by William L. Anderson

[Posted November 29, 2002]

In a recent newspaper interview, Al Gore finally came out of the 
socialist closet and declared that the "solution" to what he deems as a 
"crisis" in U.S. medical care is for the government to impose a "single 
payer system."  While some folks might consider Gore's remarks a setback 
to the possibilities of actually establishing free market healthcare in 
this country, actually I believe it presents an opportunity for 
advocates of freedom and private property to make the case that should 
have been made all along.

It would seem to the casual observer that Gore's remarks come at a 
curious time, his party having suffered some terrible electoral defeats 
in the last election cycle.  Furthermore, a proposal to create a 
Canadian-like system in leftist Oregon was defeated 80–20 at the polls.  
Surely if Oregon voters, many of whom are as left-wing as their 
counterparts in San Francisco, were not willing to impose a socialist 
system in their state, I doubt that the majority of American voters are 
going to imitate Canada.  Then again, never underestimate the awful 
possibilities that democracy can create, especially since the driving 
force of modern politics is raw envy.

At the same time, it seems that Gore has forgotten that the present 
Republican majorities in Congress are due in large part to the failed 
"HillaryCare" initiative of nearly a decade ago when the Clinton 
Administration attempted to de facto nationalize the health care 
industry.  Therefore, it might seem that Gore might be fighting an 
uphill battle, but I have no doubt that no matter how flawed a proposal 
he presents, one can count on entities like the New York Times, 
Washington Post, Time, and the various television news outlets, along 
with "Public" Television to carry some of the water for socialist 
medicine.  In other words, no matter how bad the argument for government 
healthcare might be, there are still people out there willing to make 

Before going further, I need to point out that in politics, marketing an 
idea is everything.  In 1990, Harris Wofford won an upset victory in his 
bid for U.S. Senator from Pennsylvania, as he campaigned on the theme 
that since prisoners in Pennsylvania's prisoners received "free" medical 
care, then all of Pennsylvania's citizens also were deserving of such 
"free" care.  That medical care in prisons is second-rate and is 
administered to people whose freedom has been taken away did not seem to 
connect with the enthusiastic voters who somehow believed that they were 
receiving substandard care while prisoners were having favors lavished 
upon them.

(Apparently Pennsylvanians conveniently forgot that they, too, could 
have all the luxuries of prison life, including free housing, three 
squares a day, and "free" healthcare.  All they had to do was to violate 
the increasing number of criminal statutes churned out by the state 
legislature or Congress and such luxurious comfort could have been 

Henry Hazlitt remarked in Economics in One Lesson that the lessons of 
the "broken window fallacy" must be learned by every generation.  Since 
I doubt that any generation has learned the proper lessons regarding 
socialist medicine, those of us who understand the real damage that 
government does in this area must be willing to explain and explain 
again just why intervention by the state into medical care will result 
in making things dangerously worse for all of us.

Despite the many disasters of socialized medicine, there are a number of 
reasons why even the idea of socialized medicine remains popular.  I 
will list some of them, and also give reasons why they are still bad 
ideas, despite the almost endless procession of advocates.

Socialist Medicine is Egalitarian

It is no secret that most Canadians and Europeans consider themselves to 
be morally superior to Americans, especially when it comes to their 
medical care policies.  While the actual technical delivery of those 
policies might differ from country to country, the results pretty much 
are the same.

All citizens (and many noncitizens) in those countries are "entitled" to 
free medical care from visits to their general practitioners to major 
surgery.  No one, regardless of income, can be turned away, at least on 
paper.  While some government plans, like those of Great Britain, permit 
private payment plans to exist, most do not.  In Canada, anyone who 
either offers payment or receives payment for providing medical services 
is guilty of a criminal act and can be prosecuted and jailed.

The way the system is supposed to work is that those who provide the 
services receive their compensation from the state and thus do not have 
to be concerned with the ability of patients to be able to pay their 
bills—which are paid by the taxpayers.  Furthermore, supporters of such 
a system contend that the needs of individuals come first, not their 
income status.  The system (again, on paper) is egalitarian, as no two 
individuals are regarded above one another, no matter their wealth or 
social status.

While such systems have their obvious supporters, it seems that all of 
this begs some serious questions.  The first is this: Why limit such 
egalitarianism to medical care?  Why not expand this "right" to 
everything?  For that matter, why was not the society depicted in Kurt 
Vonnegut's "Harrison Bergeron" (where everyone was equal in everything) 
not something to which we should aspire instead of being a spoof on 

For example, why should some people be "permitted" to live in nice 
houses or drive expensive cars while others live in hovels and drive 
lemons?  For that matter, why should there be restaurants that serve 
costly food that not everyone can afford?  If those who believe in 
egalitarian health care were being consistent, they also would support 
policies in which all goods are doled out by the state.  Moreover, 
consistent egalitarians would support a system in which individuals 
received no compensation for their services, as the state would suffice 
to provide all the goods that they need.

Wait a minute!  I believe that V.I. Lenin tried to implement such a 
system in Russia from 1918 to 1921.  After economic chaos reigned, and 
after millions of people had starved to death, he called off the dogs 
and reverted to a system that he called the New Economic Plan, and which 
in reality was a partial return to private enterprise—though the state 
still controlled much of the economy.

Faced with such a realistic history of socialism, "single payer" 
advocates like Gore prefer simply to place medical care into a separate 
category, as though the delivery of medical services was more important 
than the delivery of food, shelter, or many other goods.  What I find 
most interesting is that the documented long lines for basic service in 
Canadian medical care, as well as the deterioration of health care 
facilities actually are points of pride with many Canadians, as they 
look upon this sad situation as proof of their high moral standing.

The egalitarian mindset holds that absolute equality is the most 
important social good, so if one Canadian (or European) must suffer from 
substandard medical care, then all Canadians should likewise suffer.  Of 
course, the Canadian government still permits citizens to travel to the 
United States to take advantage of the "immoral" U.S. system.  Should 
the USA adopt the Canadian system, as Gore now advocates, those poor 
Canadians will have nowhere to go and will have to bear the full brunt 
of their system.  Indeed, should that happen, one can be assured that if 
misery loves company, North America will be full of miserable—but 
morally superior—people.

All Other "Industrialized" Nations Have Government Health Care

This is one of those slogans that should be further deconstructed.  A 
decade ago, advocates of socialist medicine were proclaiming that all 
other "industrialized" nations—except for South Africa—had 
government-run health care.  Since at that time South Africa was 
considered an international political pariah for its racial policies, 
the implication was that only a "racist" nation would fail to have 
government medicine.

Of course, now that South Africa no longer has the apartheid system in 
place—replaced by the African National Congress—those comparisons are no 
longer made.  (Another reason is that South Africa is quickly reverting 
to a much more primitive economy of Third World status, so it would not 
matter what system the government were to put into place there, as no 
one outside of South Africa even will notice.)

The "industrialized nations" reasoning is a non sequitur.  Just because 
a country has an "advanced" economy does not automatically mean that 
government medicine must follow.

The reason many people use this argument is because the attitude of 
intellectuals is that Europeans are morally and intellectually superior 
to people in this country.  Europeans long have decried the "dog eat 
dog" capitalism of the USA and its institutions of private property, 
forgetting, of course, that capitalism, markets, and private property 
created the prosperity that enables those governments to fund socialist 
medicine.  Not long ago, Europeans, and especially Great Britain and 
Germany, also had strong private property rights, but those rights now 
seem archaic to people in those countries, who instead have succumbed to 
the religion of statism.

Also, keep in mind that "industrialization" itself is not a sign of 
civilization.  The former Soviet Union was considered to be an 
"industrialized" nation, which may or may not have been true, but the 
presence of numerous industrial operations did not bring prosperity and 
freedom to the people of that hapless country.  Furthermore, the "free" 
medical care for the average person—supposedly an admirable part of the 
communist regime—made the most substandard care given in the USA seem of 
highest quality by contrast. (Robert Hessen once remarked that the 
Soviet Union was the only nation that managed to give the world 
simultaneous industrialization and famine.)

Furthermore, many people on the left who make the remark about 
government medicine and industrialization are the first to condemn 
large-scale manufacturing of goods.  Yet, the only reason that the 
European states can offer even decent tax-funded health care is because 
those industrialized societies still are very productive.  One cannot 
simultaneously have the green utopia of which the left dreams and high 
quality medical care.

Socialist Medicine Costs Less than Private Health Care and Provides 
Superior Service
I have seen this argument used a number of times, most recently in the 
campaign in Oregon where proponents of the socialist medicine initiative 
claimed that elimination of "overhead" by private insurance companies 
and by private practitioners would result in wondrous cost savings that 
would make the program pay for itself. The problem is that such 
advocates are ignorant of the word "cost," thinking it to be only a 
monetary term.

Take individuals in Canada who suffer from large kidney stones, for 
example.  In the USA, a procedure called lithotripy is readily 
available.  (This method uses sound waves to break up large stones so 
individuals can more easily pass them.)  Canadian medical authorities, 
on the other hand, rarely make such treatment available and make those 
victims of kidney stones deal with them in the most painful way.  (Not 
all U.S. kidney stone sufferers are given lithotripy, but they almost 
always receive more intensive care than do Canadians.)

Since all medical prices are controlled by the Canadian authorities, 
treatment of kidney stones is less expensive north of the border, at 
least on paper.  However the real costs are borne by the consumers of 
such medical malpractice.  It may be cheaper according to some 
accounting ledgers to make people stand in line and wait (and wait and 
wait) for basic health care, not to mention needed surgery, but when one 
factors in all the opportunity costs, suddenly Canadian medicine is no 
longer so cheap.

One area in the United States where the government regulates medicine in 
a quasi-Canadian fashion is organ transplants.  Because government 
controls the source of transplants—the transplantable organ—there are 
waiting lines thousands of people deep, and in this country, far more 
people die each year waiting for organs than were killed in the 
September 11, 2001, massacres.

In fact, none other than Al Gore himself authored the law that restricts 
the supply of available organs for transplant.  The reasoning behind 
making organ donation an "altruistic" endeavor in which the live donor 
or family of a deceased donor does not receive payment for the organ is 
two-fold.  First, as advocates say, it encourages "altruism," which they 
say is always good for society.  Second, they contend that by making the 
basic "input" of a transplant operation a "free good," it "holds down 
the costs of transplants."  This is nonsense.

In reality, such a policy actually drives up the costs of transplants to 
individuals and their families.  While it is true that the organ is 
"donated" for free, the government-created procurement organization that 
actually takes possession of the organ before a transplant is 
well-compensated for that organ.

Furthermore, by restricting the supply of organs, the supply of 
potential transplant operations also is restricted, which ultimately 
drives up the price of the finished product, a successful organ 
transplant.  Like the government oil regulators who forced artificially 
low prices on U.S. crude oil during the 1970s, ostensibly to hold down 
the price of gasoline at the pump (this policy, not surprisingly, 
actually forced up gasoline prices), the government acts in the name of 
"cost savings" to force up costs everywhere else.

The ultimate cost, of course, is death.  In government parlance, a dead 
person needs no medical attention, so the cost to the system to let a 
person die prematurely is zero.  

The political classes have insisted that the only deaths on September 11 
that actually mattered were the police and firefighters who lost their 
lives when the World Trade Towers collapsed, when in reality the losses 
of key personnel in world finance operations was immense. While the 
deaths of government employees in the Trade Towers attack were tragic 
and costly to New York City, the world economy lost even more when 
thousands of traders and executives and all their knowledge and 
expertise vanished when the towers fell to the ground.

The death of anyone usually is a tragedy to someone. Furthermore, death 
often means the loss of an income earner or someone who contributed in 
an important way to the well being of a family or even a society.  A 
system like that in Canada and what is in place in Europe that actually 
speeds up the process of death does not perform a "cost saving" benefit 
to a society, but rather is costly in so many ways, some easily measured 
and some not, but a cost all the same.

Medical Care should not be Subject to Laws of Economics
A favorite pejorative term of the left is "commodification," which means 
that an item of necessity should not be treated in economic terms, and, 
especially should not have a money price placed upon it.  Thus, a recent 
issue of Mother Jones that was dedicated to the future of water demanded 
that the state take over the process and delivery of fresh water, since 
to do otherwise would be to "commodify" water.

 Again, we are dealing with nonsense.  Private firms are not able to 
take something that is so plentiful (like air) and turn it into a 
"commodity," at least in most situations.  (Try breathing underwater.  
At that point, someone might appreciate a canister full of fresh, 
breathable air that otherwise would be nonexistent, and for which one 
must purchase.)

To put it another way, potable water in most situations is not a free 
good, a situation that is borne of nature, not the greed of individuals. 
 That fact makes the processing and selling of fresh water by 
individuals and firms an attractive process, but all they are doing is 
taking a scarce resource and making it available to individuals who are 
willing to give up something scarce in their own possession to have it.

Likewise, health care is a scarce good, whether or not we wish it to be. 
 From the individuals who perform acts of medical care to the medicines 
and various medical devices used to deal with health and 
wellness-related issues, all of these things are scarce and no amount of 
rhetoric from intellectuals and the political classes can change that 

The issue, then, is how to create and distribute these scarce goods.  
Gore and his followers insist that it can only be done by the state.  
While his arguments literally hold no logical water, many influential 
people will champion them.  It is our job at least to point out the 
awful consequences that will visit us should the government take us down 
this road.  Our arguments may not be popular, and even the Republicans 
are likely to shy away from them, insisting instead on a "Gore lite" 
medical passage.  However, our arguments in the end are logical and 
correct, and we need to spread them wherever possible.


William Anderson, an adjunct scholar of the Mises Institute, teaches 
economics at Frostburg State University. Send him MAIL. See his Articles Archive.

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