Friday, October 31, 2008


As mentioned below, healthcare is not a right. It has not been recognized as such by the Supreme Court and more importantly it cannot be practically treated as a right. What those who advocate a right to healthcare are proposing is that halthcare be "declared" a right, but this is simply a euphemism. What they really advocate is that healthcare be treated as an entitlement. This is just as impractical however, since the practical limits on recognizing healthcare as a right also apply to viewing it as an entitlement; one that would prove unworkable in practice.

Some people make the false distinction between rights and privileges, concluding that if healthcare is not a right, it must be a privilege. This is not true, as a provider's obligation to provide healthcare services arise from ethical concerns and contractual relationships. They are not privileges bestowed upon a privileged class to be exercised at the pleasure of the favored. The consideration of healthcare in terms of rights and privileges is pointless, because such consideration only seeks to identify a source by which services must be provided, and a rationale by which they may be accessed. These are secondary concerns.

First and foremost, healthcare should be thought of as a limited resource. It is not a social amenity that flows undiminishingly from government altruism, the supply of which is both created by, and is wonderful proof of, community compassion. Healthcare rather is a worthwhile endeavor that is subject to human folly, greed, virtue, and humanity. It is limited by hard choices and the often unacknowledged inadequacies of medical science.

A sound healthcare policy is impossilbe without first recognizing that healthcare is a resource, limited by a finite pool of talented professionals and the practical divide between what is desirable at any cost and what is possible in an economically sustainable system.

One of the great difficulties in managing healthcare as a resource is that conventional methods do not apply. If the government wished to conserve limited resources it would do so by taxing their consumption. If it wanted to encourage development of resources, it would subsidize their production. When the government "provides heathcare" meaning that it acts as the middleman to process payment form the taxpayer, on behalf of the patient to the provider, it in effect subsidizes the consumption of a limited resource. More importantly, it subsidizeds the demand for the resource, leading to inexorably higher costs, as the supply is subject to more practical limitations. This inevitably leads to rationing on the basis of cost.

A more realistic approach is to have any subsidy (if at all) directed toward development of those therapies that are, or will be, cost effective. This obviously also is a form of rationing, but is rationing on the basis of cost efficiency. This has the benefit of favoring those therapies that are not necessarily cheaper, but cheaper for the benefit they provide. This would not deprive patients who are willing to to pay for less cost-effective means of therapy of their choice of care; it would simply use market mechanisms to select out the most cost effective medical practices to make the overall system more efficient..

Thursday, October 30, 2008


As I opine here, the answer is "no." As mentioned, healthcare is not a right, because it is a service that must be provided by others, and no one has a claim of right on the endeavors of another. There is no claim, for example, that one's rights are violated if the police do not prevent a crime.

Furthermore, healthcare is not only a service, it is a limited resource, and the fact that it is limited makes it practically impossible for it to be a right. "Limited" implies that not everyone can have it, and it is absurd to argue that there is a right to something that one cannot have. Consider for example the case of claiming that liver transplants (which are inarguably healthcare) are a right. Obviously there are not enough liver donors to go around, so some people who will die without a transplanted liver will not get one. Any "right" to a new liver in such a case is a rather hollow one.

As a practical matter all heathcare is rationed. This fact is incompatible with healthcare being a right, and it is mere demagoguery to pretend that this is not so. Likewise, healthcare is not a right because there is no firm understanding of what healthcare is. Chiropractic therapy can reasonably be considered healthcare when applied to musculoskeletal ailments, but might be viewed more skeptically when considered a cure for cancer. Aromatherapy may have some health benefits, but it is a strained argument that asserts that it is a right. Some cosmetic procedures might qualify as healthcare while others would not, but drawing the distinction would seem contrary to the spirit of rights.

The range of healthcare services includes a number of interventions of varying degrees of cost, effectiveness and availability. This necessitates the judicious use of some of these modalities, allowing access to some people but not others, again a situation anomalous to the common understanding of rights.

To get around these informities, those who assert that healthcare is a right qualify their claim by saying that "basic" healthcare is a right, a limitation that argues against the premise. That is like saying that the First Amendment guarantees a right to express basic opinions or practice basic religion. Civil libertarians would find little comfort if the Fourth Amendment protected the right of the people to be basically secure in their persons, papers and effects. Rights should rest on firmer foundations than transient interpretations of what is "basic."

Finally, the Supreme Court, through Justice Marshall, understood the importance of healthcare without being gulled into recognizing it as a right (Estelle v. Gamble, 420 U.S. 97):

Similarly, in the medical context, an inadvertent failure to provide adequate medical care cannot be said to constitute "an unnecessary and wanton infliction of pain" or to be "repugnant to the conscience of mankind."

In fact, the Sumpreme Court was even more explicit:

The Constitution imposes no obligation on the States to pay the pregnancy-related medical expenses of indigent women, or indeed to pay any of the medical expenses of indigents.

Maher v. Roe, 432 U.S. 464 (1977) If the Consititution imposes no obligation to pay for the medical expenses of indigents, it cannot be said to guarantee healthcare as a right.

Tuesday, October 28, 2008


"Fairness" has assumed a prominent role in economic and political discussions lately. Pundits and politicians compare varous economic schemes as though fairness were a commodity in itself. I propose here though, that fairness is given too much deference. I submit that an economic plan that leads to the production of wealth, but that is perceived as unfair is better than a fair plan that leads to stagnation.

Fairness is often used as a synonym for justice. This confusion may be deliberate or not, but it is definitely unhelpful. Fairness is an attribute of a process, not an outcome, and is specifically refers to whether such a process is free from bias or improper influence. The outcome of a process may be just or unjust regardless of whether the process was fair. It is seemingly unfair that some basketball teams have players that are taller and more talented than others, yet if the game is played according to the rules free from bias or manipulation, the outcome, even if a foregone conclusion cannot be considered unjust. It may seem unjust that one person takes an entire jackpot for himself, but if the process is the result of a blind lottery or the flip of a fair coin, there seems to be no valid grounds for complaint.

The veneration of fairness as an end rather than as a desirable attribute of a means is the result a common oversight: desirable attributes are desirable first and foremost because they are useful. Fair processes are presumed to produce better results than biased ones, and fair competitions are presumed to produce more worthy winners than those that are rigged. Democracy, for example, accomplishes its purposes more readily when elections are fair than when they are not.

There are many experiences in life that are not fair, simply because there is no benefit of fairness in them. It is not fair that a model citizen develops cancer, while a criminal does not. The purposes and processes of biology are independent of social merit. Likewise, it may seem unfair that the daughter of an industry magnate has certain advantages over the son of a laborer, but this only become true if the latter proves himself more deserving of an outcome that he is then denied.

Fair processes are more likely to lead to just outcomes. Imposing fairness in outcomes is likely to produce only a moribund equilibrium, where no one dares much nor accomplishes much, because results are divorced from merit. And that is not only ultimately unfair, it is unjust.

Wednesday, October 22, 2008


Fantasy is the seed and root of every progressive movement. This is self-evident to some degree, since progressives strive for a condition that does not exist and has never existed, except in the fantasies of the most devout.

Some of these fantasies are meant to be inspirational, like the virtuous proletariat marching arm in arm toward socialist utopia, or the ummah living in Islamic tranquility. Most of these fantasies tend to be fantasies of abstraction, like "fairness" or "justice" or "equality." The abstraction takes the world of the progressive and dessicates it until there is nothing left but the fantastic and unobtainable ideal. But a world that is so narrowly focused ceases to be a world. All progressive movements and their associated fantasies inevitably degenerate into a unitary vision, a homogenizing monotony that is at odds not only with human history, but with the human spirit.

The problem with adopting a fantasy as a world view, is that fantasist often becomes the fanatic, believing not only that his fantasy is desirable to himself but necessary for others. Then, whether it is the degenerate religious fantasies of al Qaeda, or the political fantasies of the Khmer Rouge, or the racial fantasies of the National Socialists, human catastrophe follows.

Fantasy is part of every healthy human mind, but the ability to make the key distinction between fantasy and real life is a necessary part of leaving childish things behind.

Sunday, October 19, 2008


Emotions are notoriously bad counselors. The heat of passion is much more likely to produce regret than glory. It should be remembered that animals have emotions, but this fact does not seem to have contributed much to the collective achievements of the animal kingdom. One typically looks first to the level-headed for direction in a crisis; likewise, chldren are apt to have their conduct directed by emotional wants, a trait that necessitates the involvement of grown-ups in the more crucial decisions.

The pursuit of emotional satisfaction far too often leads to folly and pain, yet a great deal of political discourse targetss emotional chords. This is particularly true in the present campaign, where such airy and vacant themes of change and hope are the center of the debate. It is not cynical to observe that that the vilification of Sarah Palin, the visceral hatred of all things Bush, and the irrational platitudes goading class warfare are appeals to emotion rather than thought. This is not likely to turn out well.

The politics of the moment seek to apply the formidable intellectual, economic and cultural resources of the United States to the ultimate end that persons who share a particular ideology will feel good about themselves. We really aren't being courted by "Change we can believe in" as much as "Change we can feel good about."

Just as the president has very little control over economic cycles (the NASDAQ lost 45% of its value under President Clinton), a president (at least with due respect for the Constitution) can't really deliver on promises of self esteem, or ensure that the emotional tantrums of an ideological fringe will have better uutcomes than the emotional tantrums of preschoolers.

There is a segment of the American Left that wants war-crimes trials, that wants Wall Street executives frog marched on the evening news for the sheer schadenfreud of it. They want to name sewage plants ofter George W. Bush, and "ban" the military from their communities because they think that childish emotions must lead to eternal truths. Of course, those that look to a "progressive" government for progress and emotional satisfaction will be disappointed. The world is too complex and too dangerous to allow serious leaders to accede to the emotional outbursts of angry and unhappy people.