Todd Wilemon, a managing director at NYSE Euronext and a regular Fox Business commenter, was foolish enough to do an interview on health care with The Daily Show (a program about which I had a bit to say over the weekend), and the results are approximately what one would expect, which is to say, he came off like an inarticulate jackass. The headline quote came when Mr. Wilemon was asked about what poor people who cannot afford health insurance should do. His answer: “Stop being poor.”
For that, he is being treated as the second coming of Marie Antoinette (the cartoon Marie Antoinette of the class-warrior imagination, not the actual Marie Antoinette), and held up for sundry scorn and general ridicule.
The fact will not occur to the sort of people who watch The Daily Show, but the persistent lack of access to good health care among poor people in the United States is evidence more for the case of conservative health-care reformers than for Barack Obama and the cruelly misnamed Affordable Care Act. Specifically, it is evidence that we have not learned the critical lesson of Medicaid: Appropriating a certain amount of money and labeling it “health care for the poor” is not the same thing as providing poor people with access to doctors, hospitals, and medicine. It is easy to move money from one pocket to another, which is how we manage to spend a figure approaching a half-trillion dollars per annum on Medicaid with very little to show for it in terms of better health outcomes for poor people. In Tennessee, Medicaid alone spends about $10,000 annually for every poor person in the state, and poor Tennesseans of retirement age or older already have access to Medicare.
We spend the money, but we do not get the health care.
The underlying fact here is: Dollars ≠ Doctors. There are many reasons for that. One is that appropriating money for health care does not exnihilate doctors, pharmaceuticals, or hospitals into existence; rather, it simply injects more money into the chase after the same supply of goods and services, which is a recipe for price inflation rather than one for expanded coverage. Second, it is a terrible program from the providers’ point of view, which is why medical professionals who have a choice increasingly refuse to take on Medicaid patients. Subsidized access to a doctor who categorically refuses to see you is of no benefit to poor people who need medical treatment. One of the critical shortcomings of the Affordable Care Act is that it doubles down on this folly: Its byzantine architecture of subsidies and mandates does not add to the supply of medical goods and services, and in fact probably will reduce that supply as it encourages owners of both human and financial capital to invest their resources elsewhere. A bright and driven young person with the intelligence and ambition to do the grueling work necessary to become a physician has more attractive career choices than that, and investors must certainly think twice about betting large sums of their own money on firms that will be under ever-more-picayune federal micromanagement.
Which is to say: The only real solution to health-care poverty is for people to stop being health-care poor. The solution to relative scarcity is relative abundance. Market-oriented health-care reforms, such as opening up narrow state-regulated health-insurance markets to national (even better: global) competition would draw more resources into health insurance and, more important, into health care itself.
Mr. Wilemon’s “stop being poor” was not a standalone statement. He appended to it the pragmatic counsel that one should work on one’s education and get — and keep — a job, which is how people stop being poor in the developed world.
But there is a broader dynamic at work: Stop being poor is a very good description of U.S. economic policy from the 19th century forward. Free enterprise and free markets were the most important part of that, but there was a role for government activism as well, for instance President Lincoln’s enthusiasm for “internal improvements” and partial political sponsorship of such enterprises as the building of canals and the development of the railway network. If conservatives and a good deal of the public at large are skeptical of the modern analogues of those activities, such as increasing government support for higher education or President Obama’s so-called investments in such industries as alternative energy, it is more because of the fact that our universities have been converted in considerable degree into overfed fiefdoms for left-wing activists and that federal “investments” too often take the form of payoffs to political cronies such as public-sector unions and politically connected businesses that launder some portion of their benefits back into campaign contributions.
While there is a very good case for doing so, conservatives are not very much inclined toward abolishing local public schools or state universities. But more responsibly run universities and public institutions could reasonably expect a more favorable reception from conservatives. It is also the case that conservatives interested in such “internal improvements” as expanding domestic energy production or supplementing the existing electricity-generating infrastructure with nuclear power — excellent investments both, requiring very little beyond getting government out of investors’ way — run into adamantine opposition from the very people who claim to be looking for ways to invest in the future of our economy.
Stop being poor has worked very well for the United States, which is why the United States has a very different set of economic problems than does, say, India or Haiti. Earlier in our national history, confidence in access to basics such as food and shelter was by no means certain for many Americans. But then they stopped being poor. As recently as the 1950s, books were a luxury item for many Americans. But then they stopped being poor. As recently as the 1970s, the cost of groceries consumed a much larger share of the average family’s income than it does today. But then they stopped being poor. Food stamps did not make food plentiful and cheap; more farmland, better irrigation systems, Monsanto lab geeks, and GPS-enabled combines did that.
Moving money around, whether the pot says “health care” or “education,” does not expand wealth, wealth being the available supply of goods and services. Mike Markkula, who was rich enough to be retired at 32, could have paid an extra $250,000 in taxes in 1977 — something closer to “his fair share” as President Obama might put it — or he could have given $250,000 to charity. Instead, he invested $250,000 in the two-man firm of Apple, thereby helping to create a firm valued at just under a half-trillion dollars today, which directly employs some 80,300 people, is responsible for the gainful employment of many more, and helped create a radical expansion in the supply of goods and services available to people — inventing new goods and services along the way. That is how you stop being poor.
Mr. Wilemon will of course be laughed at by all the right people. They should be listening to him. I would be very surprised indeed if there were a single charitable organization in the world that had done as much to help people stop being poor as the New York Stock Exchange has.
— Kevin D. Williamson is roving correspondent for National Review.
Correction: Fox Business writes to note that Mr. Wilemon is not a Fox Business “contributor,” which is a contracted employee, but a regular guest. According to Mr. Wilemon’s bio, he appears on “Bulls and Bears” on Mondays and Thursdays.