Health Care

From Critiques Of Libertarianism
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Despite superior results from socialized health care in every developed nation, libertarians insist on privatizing. Public health is the outstanding government success story. The sewers of Rome have saved far more lives than the legions of Rome ever killed. Killing by governments is tiny compared to the lives saved by government-eradicated smallpox alone. Libertarians frequently insist that Private Charity could replace socialized health care, but it has never done this anywhere in history.

The highest health care costs in the developed world are in the US, where conservatives have kept the system largely private. The rest of the world has more socialized health care systems. In the US, the portions of the health care system that are socialized (Medicare, Medicaid, the VA health system) are much more economical than the private sector.

Singapore also seems to have a really good and economical health care system that is in large part private, but this is done though centrally planned "managed capitalism", which libertarians would describe as government interference with markets.


Socialized Medicine (7 links)
The proven method to the most economical and broadest provision of health benefits to a nation's populace. Rejected by libertarians because it is a government program; that is more important to them than the life and health of people.
Alternative Medicine Fraud (10 links)
Libertarians want untrammeled freedom to buy and practice "alternative medicine". Yet they claim to oppose fraud and the vast majority of the multi-billion dollar "alternative medicine" industry is fraudulent and wasteful if not harmful. 2020 estimates range from 18 to 62 billion dollars wasted annually in the USA.
Drug Legalization (15 links)
Long before libertarians advocated legalizing drugs, liberals advocated legalizing drugs. The difference is how they would be legalized: libertarians want unregulated drugs, and liberals want drugs regulated from a Public Health Approach by organizations such as the FDA.
Epidemics (4 links)
Libertarians have no way of defeating epidemics of contagious diseases. Their ideology does not allow quarantine, mandatory vaccination, and other measures that are essential to stopping epidemics such as Ebola, Corona virus, SARS, measles, polio, smallpox, etc.
Fluoridation and Iodization (1 link)
Fluoridation is an amazingly cost-effective solution to the huge problem of dental caries. Libertarians who object to fluoridation ought not drink "guvment water" anyhow. Iodization is an important antidote not only to goiter, but to significant mental retardation.
Food and Drug Administration (15 links)
The FDA plays a very important part in moving food and health care from "buyer beware" to the informed consumers that market advocates think are necessary for optimum results. Labeling and evidence-based claims only infringe freedom to mislead the gullible for a buck. Libertarians uniformly hate the FDA because it bans their favorite illicit substances.
Private Charity (8 links)
Private charity is the libertarian's magical alternative to government redistribution. All of history shows that private charity has never and never will be up to the task of alleviating problems of poverty and other injustice or health care. To a libertarian, private charity is the only charity because "taxation is theft". Private charity has always been manipulative in addition. Private charity by the rich is possible because the rich have excessively taken their share from workers and customers. Better the workers and customers are able to spend that money themselves to support the needy, or contribute taxes towards it.
Public Health Approach (22 links)
The public health approach treats problems (such as infectious diseases, addictive drugs, gambling, crime, extramarital sex, pollution and other environmental problems) with harm reduction, rather than simple moral judgements or prohibition. Libertarians still oppose it because it is a successful government social program and an alternative to their radicalism.
Sewers (2 links)
Libertarians like to complain that governments are responsible for deaths through wars, etc. But they never consider how governments prevent deaths. The sewers of Rome have prevented far more deaths through sanitation than the legions of Rome ever killed in wars. Sewers are natural monopolies.
The Drug Industry (13 links)
Legal and illegal, medical and alternative, the drug industry is responsible for enormous numbers of deaths and addictions, extortionate prices, not to mention enormous amounts of fraud in alternative medicines. Its harms far exceed those of wars. The drug industry absolutely requires regulation, but it is also one of the worst practitioners of regulatory capture.
The Tobacco Industry (11 links)
The tobacco industry is notorious for its enormous public relations battle to preserve its ability to addict new generations of children. Science denialism, suppressed and secret research, legislative blockages, avoiding FDA oversight, and other tactics result in an industry that is still responsible for 300,000 US deaths per year and 5 million worldwide (growing rapidly.)
Vaccination (10 links)
Libertarians are split about mandatory vaccination. Those opposed claim it "violates individual liberty" and/or buy into anti-vaxer denialism and conspiracy theories. Some support mandatory vaccination because otherwise you are putting others at risk. But the fact of the matter is that mandatory vaccination resulted in the only human disease eradication to date: smallpox, which killed roughly 5 million per year.
A Nation’s People Offer the Best Return on Investment [More...]
Countries that spend on education, protect the environment and tackle inequality tend to outperform others.
Ayn Rand Railed Against Government Benefits, But Grabbed Social Security and Medicare When She Needed Them [More...]
"Rand also believed that the scientific consensus on the dangers of tobacco was a hoax. By 1974, the two-pack-a-day smoker, then 69, required surgery for lung cancer. And it was at that moment of vulnerability that she succumbed to the lure of collectivism."
Belle Waring on public health practices in Singapore [More...]
Tickets for mosquito breeding sites, schools closed during outbreaks, mandatory vaccination. "The mosquito police can come in your house anytime and check the water in your flowers!"
Ebola and Inequality [More...]
"How countries structure their health-care system -- and their society -- makes a huge difference in terms of outcomes. America and the world pay a high price for excessive reliance on market forces and an insufficient attention to broader values, including equality and social justice."
Fact-Checking the Fact-Checkers on Medicare-for-All [More...]
Mercatus coached authors of 3 supposed fact-checking articles to accept its misrepresentations of Medicare-forAll.
Freedom From the Market: America’s Fight to Liberate Itself from the Grip of the Invisible Hand (book, online)
Libertarians like to claim that government dependency make people unfree. Konczal argues that market dependency is a real unfreedom, and people want different freedom than market freedom. Just think about health care for most Americans. "What is dysfunctional about our current economy and politics comes from extreme market dependency."
Friedrich Hayek Joins Ayn Rand as a Hypocritical User of Medicare [More...]
"This should put Hayek in some sort of libertariam circle of hell, along with Ayn Rand, who took Medicare and Social Security payments when she was diagnosed with lung cancer."
Harvard Injury Control Research Center [More...]
A great resource on the public health viewpoint for reducing injury. The Firearms Research section has pointers to a great many recent resources and debunks much propaganda.
Health freedom (RationalWiki) [More...]
Health freedom is the idea that people should be able to choose whatever medical treatment they want. It is a concept that seems intuitively good, but like many phrases introduced by groups or people with partisan political goals, is actually a code for an agenda.
I don’t think the Swiss health care system is what they think it is [More...]
Aaron Carroll corrects notions that Swiss health care is more free-market and less socialized than Obamacare.
Is America's health care underperformance a myth? [More...]
No: we really do underperform. Noah Smith takes on AEI's Cliff Asness to show decisively that healthcare costs are very high in the United States compared to socialized countries.
Lead Poisoning: The Ignored Scandal [More...]
The lead industry obstructed government regulation of lead in paint and gasoline for more than 50 years after it was discovered to cause retardation. This resulted in millions of children poisoned by lead, a process that is still continuing because of ubiquitous lead paint in older houses.
Magic Bullet: The History Of Oral Rehydration Therapy [More...]
Government-sponsored research developed one of the greatest life-savers for children in the third world.
Markets in Organs (7 links)
Society is very leery of creating markets for organs, for very good reasons. Many libertarians (following ideological dictates of Self-Ownership and Market Fundamentalism) think organ markets should be unregulated.
Private charity can't replace government social programs [More...]
To suggest that community or faith-based charities can effectively supplant government social programs is a fantasy that serves only as a talking point to cut those programs.
Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries (The Lancet) [More...]
"Despite the common reliance on industry self-regulation and public–private partnerships, there is no evidence of their effectiveness or safety. Public regulation and market intervention are the only evidence-based mechanisms to prevent harm caused by the unhealthy commodity industries."
Ron Paul’s Campaign Manager Died Sick and Uninsured, the Way ‘Freedom’ Allows [More...]
Ron Paul cried cocodile tears for his campaign manager's death due to lack of health insurance that he should have provided.
Take Away the Entire Welfare State From Employers [More...]
"The phrase "employer-provided welfare state" might seem to be a contradiction, but it's an apt description of what we have in this country. Employers don't just pay out cash incomes to workers, but are instead tasked -- whether by law or not -- with running complex social insurance schemes among their workforce."
Ten Great Public Health Achievements -- United States, 1900-1999 [More...]
"Since 1900, the average lifespan of persons in the United States has lengthened by greater than 30 years; 25 years of this gain are attributable to advances in public health."
Thank you, Singapore [More...]
Singapore's "managed capitalism" centralized planning has resulted in a system with roughly 1/4 the cost of the US "free market" health care system and much better health outcomes.
The Alcohol Industry (4 links)
The alcohol industry is responsible for roughly 6 times more deaths than are due to violence. In addition, there are high secondhand harms. Taxation to raise the price and bans on advertising are very effective at reducing sales and demand. Worldwide, public health measures are reducing consumption.
The Elasticity of Demand With Respect to Product Failures; or Why the Market for Quack Medicines Flourished for More Than 150 Years [More...]
Markets did not punish the quack medicine industry due to unusually low elasticity of demand with respect to product failure and bounded rationality. The conclusion mentions that recent resaerch shows the FDA increased consumer welfare.
The Genetic Commons (7 links)
Unregulated markets in antibiotics and pesticides select strongly for resistant genes, resulting in widespread resistance to antibiotics and pesticides. This is a classic tragedy of the commons, requiring regulation. Examples include DDT, MRSA, and resistance to RoundUp.
The Immediate Global Costs of Pollution [More...]
"The studies suggest that roughly 8.4-9.0 million people die each year from pollution... one set of estimates suggests that the costs of pollution might be about $4.6 trillion, or equal to about 6.2% of global national income... The Lancet Commission is saying that steps to reduce climate change would pay for themselves in terms of avoided mortality in air pollution."
The Mercatus Center’s Estimate of the Costs of a National Single-Payer Healthcare System: Ideology Masquerading as Health Economics [More...]
Blahous’ biased, anti-single payer estimate inadvertently bolsters the evidence that a single payer reform would greatly increase the efficiency and fairness of the U.S. health care system.
The very worst version of the sham known as “right-to-try” is poised to become law [More...]
"... powerful forces are backing right-to-try, including the Koch brothers and Vice President Mike Pence... Right-to-try is only a little about helping patients. It’s far more about dismantling the FDA and giving drug and device manufacturers more freedom to market drugs and devices with much less testing."
Uncertainty And The Welfare Economics Of Medical Care [More...]
Kenneth Arrow's classic 1963 article that details the differences between the medical care industry and competitive market models. This is why privatizing health care does not work well.
Under Neoliberalism, You Can Be Your Own Tyrannical Boss [More...]
Perfectionism makes us scornful of each other, afraid of each other, and unsure of ourselves at best. It prohibits the types of solidaristic bonds and collective action necessary to take on neoliberal capitalism, the very thing that generates it. The only possible antidote to atomizing, alienating perfectionism to reject absolute individualism and reintroduce collective values back into our society.


People who think "free markets" work in healthcare or the Internet are just as functionally stupid about economics as the most hardline Communist who thinks that the government should exercise full control of the toothpaste market. Most of the world understands by now that the second guy is a dangerous fool. But we're at a weird point in history where the first guy undeservedly has more credibility. He shouldn't--and he won't for long.
David Atkins, "Americans: we love paying more for less"
It’s always worth remembering that when it comes to health care, it’s the private sector, not government programs, that suffers from stifling, costly bureaucracy.
Paul Krugman, "Medicaid on the Ballot"
We are going to need a bigger and better government. The private unregulated market does not do well at health-care finance, at pensions, or at education finance. The private unregulated market does not do well at research and early-stage development. The private unregulated market does not do well with commodities that are non-rival, or non-excludible, or produced under conditions of greatly-increasing returns to scale. We are, in all likelihood, moving into a twenty-first century in which these sectors will all be larger slices of what we do. Thus in the twenty-first century a well-functioning economy will need a larger government share in the economy than was needed in the twentieth century.
Brad DeLong, "My Take on the Seven Things We Need to Focus on for Equitable Growth in America: Thursday Focus"
It seems to me that there are five areas in which government spending has a demonstrated superiority over the private sector -- health and disability insurance, education, old-age pensions, infrastructure spending, and military spending. It seemed to me that structural changes in our economy and society were driving the amount of money we ought to spend in sum on those five up, hence the enlargement of government.
Brad DeLong, "Nick Eberstadt and the "Takers" Once Again: More Reflections on the General Theory of the Moocher Class"
Medicare has its problems -- but all the evidence says that it is substantially more cost-effective than private insurance. Partly this is because it has lower administrative costs; partly it’s because Medicare is able to use its market power to negotiate lower prices. And the international evidence is overwhelming: single-payer systems are much cheaper than systems centered on private insurance.
Paul Krugman, Joe Lieberman’s Plan to Make Health Care Worse and More Expensive
In the particular circumstances of a given age or nation, there is scarcely anything really important to the general interest, which it may not be desirable, or even necessary, that the government should take upon itself, not because private individuals cannot effectually perform it, but because they will not.
John Stuart Mill, "Principles of Political Economy with Some of their Applications to Social Philosophy (7 ed.) Book V Chapter XI" pg. 606.
Large-scale government social-insurance programs are the best way we have found to achieve major and important public purposes. There has never been a private marketplace offering unemployment insurance. The unemployment insurance program works quite well: It gets money to people who have previously paid for it when they need it. Edward Filene’s welfare-capitalist notion that defined-benefit pensions offered by employers and more recent hopes that defined-contribution 401(k)s could provide old-age pensions more efficiently and effectively than Social Security have not covered themselves with glory over the past generation: Too many defined-benefit private pensions have not been paid out in full as promised, and too much wealth invested in 401(k)s has been skimmed off to enrich the princes of Wall Street. In health care, despite extraordinary administrative inefficiencies and little ability to improve quality and cost-effectiveness, the private insurance marketplace works—unless you are old, sick (and happen to be out of a job), or poor. Yet it is the old, the sick, and the poor who need health insurance most—hence, Medicare and Medicaid.
Brad DeLong, "Shrugging off Atlas"
We are willing to pay hefty premiums to private HMOs, but not the taxes to finance a national healthcare system[...] We tolerate the hardball nastiness of the private collection agency but work ourselves into a rage at the very idea that the IRS will get serious about tax evasion.
Robin Einhorn, "Tax Aversion and the Legacy of Slavery"
Where, as in the case of sickness and accident, neither the desire to avoid such calamities nor the efforts to overcome their consequences are as a rule weakened by the provision of assistance — where, in short, we deal with genuinely insurable risks — the case for the state’s helping to organise a comprehensive system of social insurance is very strong…. Wherever communal action can mitigate disasters against which the individual can neither attempt to guard himself nor make provision for the consequences, such communal action should undoubtedly be taken.
Friedrich von Hayek, "The Road to Serfdom" p. 134.
[...] the failure of the market to insure against uncertainties has created many social institutions in which the usual assumptions of the market are to some extent contradicted. The medical profession is only one example, though in many respects an extreme one. All professions share some of the same properties. The economic importance of personal and especially family relationships, though declining, is by no means trivial in the most advanced economies; it is based on non-market relations that create guarantees of behavior which would otherwise be afflicted with excessive uncertainty. Many other examples can be given. The logic and limitations of ideal competitive behavior under uncertainty force us to recognize the incomplete description of reality supplied by the impersonal price system.
Kenneth Arrow, "Uncertainty And The Welfare Economics Of Medical Care"