Recent reading:
Fed-Acorn Criminality
The Money Monopoly
Learning for Liberty
A Fresh Voice: Star Parker
Often the facts that are least observed are the ones in plain view. The President's health plan is one of the biggest stories this year. Yet, if you go to the White House website and look up his health plan under "issues", you will find a video of his speech before a joint session of congress, a transcript of that speech, a summary of its announced benefits, and a one-page printable pdf file excepted from the summary. For greater detail you would have to go to one or another bill that has been introduced in congress, none of which has the President's endorsement.
This weekend the President provided a media blitz, appearing on every Sunday morning talk show. He seems urgently to seek public endorsement of his "plan". But what plan? He wants the endorsement of the public without presenting congress with a bill to consider, and without having to argue for that bill.
"Let the jury consider their verdict," the King said, for about the twentieth time that day.
"No, no!" said the Queen. "Sentence first-- verdict afterwards."
"Stuff and nonsense!" said Alice loudly. "The idea of having the sentence first!"
"Hold your tongue!" said the Queen, turning purple.
"I won't!" said Alice.
"Off with her head" the Queen shouted at the top of her voice. Nobody moved.
"Who cares for you?" said Alice (she had grown to her full size by this time). "You're nothing but a pack of cards!"
The President's approach, leaving the dirty work to Congress, is but an extension of the approach congress itself uses: off-loading the unpleasant details of rule-making to bureaucrats. Bills are often passed that are simply statements of good intentions, very often conflicting with one another. The agencies charged with enforcing the law are also charged with writing the regulations to be enforced. This relieves congressmen of direct responsibility for what they have done. They can always say that whatever regulation and enforcement resulted was not what they intended, and that (what else)
reform is needed.
For example, consider a typical thousand-page bill robbing various Peters to pay various Pauls. It may not be clear from the bill itself just who will be Peter and who will be Paul. Best leave such details for later, after the bill becomes law. Beforehand, everyone is encouraged to think of himself as Paul.
Consider the plight of the poor congressman. His job description is to write laws to restrict people's freedom. He must do this in a nation that views itself as a bastion of freedom. Surely it would be easier to sell refrigerators in Alaska. How can shackles be made to seem desirable? It is an intellectual challenge, but there are always court intellectuals who rise to the occasion; that is a subject for another day.
In the case of health care, as so often happens, some of the biggest losers appear to be the young. The healthy young will be forced by law to buy insurance that they very likely do not need. They must do this while working for the lowest wages of their lives. They already help to pay for the retirement and medical care of their elders through social security and medicare. They have been forced to spend the first twelve years of their education in generally poor-to-mediocre public schools. They risk being drafted into the armed forces. They may be denied employment at low starting wages by minimum wage laws and union shops. If they take government student loans, they will find no escape through bankruptcy. All this while they are engaged in some of the socially most important activities of their lives: education and raising families. If any group should find the status quo wanting, it is our young.
Another group of losers is the medically ignorant. Ours is a culture of specialists. We are encouraged to rely on professionals and experts in most things, particularly in medicine. Yet even today's medical procedures cover a broad spectrum in terms of effectiveness. Now, as ever, surgery can often save one's life. Yet many expensive procedures do little or nothing to reduce mortality, that is, to delay the expected time of death. A recent study found that for those suffering a first heart attack,
aerobic exercise produces better outcomes than angioplasty. Another study found that the use of x-rays in cancer detection produces about as much additional cancer as would have occurred without it. In the opinion of some doctors, the use of drugs to treat chronic diseases that are not well understood does more harm than good. A colonoscopy can find cancer, but it can also result in a punctured colon. There are nearly as many deaths from the latter as there are cancerous tumors discovered by the former. Surveys have found that though oncologists make most of their income by administering chemotherapy, most of them would not use it if they themselves developed cancer.
The point is that most medical interventions are a double-edged sword. There is no time in life when the phrase
caveat emptor (buyer beware) is more urgent than when you are making medical decisions. Making medical care free at the time of use causes people to use it far more often than is good for them. The result is higher insurance costs and poorer health outcomes.
Hayek justified freedom by observing that information and knowledge are local and broadly distributed. No central authority can know enough, or attain sufficient certainty, to justify making local decisions by force of law. The history of the Soviet Union, Castro's Cuba or Mao's China should make the point. If not, look at the history of urban renewal or public housing in this country.
The only unique product that a government has to offer is force. Small government thus means a minimum use of force. Rather than looking for new roles for government, it would be better to strip government of any roles that do not absolutely require the use of force. Like commerce, banking, education, pensions, medicine....
If voters can ever get their act together, they will find that government is no more fearsome than a pack of cards.
