Ethics and Freedom

The basic premise of "Universal" health care is that someone else, namely the federal government, should be responsible for paying the medical bills of the entire nation. Some go further and want to see the federal government provide the medical service much as it already provides a military. Either way, the premise is the same: health care is a "basic right," and should be provided to citizens by the government with little to no restriction.

Of course in our society as in just about every other, "the government" is funded via taxes, which means that universal health care effectively mandates that an individual's health care is not just his own responsibility, but mine, yours, and all citizens.

In a free-market system, each individual is financially responsible for his own care. Obviously there is a problem with this simple, effective idea, or nobody would be trying to change the system. The problem is that most people are unwilling, or unable, to pay for the entire cost of their medical service.

Of course, we see a lot of these struggling people on the news who don't qualify for Medicaid but are still too poor to afford health insurance or pay their own bills. Or there's the woman battling a life-long illness and the money's finally run out. Anecdotal evidence abounds.

We'd have to have a heart of stone wish this situation on these people, so we think something should be done. Heck, shouldn't the government pay for it?

Let's examine our current situation. Instead of involving the government, wouldn't it be far more efficient if a group of people were to give this desperate person money directly? Why doesn't that happen consistently? Why aren't people knocking on my door asking for money to pay their health care bills? I have some neighbors and friends who I'm sure I could help, if they only asked. Why aren't they asking?

The answer is partly that for a person to directly ask for financial assistance is considered an imposition, rude, or impolite, and partly because the expected return on such activity (begging) is low. Also, going door-to-door to ask for money would be impractical, especially for a busy, sick person.

To that end we have charities, which exist to connect the people in need with the people who are willing to help them. Consider St. Jude Children's Hospital, certainly a worthy charity. St. Jude is a case that works largely through voluntary private funding.

Most, if not all, people would commend St. Jude as an admirable and worthwhile enterprise. What would happen, however, if St. Jude hired a particularly annoying telemarketing firm to collect donations? Probably there would be less good will toward St. Jude and such a move would hurt their reputation.

What if St. Jude hired a bunch of gangs who would intimidate people into giving donations? What if these gangs gave people a year to donate voluntarily, then kidnapped people who refused and held them in prisons? What if the gangs were paid handsomely by St. Jude to do this work?

Odds are quite a few people would have a problem with St. Jude at that point, because to accomplish a worthwhile goal, they would be using violent methods of coercion.

The government, in this case, is directly analogous to the gangs hypothetically hired by St. Jude's hospital. Just like the gangs, government power comes from the threat of violence and imprisonment. If you don't believe that, try voluntarily not paying your taxes and see what happens.

The ethical question comes down to this: if you are not willing to personally threaten someone with violence so that they pay for your medical bills, why is it acceptable for an intermediary to do it for you?

Is it because a majority of people think it's ok? If yes, then is it ethical for a majority of people to vote to legally censor, imprison, or persecute a minority? Until you can logically answer these questions, the basic premise that one person is responsible for another person's health care, and should be held to that responsibility through use of government force (taxes backed by threat of violence), is inconsistent.

As a hint, if you still would like to argue for universal health care, "the ends justify the means," and "ethics are completely relative and defined by the strongest party (might makes right)" are your two options for a logically consistent basis for your argument.

Personally, I'm willing to accept that in some extreme cases the ends do justify the means. An example is killing in self-defense, which I find perfectly reasonable, and is an adequate reason for the feds to fund a military. Also public-works and infrastructure projects seem reasonable to me. The U.S. Constitution specifically allows for road-building to support a postal service, and although I wouldn't threaten to kill someone for not paying for a road, it's reasonable to assume that roads are popular enough (even historically) that I wouldn't have to.

Reasonable people recognize that transportation would be nearly impossible, or certainly very difficult and costly, if the government were not involved. A single small entity could block building of an interstate highway by asserting property rights. I don't think there's a clear ethical answer here; only the very hard-core libertarians would argue the validity of eminent domain in all cases.

That medical care falls under the same category as national defense and highway building, however, is quite a stretch. We'll examine why later.

Be that as it may, if you think that the ends justify the means and that is your ethical basis for universal health care, continue to the next part of this argument, which examines the inevitable result of socialized medicine. At that point you can decide what means are appropriate to achieve that end.