Garvan F. Kuskey, DDS, has offices in Santa Barbara, California. His article is reprinted by permission from the Journal of the California Dental Association, July, 1973.
Seventeen years ago the Austrian economist Ludwig von Mises observed that the people of the United States enjoyed the highest standard of living of any people in the world; but only because the United States government embarked much later than the governments in other parts of the world upon the policy of obstructing human enterprise and endeavor.1 The dismal results of government intervention in the areas of agriculture, education, employment, housing, urban renewal, mail carriage, and transportation, to name but a few, are a matter of record.2,3,4,5,6,7,8
Today it appears that the U.S. government is on the verge of a massive intervention into the practice of dentistry and medicine, because of an alleged "health crisis" in America. This impending action, which has the blessing of both political parties as well as elements in the ADA and AMA, has been given the name "National Health Insurance," a political euphemism for socialized medicine.
When exposed to the ample body of evidence which documents the fact that no such crisis exists9 supporters of government medicine generally point out that there are, nonetheless, still those who are not benefiting from our health care system. For example, in our own area of dentistry we are told by our liberal and conservative colleagues alike of the millions of cavities that are going unfilled in the mouths of the deprived and disadvantaged. The fact that there are also millions of unfilled cavities in the mouths of affluent suburbanites does not give them pause; we are still told that our free-enterprise system of health care, good as it is, must be changed, even drastically, in order that the medically indigent receive the care to which they are entitled. (For example, 95 per cent of all dentists examined in the oral health screening panel by Dr. Sherwin Z. Rosen at the October 1972 ADA convention in San Francisco had dental disease; 60 per cent had periodontitis. This unusually high incidence of pathology can hardly be attributed to lack of education or financial resources. What it does tend to confirm is that many Americans, rich and poor, educated and uneducated, choose to allocate their time and resources to activities other than achieving proper oral health. A government program of either treatment or education is unlikely to alter this situation. — JADA 86:743, April 1973).
Foreign Experience
At this point discussions of socialized medicine usually devolve into pragmatic considerations of whether or not this or that program of government health care will work. From the abundant evidence available which describes the experience in other countries which have adopted various plans of socialized medicine, it would appear that government medicine in any form is more costly than privately rendered care, is inefficient in its delivery, and often militates against the very persons it is designed to help.¹º,¹¹ We commit a serious error, however, if we focus all of our attention upon these pragmatic considerations without first determining whether or not it is possible for a person to actually possess a right to health care (or, as it is often more skillfully stated, a right to access to health care).
Before discussing health care "rights" it is necessary to first examine the philosophic underpinnings of the concept of rights itself. Exactly what constitutes a human right? Does a right come into existence because a legislature proclaims it? Can a president create human rights? Or a "majority"? To answer these questions we must begin our logical progression from the irrefutable premise that man exists. Since man exists as a living being, it can be apodictically stated that a human individual’s most fundamental right is the right to his own life. From the time of the Greek philosophers to the present no one has stated this fact more concisely than the British political philosopher Auberon Herbert:
"The great natural fact of each person being born in possession of a separate mind and separate body implies ownership of such mind and body by each person, and rights of direction over such mind and body; it will be found on examination that no other deduction is reasonable." Elaborating on this point, Herbert devastates the argument that "society," the State, or anyone else has a valid claim on one’s person:
"If there is one thing on which we can safely build, it is the great natural fact that each human being forms with his or her body and mind a separate entity —from which we must conclude that the entities belong to themselves and not to each other. As I have said, no other deduction is possible. If the entities do not belong to themselves, then we are reduced to the most absurd conclusion: A or B cannot own himself; but he can own, or part own, C or D."¹²
The Right to Produce
The right to one’s own life implies a major corollary: the right to engage in the production of values which will sustain that life.13,14 These values are accordingly the exclusive property of the individual who produces them. If an individual’s property is seized from him by force (or threat of force), his right to his property does not transfer to the robber. This fact is not altered whether the robber is acting alone or is a member of a gang of robbers. Even if a majority of individuals in a given geographic area sanctions the robbery, the owner has not lost his right to his property.15 We can therefore posit that the right to one’s own life, as well as the corollary rights thereof, accrue to each individual quite independent of the will of legislatures, presidents, or majorities. Rights, of course, cannot exist in conflict. Thus the right to use or dispose of one’s property implies a mandate to refrain from physical interference, or the threat thereof, with another individual’s right to use or dispose of his property.
A Right to Health Care?
On the basis of the foregoing we can now examine whether a right to health care can exist. Health care is a service provided by doctors and others to people who wish to purchase it. A person in need of health care (or, for that matter, food, clothing, housing, transportation, or recreation) does indeed possess a right to seek to enter into a bilaterally voluntary exchange with a health care provider (or grocer, clothier, builder, auto dealer, or travel agent). But the mere existence of a need for a service or good does not imply a right to it.
In current political parlance, the "right" to health care has come to mean the right to health care at the expense of someone other than the recipient of the service. There are four ways this can occur: 1) by the doctor voluntarily giving his services to the patient; 2) by a charitable individual or organization voluntarily donating the cost of the patient’s treatment; 3) by the patient or his agent physically coercing the doctor into providing the service; or 4) by the patient purchasing the service with funds seized from others in the form of taxes. It should be immediately apparent that while the first two examples constitute morally proper transactions, the latter two constitute blatant abrogations of genuine rights: either the doctor owns his own life or the patient owns it; and, as in the fourth case, either the individual taxpayers own their own lives, or the patient owns them. The absurdity of a person in need of health care owning a part of a doctor’s life, or a part of anyone else’s life, has been well demonstrated by Herbert.
To claim, then, that medical care is a right — that a man has a right to be cared for by somebody else — raises the question: What of that other somebody’s rights? Since rights cannot exist in conflict, we can arrive at no other logical conclusion: There exists no such thing as a right to health care.
What Can Be Done
Once we have disabused ourselves of such fallacies as the existence of a U.S. "health care crisis," the "right" to health care, or the ability of the government to deliver what the private sector cannot, we can get on with the business of trying to solve those medical and dental problems that are soluble at all. For example, approximately two-thirds of American mortalities other than those attributable to the senile cessation of body functions are due to diseases known to be caused or exacerbated by such factors of personal choice as alcohol, tobacco, or overeating; or due to accidents.16 What government program, short of outright imprisonment, could change this?
Those who advocate NHI frequently attempt to buttress their position by pointing at the catastrophic illness that bankrupts a family; or the seemingly unresolvable "lifeboat" situation wherein a mythical doctor in a sparsely populated rural county demands an outrageous fee to save the young widow’s life. Although it is often assumed that only the government can resolve these classical health dilemmas, this assumption is clearly in error. For example, it is an accepted norm in our society to insure one’s house against fire; does not common sense dictate a similar practice with regard to one’s own health? Catastrophic health insurance is readily available for the daily price of a package of cigarettes.17 For the family that is so destitute that it cannot afford even the most modest health insurance premium, there exist in the U.S. today an abundance of private charitable organizations which offer all forms of succor, including health care, to the poor.18 It is worthy of note that they exist in spite of confiscatory taxation on the private incomes that provide the bulk of their support. The "lifeboat" health situations are in actuality so rare that they cannot be used with any statistical validity in justifying a change in our present system of health care delivery.
Government-Caused Problems
Many of the ills that affect the health of the average American are due to poor diet and inadequate housing; not faulty health care. Those doctors who are willing to go beyond the confines of their clinical practices to relieve the distress of the medically indigent should examine the extent to which poverty — and the consequent inability to purchase sufficient health care, or the inability to live in a healthier environment — is the direct result of prior government intervention into the economy. Carson, Hazlitt, Anderson, and others19,20 describe at length how many of the "disadvantaged" in our society are made so because government minimum wage laws have forcibly disemployed them; how workers, particularly minority group members, are excluded from the labor market by government-protected labor unions; how would-be entrepreneurs with little capital are denied entrance to many areas of business by expensive government licensing and government-created monopolies; how many of the poor are torn out of their modest homes and pushed into unhealthy slums to make room for the plush shopping malls, luxury high-rise apartments, and freeways of government "urban renewal" projects; how inadequate diets are in part the result of government taxes which comprise almost half of the purchase price of food. It flies in the face of reason to suggest that medical indigency induced by previous government interventions into the economy be ameliorated by further government intrusion which will of itself additionally pauperize those who are Dared to pay for the new health programs.
Summary and Conclusions
While there are indeed some Americans who are not in a financial position to fully utilize all of the benefits of our free-enterprise health care system, this in no way indicates the existence of a "health care crisis" in this country. Their ability to purchase health care would be greatly improved, however, if they could obtain relief from the onerous burden of government taxation they are enduring.
The establishment of a system of socialized medicine is justified by its advocates because they feel some Americans have a "right" to health care at the expense of others. Some feel that the government could provide better health care than do private practitioners and private hospitals. Such justification is clearly in error, since there exists no such thing as a "right" to health care, nor is there a shred of evidence to indicate that the government could perform any better in the area of health care than it has in the areas of housing, education, agriculture, and other areas where its failures have been monumental. In fact, government Medicare and Medicaid programs are among the principal reasons for today’s rising health care costs and clogged health facilities.
Since a medical millennium is an impossibility under any economic system, there will always be that small number of individuals who are unable to obtain the full services of the health care system. It is understandable, commendable, and in the American tradition to want to extend a helping hand to them. But does not prudence, as well as compassion for the overwhelming majority who fall within the existing system, demand that the rational critic of U.S. health care spend his time trying to improve our system, rather than trying to impose a radical change such as National Health Insurance would bring?
If the government succeeds in fastening socialized medicine upon the people of the United States, the quality and quantity of our health care will certainly decline. This will give future historians the unpleasant task of reporting that von Mises’ observation of 1956 ad become invalid: that the U.S. government, at least in terms of health care, had succeeded in adjusting the U.S. standard of living downward to match that of the rest of the world.
—FOOTNOTES—
1 Ludwig von Mises, The Anti-Capitalistic Mentality, (New York, Van Nostrand Reinhold Company, 1956), p.v.
2 Clarence B. Carson, The War on the Poor, (New Rochelle, N. Y., Arlington House, 1969), pp. 13-24, 69-116, 128-129, pp. 186ff.
3 R. W. Grant, The Case Against Public Education, (Washington, D.C., Free Campus News, Vol. 1, No. 1, 1969), p. 2.
4 Roger A. Freeman, Dead End in American Education, (National Review, Vol. XXI, No. 1), pp. 22-24.
5 See Henry Hazlitt, Man vs. the Welfare State, (New Rochelle, N. Y., Arlington House, 1969) for a comprehensive overview, in layman’s language, of the entire gamut of destructive government intervention into the economy.
6 Martin Anderson, The Federal Bulldozer, (New York, McGraw-Hill Book Co., 1967), pp. 52-70, 229.
7 Murray N. Rothbard, Power and Market: Government and the Economy, (Menlo Park, California, Institute for Humane Studies, 1970), pp. 19-59.
8 William C. Wooldridge, Uncle Sam, The Monopoly Man, (New Rochelle, N. Y., Arlington House, 1970), pp. 11-31.
9 Marvin H. Edwards, Hazardous To Your Health; A New Look at the "Health Care Crisis" in America, (New Rochelle, N. Y., Arlington House, 1972), pp. 37-128.
10 Edwards, op. cit., pp. 135-230.
11 Neil McInnes: Sweden’s Bitter Pill, (Barron’s, 26 June 1972), p. 9.
¹² Auberon Herbert, in Murray N. Rothbard, Man, Economy, and State, (Los Angeles, Nash Publishing, 1970), p. 159.
13 Gottfried Dietze, In Defense of Property, (Baltimore, The Johns Hopkins Press, 1963), p. 49.
14 Rothbard, Power and Market, pp. 176ff.
15 It is interesting to note that if we bestow the name of a government taxing authority (i.e., "the School Board" or "the County Tax Collector") upon the gang of robbers, the nature of the act of theft is not at all altered, nor does the proper owner of the seized property lose his right to it. See also Robert LeFevre, The Philosophy of Ownership, (Santa Ana, Rampart College Press, 1971), pp. 23-42.
16 Department of HEW, Public Health Service, Vital Statistics of the United States 1968, Vol. II. Mortality. Part A, (Rockville, Md. National Center for Health Statistics, 1972), pp. 1-6, 1-7. First pointed out by Robert M. Sade, Medical Care as a Right: A Refutation, New Eng. J. Med. 285; 1288-1292, Dec. 2, 1971.
17 A guaranteed renewable, $2500 deductible, no maximum limit catastrophic health insurance policy for a family of four, for example, is available at a premium of 400 per day. See Robert J. Myers and E. Paul Barnhart, Catastrophic Insurance, (Private Practice, Vol. 4, No. 10, October 1972), pp. 23-42.
18 See Richard Cornuelle, Reclaiming the American Dream, (New York, Random House, 1966). Cornuelle is chairman of a private charitable foundation.
19 Yale Brozen, Ghetto Economics, (Reason Magazine, Vol. 3, No. 8: November 1971), pp. 8-12.
20 Dr. F. A. Harper, chairman of the Institute For Humane Studies: personal communication of November 20, 1972, relating to cost of government as a part of each dollar of personal income spent: 43 per cent as of 1972.
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The Anti-Capitalistic Mentality
The people of the United States are more prosperous than the inhabitants of all other countries because their government embarked later than the governments in other parts of the world upon the policy of obstructing business.
LUDWIG VON MISES