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Self-Deception about Medical Care

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Sloppy thinking can make intelligent people say stupid things. Take Christine Cassel. She has been a physician specializing in geriatric medicine for 30 years and recently published Medicare Matters, a brief against privatization of the huge, brittle government program. Interviewed recently on National Public Radio, she made this argument for public support of Medicare: It is not simply a program for the elderly, she said. “It is a family program. If Medicare didn’t exist, we’d be paying those bills.”

I don’t know who Dr. Cassel thinks is paying the bills now, but I have a pretty good idea it’s you and I and anyone else who pays taxes. I truly can’t imagine what Dr. Cassel thought she was saying. It’s possible she was engaging in sophistry, but she might really believe what she said. For many people, government’s distribution of money is completely unrelated to its collection of money. On days they are thinking about distribution, the furthest thing from their minds is collection. It’s self-deception, but it’s effective.

This may be why such people can’t see government for what it is: a massive transfer machine. In the end, all government can do is move money from one person to another. Whether you think that’s right or wrong, let’s at least agree on what it does. Government takes from A to give to B, and it uses the threat of physical force (such as incarceration) to ensure that A will surrender whatever is demanded of him. Government looks a lot less attractive when described in those terms — which may be one reason why people such as Dr. Cassel don’t want to think of it that way. It’s too unpleasant.

Once we see the nature of government clearly, her fallacy becomes glaring. Not everyone has sick elderly parents. Obviously, they would not be paying additional medical bills if Medicare did not exist. Many people have sick elderly parents who would have had medical insurance had Medicare not existed. Those people also would not have had additional medical bills. True, some people have sick elderly parents who would not have had medical insurance. Does that justify Medicare? How so? Ordinarily, we think that being unable to afford something does not justify taking it from someone else. Why is this principle suspended when it comes to medical care?

A large part of Dr. Cassel’s erroneous thinking lies in her failing to realize that if you change one thing, you will necessarily change others. She looks at all the elderly people on Medicare and imagines that if government is subtracted from the picture, all medical care is subtracted with it. Not so. Most people, knowing the government was not going to pay for their care, would have bought private insurance. But that’s only the most obvious answer. Long before there was Medicare and Medicaid, many people of modest and low income received decent medical care through fraternal organizations. Lodges would sign contracts with doctors, in effect buying services in bulk that, throughout the year, would be distributed to members and their families at affordable prices. The system made medical care accessible while maintaining self-responsibility and cost-consciousness.

It was so successful that other doctors, fearing that competition would reduce their incomes, got their government-backed medical societies to crack down on “lodge practice.” Who would argue that today’s precarious method of providing medical care and insurance — through government and bosses — is superior?

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    Sheldon Richman is vice president of The Future of Freedom Foundation and editor of FFF's monthly journal, Future of Freedom. For 15 years he was editor of The Freeman, published by the Foundation for Economic Education in Irvington, New York. He is the author of FFF's award-winning book Separating School & State: How to Liberate America's Families; Your Money or Your Life: Why We Must Abolish the Income Tax; and Tethered Citizens: Time to Repeal the Welfare State. Calling for the abolition, not the reform, of public schooling. Separating School & State has become a landmark book in both libertarian and educational circles. In his column in the Financial Times, Michael Prowse wrote: "I recommend a subversive tract, Separating School & State by Sheldon Richman of the Cato Institute, a Washington think tank... . I also think that Mr. Richman is right to fear that state education undermines personal responsibility..." Sheldon's articles on economic policy, education, civil liberties, American history, foreign policy, and the Middle East have appeared in the Washington Post, Wall Street Journal, American Scholar, Chicago Tribune, USA Today, Washington Times, The American Conservative, Insight, Cato Policy Report, Journal of Economic Development, The Freeman, The World & I, Reason, Washington Report on Middle East Affairs, Middle East Policy, Liberty magazine, and other publications. He is a contributor to the The Concise Encyclopedia of Economics. A former newspaper reporter and senior editor at the Cato Institute and the Institute for Humane Studies, Sheldon is a graduate of Temple University in Philadelphia. He blogs at Free Association. Send him e-mail.