On Sunday, Senator Bernie Sanders took to Twitter to deliver one of his usual messages. “People go to the doctor because they’re sick, get a diagnosis from their doctor, but they can’t afford the treatment,” he wrote. “How crazy is that!”
I responded snarkily, “I go to a fancy store to check out a piece of furniture, can’t afford it. That’s totally crazy!”
This prompted spasms of apoplexy on the left. How could I dare to compare medical care to furniture? Was I equating the value of the two? Was I suggesting that the necessity of furniture was somehow comparable to the necessity of medical care?
Of course not. That would be idiotic. I was pointing out that medical care is a commodity, and that in life, we are often faced with commodities we cannot afford. But this mere observation caused a ruckus on the left. “Necessities don’t compare to luxuries!” said one angry tweeter. “Bless characters like Ben Shapiro for demonstrating the complete soullessness of capitalist ideology,” tweeted another.
The idea here seems to be that unless you declare medical care a right rather than a commodity, you are soulless — that as Marx might put it, necessity, rather than autonomy, creates rights.
This is foolhardy, both morally and practically.
Morally, you have no right to demand medical care of me. I may recognize your necessity and offer charity; my friends and I may choose to band together and fund your medical care. But your necessity does not change the basic math: Medical care is a service and a good provided by a third party. No matter how much I need bread, I do not have a right to steal your wallet or hold up the local bakery to obtain it. Theft may end up being my least immoral choice under the circumstances, but that does not make it a moral choice, or suggest that I have not violated your rights in pursuing my own needs.
But the left believes that declaring necessities rights somehow overcomes the individual rights of others. If you are sick, you now have the right to demand that my wife, who is a doctor, care for you. Is there any limit to this right? Do you have the right to demand that the medical system provide life-saving care forever, to the tune of millions of dollars of other people’s taxpayer dollars or services? How, exactly, can there be such a right without the government’s rationing care, using compulsion to force individuals to provide it, and confiscating mass sums of wealth to pay for it?
The answer: There can’t be. Rights that derive from individual need inevitably violate individual autonomy. In response to my tweet, my colleague, New York Magazine’s Jesse Singal, wrote that “free markets are good at some things and terrible at others and it’s silly to view them as ends rather than means.” That’s untrue. Free markets are expressions of individual autonomy, and therefore ends to be pursued in themselves.
Rights that derive from individual need inevitably violate individual autonomy.
Practically, declaring medical care a right does not guarantee its provision. Justice Ruth Bader Ginsburg said at one point that she would model new constitutions on the South African constitution, which guarantees that “everyone has the right to have access to health care services, including reproductive health care. . . . The state must take reasonable legislative and other measures, within its available resources, to achieve the progressive realization of each of these rights.” Yet the World Health Organization ranks South Africa somewhere near the bottom of the globe in terms of medical care.
What happened? Why didn’t the right self-actualize?
Because medical care is a commodity, and treating it otherwise is foolhardy. To make a commodity cheaper and better, two elements are necessary: profit incentive and freedom of labor. The government destroys both of these elements in the health-care industry. It decides medical reimbursement rates for millions of Americans, particularly poor Americans; this, in turn, creates an incentive for doctors not to take government-sponsored health insurance. It regulates how doctors deal with patients, the sorts of training doctors must undergo, and the sorts of insurance they must maintain; all of this convinces fewer Americans to become doctors. Undersupply of doctors generally and of doctors who will accept insurance specifically, along with overdemand stimulated by government-driven health-insurance coverage, leads to mass shortages. The result is an overreliance on emergency care, costs for which are distributed among government, hospitals, and insurance payers.
So, what’s the solution for poor people? Not to declare medical care a “right,” and certainly not to dismiss reliance on the market as perverse cruelty. Markets are the solution in medical care, just as they are in virtually every other area.
Treating medical care as a commodity means temporary shortages, and it means that some people will not get everything we would wish them to have. But that’s also true of government-sponsored medical care, as the most honest advocates will admit. And whereas government-sponsored medical care requires a top-down approach that violates individual liberties, generates overdemand, and quashes supply, markets prize individual liberties, reduce demand (you generally demand less of what you must pay for), and heighten supply through profit incentive.
So, back to the furniture.
#related#Let’s say your life depended on the following choice today: you must obtain either an affordable chair or an affordable X-ray. Which would you choose to obtain? Obviously, you’d choose the chair. That’s because there are many types of chair, produced by scores of different companies and widely distributed. You could buy a $15 folding chair or a $1,000 antique without the slightest difficulty. By contrast, to obtain an X-ray you’d have to work with your insurance company, wait for an appointment, and then haggle over price. Why? Because the medical market is far more regulated — thanks to the widespread perception that health care is a “right” — than the chair market.
Does that sound soulless? True soullessness is depriving people of the choices they require because you’re more interested in patting yourself on the back by inventing rights than by incentivizing the creation of goods and services. In health care, we could use a lot less virtue signaling and a lot less government. Or we could just read Senator Sanders’s tweets while we wait in line for a government-sponsored surgery — dying, presumably, in a decrepit chair.