Much remains unknown about the person responsible for the murder of UnitedHealthcare CEO Brian Thompson. We don’t know what “brain fog” is and whether Mangione, the young man accused of murder, suffered from it as reported. But there’s certainly a lot of fog in the air about the support he received after his arrest, and the ideas about health insurance that lie in the zeitgeist more generally.
For many people, medical care and health insurance are special products because they directly relate to life, death, and bodily integrity. Food, clothing, and shelter are also candidates. Furthermore, individuals make trade-offs between health and other goods and activities, such as smoking, drinking, and mountain climbing. The problem lies in the unbridgeable gap between scarce resources and limitless human desires, which is the subject of economics. This gap can only be partially bridged by wealth. For almost 100% of humans before the Industrial Revolution, partial solutions did not exist. Similarly, partial solutions do not yet exist for the many populations of the Third World who are exploited by their own governments.
A placard held up by one of Mangione’s supporters at the demonstration read:
Privatized healthcare is a crime against humanity
Privatization? What was it like before it was privatized? And who privatized it? Perhaps the implicit fog model is that 100,000 years ago, healthcare was made available for free by benevolent governments, but as “neoliberalism” began its assault on nirvana, crime gradually increased until it reached its apex. It was either privatized or accepted to be privatized. Today, thousands of years of war have continued between individuals and groups.
Even in affluent societies, health care is not a “right” unless at least one of three conditions is met: First, get it through any personal contract. Second, you enslave someone (some doctor, nurse, shareholder, taxpayer) to provide it to you. A third possibility is that some public health insurance or health care is subsidized by Buchananian “social contract” rules, where unanimous consent is perhaps plausible, or perhaps by Hayekian voluntary order rules. It will be made publicly available at a fixed price. . The justification for this third possibility is more demanding than most people think and should be treated with great care.
In wealthy countries, various combinations of the three conditions or justifications listed above allow everyone to receive a minimum level of health care. In the United States, publicly funded health care costs account for approximately half of total health care spending. But remember that these countries became rich because they privileged personal contracts as a primary condition in economic life in general. On health care issues, the United States may remain the country with the least deviation from the private contracting ideal.
Private medical companies are not going to deny what they are contractually obligated to provide to their customers, and customers can go and shop elsewhere. But costs need to be managed so that no one voluntarily invests in these companies, leaving them unable to provide services to anyone. Economic analysis shows that competition among private insurers results in the lowest attainable prices for insurance while still providing typical market diversity. The more you pay, the more likely your insurance will cover a particular claim, even if you choose a policy with less coverage. Also note that the more consumers in this market receive direct or indirect subsidies from the state, the more they bid on health care prices.
It’s important to remember that the healthcare industry is one of the most highly regulated industries in the United States, and its regulations limit competition. Most Americans receive health insurance from their employers, an unfortunate result of wage controls during World War II. To change insurance companies, you must change jobs. Additionally, it is often the employer, not the insurance company, who is trying to control insurance costs. (See Wall Street Journal, December 20, 2024, “How America’s Health Insurance Got Furious.”)
Partial or full nationalization of health insurance and medical services addresses the problem of the inevitable allocation of what consumers want by price or other means, given the necessarily limited supply. It cannot be solved. Not all Americans have access to the health care that, say, Elon Musk or Bill Gates deserves. Once price allocation is abolished, waiting lines and bureaucratic decisions become the new distribution mechanism. In Canada, where health insurance is monopolized (at the provincial level), the median time between a general practitioner referral and seeing a specialist is 15 weeks. Then another 15 weeks passed between my appointment and the start of treatment. These wait times have tripled since 1993, despite repeated and grandiose political attempts to reform the system internally. (See Fraser Institute’s Waiting for Your Turn: Canada’s Health Care Wait Times 2024 Report.) Lack of privacy doesn’t count. . These problems are unique to nationalized health care.
We should be wary of the simple argument that all problems will be solved if the state takes over health insurance and medical care. That was certainly not the case in the Soviet Union. But even a more lenient implementation would likely increase dissatisfaction among Americans who are accustomed to being treated as customers rather than public wards. It probably won’t keep the crazy weirdos in check and will probably make them even more agitated – this time against civil servants. But I’m not sure about this last part. When a society reaches that point, individuals may become submissive and give up.
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Works of art, especially those created by AI, can be interpreted in many ways