By Ben Shapiro
Wednesday, January 11, 2017
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.
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.
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.
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