeseeable, catastrophic illness or injury. It’s a voluntary pooling of wealth against the risk of such events occurring. It isn’t designed to pay for predictable, and often unneeded, day-to-day care. Unfortunately, the latter has over time become the paradigm regarding health insurance, and this taking for granted of mundane care has caused an unnecessary increase in the demand for said care, which in turn has been increasing its price well beyond the rate of inflation.

Given what we know now, what could be the result of a law mandating the purchase of health insurance? We can most likely expect people to demand more health care. After all, insurance allows them to get it virtually “for free.” This will either intensify the trend of growing health care costs, create shortages, or both. It would also likely lead to higher insurance premiums, deductibles and co-payments.

The example of LASIK also brings up an important point. Obviously, it’s not feasible to shop around for the cheapest emergency/urgent care when you’ve had a heart attack or accidentally chopped off your finger, and insurance is necessary as a safety net for procedures dealing with those and similarly immediate problems. But what if insurance paid for only those procedures, and nothing else–what if we paid out of our own pockets for every other thing? Consumers would no longer be insulated from the true cost of their care. They’d shop around for the best deals, and hold health care providers accountable for their own costs as well. If nothing else, it would create more incentive for people to engage in healthy living and preventative care.