The Best Things in Life; J. Sparks

THE BEST THINGS IN LIFE ARE NOT FREE JOHN C. SPARKS THE OLD SONG proclaims that the best things in life are free - and specifically extols such romantic items as the moon, the sky, and the flowers in spring. The composer of these popular lyrics doubtless earned his fame and royalties, though his philo sophical sentiments might not win the plaudits of classical econo mists. The latter would point out that the best things derive their value from scarcity and are far from free. A good house that may be free for the taking is extremely scarce - in fact, nonexistent. So are au tomobiles, automatic washers and dryers, stereophonic consoles, en gineering services, the latest medi cal drugs, classical art, fur coats, Mr. Sparks is an executive of an Ohio manu facturing company and a frequent contributor to THE FREEMAN. and endless other items and serv ices - all scarce at prices buyers would prefer to pay.

IVIuch as we might wish to ac quire freely these best things of life, a moment's reflection shows why that is an impossible dream. None of these items is handed to us by nature. None comes into be ing without considerable effort by persons combining skills, years of training, and savings to produce desirable products and services. These products or services exist only because they can command a price, a price sufficient to encour age productivity by those who have the inclination. The fact that some persons are willing to pay for new hats causes scarce and valuable hats to materialize. Many individuals, ,vorking sep arately or grouped in companies, try to attract those who would buy 196 THE FREEMAN April their scarce products and services. Some succeed. Some do not. And respect for the discriminating judgment of potential buyers does more to improve the quality and variety of goods and services "for sale" than does any other factor.

The composer quite properly listed love, happiness, and other intangible wonders among the best of things. It was doubtless intend ed that the individual respond by actions that would earn for him stirring soul satisfactions without an outlay of cash. Several decades later, however, the song's promise has been stretched to cover not only the philosophically-desirable objectives listed by the song writ er, but many economically-desir able products and services as well. Obsessed by desire to consume, prevailing political action attempts to by-pass the essential thought, saving, and labor that produce "the best econornic things." Progress in Medicine Successful performance of a scarce and valuable service is well illustrated in the field of medicine. A medical man of 1868, if given a glimpse· of the parade of medical accomplishments to come in the century just now ended, could scarcely have believed such mir acles possible. The description of such medical treatments, drugs, and procedures would have been a marvel to him, not to mention their blessings upon millions and millions of people. Life spans in creased unbelievably; many com mon and formerly fatal diseases virtually wiped out; human lives blossoming that otherwise had no chance - miracles all!

Such outstanding service in sav ing Iives and restoring health has brought substantial economic re ward to many of these modern men of medicine. In addition to the monetary rewards, many have known the personal satisfaction of serving the unfortunate ones lack ing the funds to pay the full price, or perhaps any price, for needed medical attention. So phenomenal has been medical progress in the United States that one would hardly expect it to be the object of political attack. Yet, a strange brand of collectivist "logic" proclaims the "right" to free services of all kinds, including medical-not the volunteered services of generous physicians to those unable to pay - but the cold, impersonal, regimented service yielded by Federal legislation. By what logic do Americans of any age expect to receive free medical care under a system of compul sion? Some may question the use of the word "free" to describe Medi care benefits. Does not each earner of income pay his own way through 1968 THE BEST THINGS IN LIFE ARE NOT FREE 197 the Federal social security system for Medicare? Furthermore, the doctor's care portion of Medicare is voluntarily chosen and paid for by the citizens. How can these be called "free"?

The answer, of course, is that no service of value can be free. Medi care is not free. It has to be paid for one way or another - or the service will not be forthcoming. But in the Medicare idea is a sub stantial element of something that to many of our countrymen ap pears to be a free benefit - or a partially-free benefit. They find it easy to assume that medical bene fits are in unlimited abundance in s tead of scarce and costly. The service seems to be there for the taking. It is true that medical drugs, technical equipment, and skills are much more plentiful than in years past; yet, they do not grow on trees. Manufacturers spend millions of dollars to con duct research and develop new medicines. But their resources are limited by the amount stockhold ers are willing to risk in the un certainty of researching and devel oping a new product. Not every one is willing or able to endure the long years of study, expense, and self-denial to become a doctor.

Doctors, therefore, are scarce. And so are the allied services such as nursing. Private and public hos pital boards constantly need to raise funds for expanded facilities and improved equipment. And the difficulty in acquiring such funds accounts for the relative scarcity of hospital services. So what? What if those who are covered under the· Medicare pro gram believe that medical services are virtually free and available in great abundance - rather than un free and relatively scarce? What difference does it make? They will receive the benefits, won't they benefits they could not otherwise afford? Consequences of Medicare IV[edicare patients no\v receiving medical attention otherwise be yond their means will not easily be persuaded that Medicare is like ly to downgrade the quality of medicine in this nation. N onethe less, the advent of Medicare and its supplemental programs will tend toward that result.

The discipline of the market that is, the exchange of values be tween persons willing to trade their scarce savings for scarce medical services - is lost, or se verely impaired. Individual de cision-making will be displaced by government compulsion. Tragic results are sure to follow. Keep in mind that the cost of Medicare was estimated by its pro ponents on the low side to render it more palatable to wavering leg198 THE FREEMAN April islators. Costs of government pro grams seldom are estimated ac curately. Medicare ran two or three times over its original esti mate in the first year. Marginal ill nesses that previously would have gone unattended now call for the doctor's attention - and add to the cost of Medicare. Patients seek more frequent and more extended hospitalization - at added cost. Medical services and medical sup plies will broaden in definition so that areas never intended to come under the program will be included - and add to the costs. Opportun ists will flock into the program, in collusion with patients, with sup plies and "semi-hospital" services and activities bordering on the fraudulent - all to become a part of the costs.

Another extra cost - over looked by the proponents of Medicare is the transformation of medical services, formerly performed free or at very low cost, into full price when eligible for government com pensation. One doctor who "be fore-Medicare" spent one day a week gratis with the residents of a home for the elderly, now allows Medicare to pay him more than $1,000 for this day. Beyond all this is the heavy cost of bureaucratic operation and the lost sense of frugality by all par ties in the program - patients, doctors, hospitals, agents, and others. What incentive remains to keep the total cost reasonable? None whatsoever. The social se curity or other tax rates will con tinue to grow until they finally be come unbearable to taxpaying sal ary and wage earners. Greater Federal deficits will bring further inflation. Those to Be Blamed And there will be scapegoats to be sacrificed. Doctors will find their fees first restricted, then fixed. Numbers of Medicare pa tients will be forcibly increased without regard for the number of non-Medicare patients the doctor may prefer to serve. And there will be a revision in policy con cerning other doctors who origi nally refused to cooperate. They will be blamed for the shortcom ings of Medicare, poor attitudes, and lack of uniform coverage and will be forced to join the pro gram.

Private hospitals also will be among the scapegoats when they seek equitable coverage of hospi tal costs not now allowable for re imbursement by the Medicare pro gram. The innocent bystanders will be those persons not covered by Medi care but in need of medical atten tion, attention they will not get because so much of the scarce pro fessional time and effort has gone 1968 THE BEST THINGS IN LIFE ARE NOT FREE 199 into red-tape, restrictions, and un necessary "doctoring." These "for gotten" people, the ineligible, self reliant families, will have to pay twice, first for the Medicare of others, and then for the care of their own families, not to mention the disproportionate share of hos pital overhead expense they will be charged. For such double out~ lay, they will receive minimum time and attention from regiment ed doctors .. This excluded group could hardly be blamed if it were to petition legislators to make Medicare coverage universal.

A further consequence of Medi care will be noted by all too few. The rate of medical growth and discovery of the last hundred years will not be maintained. Bureau cratically fixed fees will discourage the development of new surgical procedures and concepts. Difficult, time-consuming, risky, tiring, ex ploratory efforts ,vill not be worth the candle under Medicare. What fee should a doctor charge for the first heart replacement operation? And why not stick instead to $35 tonsillectomies, and $150 appen dectomies? Advancement in medi cal science is seriously threatened by Medicare. Since the program is now law, why point to the descending path it will follow? Why spell out the terrible price that all Americans the young and the elderly - will pay in terms of lower quality care, the deterioration of medical sci ence, reduced numbers of intelli gent young men entering the field of medicine and scientific medical research? What good in predicting the gloomy future of medicine in the United States? The eggs have been broken, the scrambling under way. Will such portrayals of Medi care's future return .us to our senses? Will this discussion help bring economic understanding?

Will anyone gain from this effort the courage to join in the struggle to restore freedom in this field of human activity so vital to man's 'well-being? I do not know. The Effort to Improve The attempt must be made, how ever, regardless of the heavy odds against any quick rescue of medi cine from the dismal detour it has taken. Some day, the collectivist idea will recede, as honest and in telligent human actions beat it in to retreat. Such gains, however, do not come from wishful think ing or from dire predictions of socialistic evil. Nor is it certain that they will come from the ac tual misery of the adverse results. Human nature is prone to accom modate to adversity which arrives gradually - as might be expected in medical affairs under regimen tation. Only a fresh and better under200 THE FREEMAN April standing of the achievements pos sible in a free society will wean support away from Medicare. Per sons who think they are being practical in support of government medicine might well be persuaded to transfer their allegiance to the institutions of freedom. The search for a magic political form ula that will produce the best eco nomic things is doomed to failure.

New formulas will be offered after each failure - "one more try" which will fail in turn, until hu man gullibility is exhausted. Then a renewed understanding of the blessings of freedom will return to the people of our land. To spread the understanding of freedom is our task. There is no other antidote for the regimenta tion of government control and in terference dedicated to accomplish ing the impossible. Only then will medical services and products be recognized as the best things in life, but far from free. Only then will freedom of choice and free dom of exchange return to the field of medicine. Only then will it resume its jet-like speed toward new miracles of the future. The best things of life are not free. But human freedom is the best means to attain the most de sirable "things" of our lives. ~ Ownership Means Control A MAN is free precisely to the extent that his property rights are intact, because the condition of freedom and the condition of slavery are distinguished on the basis of the right of private property. A freeman owns himself and whatever he comes by lawfully. A slave owns nothing .... Ownership, however, means more than the possession of formal legal title to things. It means control. Control means authority over use, and over disposition as well. It means the condition in which one has the authority to follow his own preferences.

SYLVESTER PETRO From testimony before Senate .Judiciary Committee on the 1966 Civil Rights Act PAUL L. POIROT PERHAPS not always, but often the grass is greener on the other side of the fence. And if there be such a thing as progress, it must be primarily in terms of the free dom of the individual to travel and trade and find out what is beyond that fence. A fence, of course, is a barrier - sometimes natural, as in the case of broad oceans or rivers, impenetrable jungles, lifeless des erts, steep mountainous terrain, or just empty space - sometimes man-made of mined harbors and passes, guarded walls, locked doors, barbed wire entanglements, iron curtains, restraining laws, or just red tape. And lack of knowl edge and information, lack of im agination and initiative and in gen uity, lack of effort, lack of vision and courage and faiththese may be barriers, too, more internal than external.