September

Market-Based Environmentalism vs. The Free Market by Roy E. Cordato Why incentive-tampering should be viewed with suspicion. Mises's Legacy for Feminists by Wendy McElroy Class analysis within the framework of individualist thought. Special Announcement Lafayette: Hero of Two Worlds by Jim Powell An apostle and defender of liberty. COLUMNS NOTES from FEE-The Nanny State by Donald J. Boudreaux IDEAS and CONSEQUENCES-Government and Disaster Relief by Lawrence W Reed POTOMAC PRINCIPLES-Military Follies and Memorial Day Memories by Doug Bandow ECONOMICS on TRIAL-Getting PublishedAn "Austrian" Triumph by Mark Skousen DEPARTMENTS Perspective-Sheldon Richman Book Reviews •Poor Policy-How Government Harms the Poor by D. Eric Schansberg, reviewed by George C. Leef; The Concise Conservative Encyclopedia by Brad Miner, reviewed by Aaron Steelman; The Diversity Machine: The Drive to Change the "White Male Workplace" by Frederick R. Lynch, reviewed by Brad Stetson; The Conservative Intellectual Movement in America: Since 1945, 2nd edition by George H. Nash, reviewed by Robert Batemarco; The Young Entrepreneur's Guide To Starting and Running a Business by Steve Mariotti, reviewed by Richard A. Cooper.

THEFREEMAN IDEAS ON LIBERTY Published by The Foundation for Economic Education Irvington-on-Hudson, NY 10533 Phone (914) 591-7230 FAX (914) 591-8910 E-mail: freeman@westnet.com FEE Home Page: http://www.fee.org President: Donald J. Boudreaux Managing Editor: Beth A. Hoffman Guest Editor: Sheldon Richman Editor Emeritus Paul L. Poirot Lewisburg, Pennsylvania Book Review Editor George C. Leef Adjunct Professor of Law and Economics, Northwood University Editorial Assistant Mary Ann Murphy Columnists Doug Bandow Cato Institute, Washington, D. C. Lawrence W. Reed Mackinac Center for Public Policy Midland, Michigan Mark Skousen Rollins College, Winter Park, Florida Contributinf( Editors Charles W. Baird California State University, Hayward Peter J. Boettke New York University Clarence B. Carson American Textbook Committee Wadley, Alabama Thomas J. DiLorenzo Loyola College, Baltimore, Maryland Joseph S. Fulda New York, New York Bettina Bien Greaves Resident Scholar, FEE John Hospers University of Southern California Tibor R. Machan Auburn University Ronald Nash Reformed Theological Seminary Edmund A. Opitz Chatham, Massachusetts James L. Payne Sandpoint, Idaho Jim Powell Westport, Connecticut William H. Peterson Adjunct Scholar, Heritage Foundation, Washington, D.C.

Sheldon Richman The Future of Freedom Foundation Jane S. Shaw PERC, Bozeman, Montana Richard H. Timberlake University of Georgia The Freeman is the monthly publication of The Foundation for Economic Education, Inc., Irvington-on-Hudson, NY 10533. FEE, established in 1946 by Leonard E. Read, is a nonpolitical, educational champion of private property, the free market, and limited government. FEE is classified as a 26 USC 501(c)(3) tax-exempt organization. Copyright © 1997 by The Foundation for Economic Education. Permission is granted to reprint any article in this issue, except "Lafayette: Hero of Two Worlds," provided credit is given and two copies of the reprinted material are sent to FEE. The costs of Foundation projects and services are met through dona tions, which are invited in any amount. Donors of $30.00 or more receive a subscription to The Freeman. Student subscriptions are $10.00 for the nine-month academic year; $5.00 per semester. Additional copies of this issue of The Freeman are $3.00 each. For foreign delivery, a donation of $45.00 a year is suggested to cover mailing costs.

Bound volumes of The Freemanare available from The Foundation for calendar years 1972 to date. The Freemanis available in microform from University Microfilms, 300 N. Zeeb Rd., Ann Arbor, MI 48106. PERSPECTIVE The "Right to Medical Care" The idea of a right to medical care is so blithely tossed around that most people never take time to ponder the rather serious consequences that would flow from it. It is a classicpseudo-right. A pseudo-right is any claim expressed in rights language that would expand the power of the state at the expense of genuine rights. The "right to medical care" is seductive. People not accustomed to dissecting polit ical discourse will think of the benefits of having their medical services provided "free" or at a guaranteed affordable price. More sophisticated people may see the proposal as a giant insurance system and feel that there can be no danger in it. If all citizens pay and all have access to care when they need it, what could be wrong?

Well, a lot could be wrong. Let's start with something basic: for a right to be genuine, it has to be capable of being exercised with out anyone's affirmative cooperation. The full exercise of my right of self-ownership requires you to do nothing except refrain from killing or assaulting me. The full exer cise of my property rights requires you to do nothing except refrain from taking what is mine. You have no positive, enforceable obligations to me, apart from any you accept through contract. That principle of nonobligation is an excellent test to which we can submit any proffered right. How does the right to medical care hold up? Leaving out self treatment, it is difficultto see how there can be such a right. Medical care, unlike air, is not found superabundant in nature. It is produced by someone who spends re sources to acquire expertise and education. It requires the use of instruments and drugs, which have to be manufactured by some one. Who is to provide these things? Does the provider have any choice in the matter?

What if he refuses? Should he be forced? If 522 so, how shall we distinguish that person from an indentured servant or slave? Since the "right to medical care" requires an affirmative obligation, it fails the rights test. Put simply, that "right" cannot coexist with the right to be left alone. Implementation of the "right" does not typically entail forcing doctors, nurses, and manufacturers of medical instruments and pharmaceuticals to provide their services at gunpoint. So what I have said above may not seem germane. But it is, because al though providers are not compelled, the taxpayers are. Taxation is somewhat less egregious than conscription, but it is still compulsion. Appropriating people's earn ings is tantamount to appropriating their time and labor. Since the compulsion of taxation is spread across large numbers of people, it is less noticeable than the con scription of medical personnel. But it doesn't fundamentally change what's going on.

That is only the beginning of what's wrong with trying to enforce a right to medical care. Imagine for a moment a right to apples. That may sound nice, but an immediate problem arises. How many ap ples? Scarcity is the natural condition, which means that any given moment our wishes exceed the supply of the things we want. (Freedom and free markets have this knack for loosening nature's rather strict bonds of scarcity.) Declaring such a right would be an efficient way of emptying the shelves of apples. And let us ignore the sig nificant question of who would produce apples if we all had a right to them. We might decide to trust people to take onlywhat they need. But that doesn't get us out of trouble. Even if we assume a popu lation of considerate people, "need," in this context, is a subjective notion. You can probably live without apples; so in one sense, you need none. But if we expand the concept of "need" a little, we open the gates PERSPECTIVE to endless disagreement over who needs how many apples. I may think I need many more than you. There is no way to resolve a dispute of that nature. Well, there is one way: the state can ration apples. We could trust the government to scientificallydeter mine how many apples each of us needs.

And ifyou believe that, you will also believe that the ruling party won't manage to get more apples than the rest of us. Government control of apples might be no more than an inconvenience. Govern ment control of medical care would be life threatening. Yet what is the alternative once a "right to medical care" is declared? There is no way all people can have all the medical care they wish to have if it is (that is, appears to be) costless. The government will have to decide who gets what. How many of us would take comfort in that? Here is the crux of the issue. The right to medical care must mean-no exceptions the power of government, in principle, to determine who gets what. It may not exer cise that power immediately. But given the economics of the matter, it will, sooner or later. I submit that this has nothing to do with rights and everything to do with con trol, literally, of people's lives.

I do not exaggerate. A major ethical issue these days involvesthe "right to die," or the right to assisted suicide. That is overshad owing one that may be more consequential, the so-called "duty to die." Some years ago, then-Colorado Governor Richard Lamm argued that old people should know when it is time to quit this earth in favor of younger people. (The civil libertarian Nat Hentoff wrote recently that Lamm is, inex plicably, a devotee of exercise.) John Hard wig, a medical ethicist and social philoso pher, has now picked up the cause of the duty to die. He writes that medical advances and an "individualist culture" may have many people believing that "they have a right to medical care and a right to live, 523 PERSPECTIVE despite the burdens and costs to our fam ilies and society." He adds that "there may be a fairly common responsibility to end one's life in the absence of any terminal illness ... a duty to die even when one would prefer to live."

For our purposes we need not address whether an old person should preserve his heirs' inheritance rather than spend it on medical care. At the moment, that is a private, not a political, matter of how one spends one's own money. (The inheritance tax could have consequences for such a decision.) What is relevant is how that ethical issue is transformed when govern ment controls medical spending via "the right to health care." The Lamm-Hardwig line would be translated into a rather un pleasant public policy: the withholding of care for the elderly in the name of "making room" for the young. The government giveth rights; the government taketh them away. As a matter of public policy, might not the politicians and bureaucrats decide that heart transplants, knee replacements, and mastectomies for octogenarians are a waste of money? This sort of thing is not considered beyond the pale in the increas ingly fragile welfare states of western Eu rope.

All of this is a rather roundabout way of identifying the worst aspect of the "right to medical care": the tethering of the citizen to the state. For all the criticism that is leveled at Medicare and proposals to reform med ical care in general, too little attention has gone to that uncomfortable fact. If govern ment controls medical spending, it controls you, including the very length of your life. We may correlate the progress of man kind with the extent of its independence from the state. To put it mildly, national health insurance would be a setback. Yet that is the direction in which we move. New regulations governing the port ability of insurance policies and coverage of existing conditions all portend creeping comprehensive control. The newest cause, uninsured children, does the same. Ludwig von Mises explained why in his Critique of Interventionism. One regulation creates problems, which are used to justify the next intervention. For example, if Congress says mental-health benefits have to be equal to medical benefits, the cost of insurance will go up. That will then be the excuse to force young people who don't wish to pay those premiums to buy insurance. Next on the agenda willbe price controls on doctors and insurance companies. When companies flee the straitjacketed market, the government will step in. This is not conspiracy. It's logic.

It all starts with an innocuous phrase, the right to medical care. Language is a potent thing. Let us handle it with care. -SHELDON RICHMAN Mr. Richman is this issue's Guest Editor. 524 THEFREEMAN IDEAS ON LIBERTY The Perversity of Doing Good at Others' Expense by Dwight R. Lee A ssume your 45-year-old friend is critically ill and will die by tomorrow morning unless something extraordinary is done. Mi raculously, it becomes possible for you to save your friend. But to do so you have to shorten the lives of all other Americans by a small amount. By taking away ten seconds of life from someone else, you can extend the life of your friend by five seconds. When this transfer is made from all 260 million Americans, he will receive approximately an additional 41 years and four months of life, thus achieving an enviable life span of over 86 years. Will you use your power to save your friend? Almost surely the answer is yes. Will saving your friend be an act of virtue? The answer to this question is more complicated.