The Immorality of Government Mandated Health Care; P. Cleveland

2. C. Fleischman and v. Lubamudrov, "Heart to Heart: Teaching Pediatric Cardiology and Cardiac Surgery to Nurses in St. Petersburg, Russia," Journal ofPediatric Nursing, Vol. 8, No.2, April, 1993, p. 135. 3. Pavel D. Tichtchenko and Boris G. Yudin, "Toward a Bioethics in Post-Communist Russia," Cambridge Quarterly of Healthcare Ethics, No.4, 1992, p. 298. 4. Here in the United States the system of fully socialized medicine is not yet complete, but we already observe the "parallel" system of health care for bureaucrats who enjoy coverage practically unseen in the private sector. Referring to this system, Dr. Stuart Butler of the Heritage Foundation remarked: "Why reinvent the wheel? If a working health-care system already exists, that's good enough for official WashTHEFREEMAN IDEASON UBERTY ington, why not to use it as our model, improve upon it and let the rest ofAmerica enjoy the same kind of program as members of Congress and Clinton's White House staff." Heritage Today, Winter 1994, p. 4.

5. N. Eberstadt, The Poverty ofCommunism (New Brunswick: Transaction Books, 1990), p. 14-15. 6. The Lancet, Vol. 337, June 15, 1991, p. 1469. 7. The Economist, November 4, 1989, p. 24. 8. Radio Free Europe-Radio Liberty Daily Report, Feb ruary 16, 1994. 9. George Schieber, "Health Care Financing Reform in Russia and Ukraine," Health Affairs, Supplement 1993,p. 294. 10. Michael Ryan, "Health Care in Moscow, British Med ical Journal, Vol. 307, September 1993," p. 782. 11. Joseph L. Bast, Richard C. Rue, and Stuart A. Wes bury, Jr., Why We Spend Too Much on Health Care and What We Can Do About It (Chicago: The Heartland Institute, 1993), p. 101. The Immoralityof Government-Mandated Health Care by Paul A. Cleveland A s America's politicians debate the issue of health-care reform, one element seems strangely missing from their deliber ations: the question of the morality of gov ernment-mandated health insurance. Is it moral for government to institute such in surance or to force employers to provide it?

The current debate assumes that it is. Dis cussion has centered primarily on how far coverage can be extended, with no effort to defend the morality of mandated coverage. To examine the morality of the proposed health reform we must ask the following questions: What is the role of government .Dr. Cleveland is Professor of Economics and Finance at Birmingham-Southern College in Al abama. and what are its moral bounds? Also, how do these bounds apply to the current health care reform debate? If, in this examination, it is discovered that government has no proper authority to insure the availability of goods and services generally, then all health-care reform proposals seeking to es tablish the provision of health insurance should be rejected. The uncritical acceptance of the proposi tion that a major purpose of government is to insure the provision of some goods or services is related to another popularly held proposition. That notion, either conscious or unconscious, is that government can miraculously generate resources to provide for people's needs. But, how is that possiTHE IMMORALITY OF GOVERNMENT-MANDATED HEALTH CARE 595 ble? Can government actually create mate rial prosperity where none existed before hand? Can it cause by fiat an increase in the number and kinds of products produced without harm? It should be self-evident that the answer to these questions is no. Gov ernment cannot create by mandate. It relies on its power of taxation and coercion to provide material benefits to selected citi zens. In order for it to provide some benefit for an individual it must impose a cost of equal or greater value either on that indi vidual or on someone else. Nevertheless, the mythical concept that government can provide cost-free benefits continues largely on the basis of wishful thinking and covet ousness.

No Consumption WithoutProduction In reality there is no effortless production of anything. We can only consume that which is produced by the sweat of some one's brow. Furthermore, our government was not primarily instituted for the purpose of production. Its primary role with respect to the economy is to punish people who use force and deceit for their own gain. History is testimony to the extent to which some individuals will inflict pain and hardship on others in order to obtain what they desire. Thus government's primary role as an in stitution is to thwart this behavior by pun ishing the perpetrators of injustice. To that end, government uses force. Citizens are required to pay taxes to support the police function of government since society bene fits from the ensuing order and peace which allow for civil relations among people. Regrettably, this same force can be put to illegitimate ends. This occurs when the government begins to play favorites among the citizens by extending benefits to some while confiscating property or curbing the rights of others. The most obvious contem porary cases revolve around the many wel fare programs established by the govern ment. Benefits are extended to some by taxing away income from others. The costs of such benefits always exceed the costs of purchasing the benefits directly because of the bureaucratic overhead needed to admin ister the programs. Current health-care re form plans follow the same approach.

Therefore, the question of the morality of any government provision of health care, or of mandated health insurance, can only be resolved by considering whether or not gov ernment redistribution of wealth is justified. Do the Ends Justifythe Means? It is tempting to say that the ends aimed for are good and argue, therefore, that such government action is good. Mter all, what decent person would not desire to see some basic provision of food, clothing, or needed medical care provided for all those who could not pay? But to conclude that gov ernment intervention is good on this basis is to argue that the ends justify the means. The ends, in and of themselves, are not a suffi cient reason for concluding that government provision of goods and services is just. I recently had a conversation with a fellow professor about the health-care situation. My colleague expressed the common view. She argued that adequate health care is a right, "because we are human." But such a statement begs the question: How does being human, in and of itself, generate any rights? It is clear that being human alone cannot justify any rights for humans. David Hume once noted that' 'the rules of morality are not the conclusions of our reason."

Therefore, if we carry Hume' s statement to its logical conclusion, we must conclude that if any human rights exist, they exist only as they have been endowed. Thus rights must be defined apart from ourselves. Ultimately they must be defined by the One who has the power of being in and of Himself, since He alone is in a position to establish such license. We are then depen dent upon His proclamation of right and wrong to discern the rights of the individual. Apart from such an endowment, there are no rights! This view was expressed in the Declaration of Independence as well as many other writings and documents of the time.

596 THE FREEMAN • NOVEMBER 1994 Rights of Individuals What are an individual's rights? As ex pressed in the Declaration, the individual is endowed with the right to life, liberty, al1:d pursuit of happiness. These rights allow each individual to use his talents and his property freely to the ends he personally has in mind so long as he does not violate the rights of others. In this context, people can voluntarily interact and trade with others on mutually agreeable terms to further their own interests. The Judeo-Christian heritage substan tially affirms this understanding of individ ual rights. The Bible requires its reader to respect the property rights of others. "Thou shall not steal," 1 and, "Cursed is the man who moves his neighbor's boundary stone,,,2 are its admonishments. In other places the Scriptures encourage hard work and honest dealings with others. Taken as a whole, the Bible prohibits the use offorce to obtain what we wish to consume for our selves. But this is exactly what transpires when government mandates a plan to pro vide health care services to everyone! As already shown, the government by defini tion employs force. It is a coercive institu tion. Thus when government begins the process of providing, or mandating the pro vision of, goods and services in society, it ceases to perform its primary function of thwarting and punishing wrongdoers and actually begins to participate in the very plunder that it was supposed to stop. By using force to take from one person in order to give to another, it is involved in stealing.

Why has government more and more compromised its position by engaging in legalplunder when it is clear that such action is wrong? There are two reasons. 3 The first is selfishness. People would rather have someone else pay for their consumption than work hard and purchase things for themselves. This is as true for health care as it is for any other consumable. This was demonstrated during the last presidential campaign when a man phoned a radio talk show. BillClinton was well ahead of George Bush in the polls and he had promised to bring about government-mandated univer sal health insurance. To this situation the man proclaimed, "I can't wait 'til Bill Clinton is elected president and gets his health-care reform through Congress. Then I won't have to pray to God that my children don't get sick." The caller had no intention of revealing his true character that day; but he did. In his proclamation we find a deeper problem. It is not that he lacks health insurance or that he cannot afford medical care. The real prob lem is that he does not want to pay for it himself. Rather, he wants someone else to pay, not as a matter of mercy shown to him, but as a matter of coercive force. Selfishness which leads to systematic thievery will de stroy a nation. A nation can survive and prosper when there are a few thieves, but as more people leave productive endeavors to participate in government largess, produc tion wanes and economic hardships in crease. This is the inevitable outcome of all government schemes aimed at providing some benefit for some citizens at the ex pense of others.

The second is perhaps the most pervasive reason for the government's drift toward promoting welfare programs in general, and for its current consideration of mandating the provision of universal health insurance. Americans have traditionally been compas sionate. Generosity for those in need has been a hallmark feature of the American experience. Private charities, churches, nonprofit organizations, and the volunteer ism associated with them have been a salient feature of our culture. Stated simply, the American people have a passion for helping out those in need. This spirit is the reason why most of our hospitals developed as nonprofit institutions. Yet it is this very passion which threatens to undermine the fabric of our society when charity is pursued by way of governmental mandate. It is not hard to see how this situation can arise. At any given point in time, the avail able resources to meet our ends are always limited. That is, we can always imagine a better circumstance than the one we are presently in. If this is true for individuals, THE IMMORALITY OF GOVERNMENT-MANDATED HEALTH CARE 597 how much more true is it for voluntary groups seeking to do good? It is, therefore, easy to see the temptation facing people who desire to show mercy and compassion to ward others: to use voluntary contributions to lobby for government action rather than devoting them directly to the cause in mind.

If the efforts are successful, the organization can tap into the much larger pool of re sources available in the public treasury to promote their cause. If passion for the cause blurs their vision, then they may well use government force and, as a result, inflict harm upon the neighbors they aim to help. Such is the state of American" do-goodism" in the twentieth century-coercive charity. This movement has been greatly aided by the religious community. One cannot read the Bible for long without realizing that it calls its followers to show mercy and com passion toward others. As a result, well meaning people have often pushed for gov ernment intervention because they see the public treasury as the only institution which has a pool of funds large enough to meet the need. However, the Bible never suggests that the government is the means through which mercy is to be shown. Actually, the evidence indicates that such action is more than inappropriate. When Satan offered to place Jesus in political control of the king doms of the earth, Jesus rejected the offer arguing that it was sin to have other gods above God.4 Jesus understood that mercy and compassion are voluntary responses motivated by love and that no government is capable offorcing people to love their neigh bors. He understood that any such attempts were nothing more than a false image in tended to mimic the real thing.

National health-care insurance, or its mandated provision, is unjust. It is nothing more than a forced charity, which is no charity at all. In this vein we might flatter ourselves into believing that we are doing good works, but it simply is not true. True mercy is extended as a matter of voluntary choice. It is not forced. Government man dates which require some to provide for others is false philanthropy. It is fundamen tally selfishness unleashed and it will thwart future prosperity. If health insurance is extended the quality of medical care will decline. The end result will be exactly the opposite of what such schemes purport to offer. Instead of provision and prosperity, pain and hardship will follow. D 1. Exodus 20:15. 2. Deuteronomy 27:17. 3. Frederic Bastiat refers to these two reasons for govern ment involvement beyond its real purpose in his book, The Law (Irvington-on-Hudson, N.Y.: The Foundation for Economic Education, 1950).

4. See Luke 4:1-13. Legal Plunder H ow is . . . legal plunder to be identified? Quite simply. See if the law takes from some persons what belongs to them, and gives it to other persons to whom it does not belong. See if the law benefits one citizen at the expense ofanother by doing what the citizen himself cannot do without committing a crime. Then abolish this law without delay, for it is not only an evil itself, but also it is a fertile source for further evils because it invites reprisals. If such a law-which may be an isolated case-is not abolished immediately, it will spread, multiply, and develop into a system. -FREDERIC BASTIAT, The Law IDEAS ON LIBERTY $ THEFREEMAN IDEASON UBERTY What NBC Didn't Tell You About Health-Care Reform by Jane M. Orient H ow much education will $2.5 million buy on prime-time network television? The NBC two-hour special "To Your Health," aired June 21, promised to provide a "vigorous, energetic discussion" that would "speak clearly" about "the most complex issue in our lifetime." The sponsor was the Robert Wood Johnson Foundation (RWJF), the nation's second largest tax exempt philanthropic organization.