Thomas Szasz, author of "The Myth of Mental Illness," in 1961, wrote a brilliant editorial in the Wall Street Journal last week criticizing universal healthcare. In case the link does not work, or becomes inoperable, I've pasted the entire piece below, in italics.
People who seek the services of auto mechanics want car repair, not "auto care." Similarly, most people who seek the services of medical doctors want body repair, not "health care."
We own our cars, are responsible for the cost of maintaining them, and decide what needs fixing based partly on balancing the seriousness of the problem against the expense of repairing it. Our health-care system rests on the principle that, although we own our bodies, the community or state ought to be responsible for paying the cost of repairing them. This is for the ostensibly noble purpose of redistributing the potentially ruinous expense of the medical care of unfortunate individuals.
But what is health care? The concept of reimbursable health-care service rests on the premise that the medical problem in need of servicing is the result of involuntary, unwanted happenings, not the result of voluntary, goal-directed behavior. Leukemia, lupus, prostate cancer, and many infectious diseases are unwanted happenings. Are we going to count obesity, smoking, depression and schizophrenia as the same kinds of diseases?
Many Americans would willingly pay for insurance to protect them against the exorbitant cost of treating their own leukemia. But how many Americans would willingly pay for insurance to protect them from the expenses of treating their own depression?
Everyone recognizes that the more fully we wish insurance companies to defray our out of pocket expenses for our car repairs, the higher the premium they will charge for the policy. Yet foregoing reimbursement for trivial or unnecessary health-care costs in return for a more suitable health-care policy is an option unavailable under the present system. Everyone with health insurance is compelled to protect himself from risks, such as alcoholism and erectile dysfunction, that he would willingly shoulder in exchange for a lower premium.
The idea that every life is infinitely precious and therefore everyone deserves the same kind of optimal medical care is a fine religious sentiment and moral ideal. As political and economic policy, it is vainglorious delusion. Rich and educated people not only receive better goods and services in all areas of life than do poor and uneducated people, they also tend to take better care of themselves and their possessions, which in turn leads to better health. The first requirement for better health care for all is not equal health care for everyone but educational and economic advancement for everyone.
Our national conversation about curbing the cost of health care is crippled by the vocabulary in which we conduct it. We must stop talking about "health care" as if it were some kind of collective public service, like fire protection, provided equally to everyone who needs it. No government can provide the same high quality body repair services to everyone. Not all doctors are equally good physicians, and not all sick persons are equally good patients.
If we persevere in our quixotic quest for a fetishized medical equality we will sacrifice personal freedom as its price. We will become the voluntary slaves of a "compassionate" government that will provide the same low quality health care to everyone.
Henry David Thoreau famously remarked, "If I knew for a certainty that a man was coming to my house with the conscious design of doing me good, I should run for my life." Thoreau feared a single, unarmed man approaching him with such a passion in his heart. Too many people now embrace the coercive apparatus of the modern state professing the same design.
Szasz's piece is so good on so many levels, it's difficult to know where to begin to comment.
For me, I think it's mostly focused on two aspects of his editorial.
The first wisely distinguishes between uncontrollable illness and effects of voluntary, unhealthy behavior. Clearly, it makes no sense for government to make everybody pay for everybody's bad lifestyle choices.
Szasz's comparison of healthcare to automotive repair is quite good, too. Or perhaps I should say contrast, because he notes that the "healthcare" is not a public service, like fire protection, which is equal when consumed, and a genuine public good.
Instead, he views it more like the choices you make when insuring your car. But that insurance doesn't cover repairs, only accidents.
And that, Szasz contends, is really all that healthcare insurance should cover, too.
Very astutely expressed, Dr. Szasz.
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2 comments:
Yeah, OK. The idea that illness is the result of voluntary choice is a pretty callous and inhumane one. It's reminiscent of good old Ronny Reagan, who said that people are homeless because they choose to be homeless.
The reality is that we're paying enormous amounts of money for worse results -- and we have 45 million uninsured.
The civilized option, followed by every other industrial democracy, is to make health care a guaranteed protection for every citizen.
Clint-
Thanks for your comment. It's not often I get to shoot at such an easy target.
First, your reality is wrong. There aren't 45 million uninsured. One very good analysis I read last month carefully classified the group to be at most about 8 million. Hardly enough to warrant destroying our existing healthcare system.
Szasz is not inhumane. His points are valid. Some disease is the result of voluntary actions, and I don't want to pay for yours or anyone elses.'
Reagan was right, in the sense that people made choices that often left themselves homeless.
It's not necessarily "the civilized option" at all to make blanket, open-ended healthcare guaranteed for every American.
Rather, it would be reasonable to give each American a tax credit with which to buy health insurance. Period.
-CN
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