Why libertarianism fails in health care
During Monday’s debate, CNN’s Wolf Blitzer asked whether an uninsured 30-year-old who had chosen to go without insurance should be left to die if he falls unexpectedly ill. Ron Paul dodged the question. “What he should do is whatever he wants to do and take responsibility for himself,” Paul said. “That’s what freedom is about.” Blitzer pressed the issue. “But, Congressman, are you saying the society should just let him die?” “Yeah!” whooped the crowd. But Paul stammered out a “no.” And perhaps for good reason.
In 2008, his campaign manager, a healthy-but-uninsured 49-year-old, died from pneumonia and left his family with $400,000 in medical debt.
I want to be delicate in how I write this post. Kent Snyder was a friend of Paul’s, and a remarkable organizer on behalf of the causes he believed in. His early death was tragic. But I want to make a policy observation that applies to millions of cases just like Snyder’s.
Health-care services are somewhat unique in that they’re a rare form of consumption that you often get and get charged for, even if you haven’t asked for them. If you collapse on a street, an ambulance will rush you to a hospital. If you get into a car accident, you’ll wake up in intensive care. If you start suffering from dementia, your family will ask the doctors to help you.
Perhaps you would have preferred that it was otherwise. Perhaps you believe so deeply in personal responsibility that you would sacrifice your life to demonstrate that individuals must suffer for their bad decisions. But it may not be up to you, and whether you get billed or your family gets billed or society gets billed, someone will pay the bill.
It’s all well and good to say personal responsibility is the bedrock of liberty, but even the hardest of libertarians has always understood that there are places where your person ends and mine begins. Generally, we think of this in terms of violent intrusion or property transgressions. But in health care, it has to do with compassion.
We are a decent society, and we do not want to look in people’s pockets for an insurance card when they fall to the floor with chest pains. If we’re not going to look in their pockets, however, we need some answer for who pays when they wake up — or, God forbid, after they stop breathing — in the hospital. And though it sounds nice to say that charities will pick up the slack, any hospital system in America will tell you that even with Medicare and Medicaid assuming much of the burden for the most intractable and expensive cases, charities are not capable of or interested in fully compensating the medical system for the services needed by the un- or underinsured.
(This article originally stated that Snyder was 30 at the time of his death. In fact, he was 49. The text has been edited to reflect that correction — Ezra.)