If you’re a limited-government advocate, you’re almost guaranteed to be a detractor of the Affordable Care Act (ACA) colloquially known as Obamacare. The AHCA from the GOP designed to replace the ACA, has recently been passed by the House, but is largely believed to not have a chance in the Senate.
If you’re old enough to recall the Clinton presidency, you may remember that Hillary Clinton was appointed by her husband Bill to the “Task Force on National Health Care Reform.” Her mission was to improve the state of health care in the United States, and her suggestion was a single-payer system similar to what many nations in Europe and Canada use.
This single-payer system was originally supported by President Obama as well, prior to becoming president. But the political climate in America is still one of limited government more often than not, so the ACA was a compromise Obama was willing to make to achieve his goal of every American having “basic access to health care.”
The bill being one of the larger in American history had a lot to it, and as such, had a lot of things people from many places on the political spectrum took issue with.
The extreme of the left, like self-proclaimed socialist Bernie Sanders argued for a universal plan, not a privatized option like the Affordable Care act. So in their estimation, the plan didn’t nearly go far enough.
Those on the right, felt the mandate requiring people to buy insurance was counter to American values, and challenged that, as well as several other facets, in the Supreme Court, ultimately losing their fight after Chief Justice John Roberts arguably rewrote the law to allow it to survive instead of casting the deciding vote to strike it down.
Many libertarians like myself, are left wondering why government should be involved in health care in the first place. I think our position is pretty consistent and straight forward, although I always cringe at the idea of speaking for other people. But I will try to state the libertarian position as I’ve consistently observed it.
Health Care is not a Right
The argument from those pushing for government-funded health care is the idea that it’s a right—some going so far as to say it’s an extension of your right to life. But let’s break that down for a second, as it depends on how you define rights in general.
The Constitution doesn’t mention health care, so there’s no honest metric one could use to say it’s a Constitutional right. However, most argue that it’s a basic human right.
If we compare health care to other well-understood basic human rights, it becomes fairly easy to understand how healthcare is different. Religious freedom, freedom of speech, freedom in general, life, air, etc., these things all have one thing in common. They do not require any action from another person.
Rights by definition, should not involve the action of another person, because otherwise, your right to have their labor or goods trumps their right to keep their labor or goods—therefore one person ends up having more rights than another.
Healthcare requires goods produced by the pharmaceutical industry and medical equipment from manufacturing companies, as well as the efforts of a medical practitioner like a doctor or nurse, it isn’t just something that exists in the ether for all to consume.
If we force those people to do such work through laws like EMTALA, which require emergency rooms to treat people, regardless of their ability to pay, this arguably violates the 13th amendment which states:
“Neither slavery nor involuntary servitude, except as a punishment for crime whereof the party shall have been duly convicted, shall exist within the United States, or any place subject to their jurisdiction.”
Making a doctor save someone’s life versus giving them the option, even if they get paid to do so, is both immoral and potentially unconstitutional.
A quick internet search yielded no instance where SCOTUS has granted certiorari (agreed to hear) any petition challenging EMTALA, although the 11th Circuit upheld the law in BAKER COUNTY MEDICAL SERVICES INC v. ATTORNEY GENERAL, August 2014, The challenge there was not against the 13th amendment, it was against the 5th, which reads as follows. (The bold portion was what the challenge argued against.)
No person shall be held to answer for a capital, or otherwise infamous crime, unless on a presentment or indictment of a Grand Jury, except in cases arising in the land or naval forces, or in the Militia, when in actual service in time of War or public danger; nor shall any person be subject for the same offence to be twice put in jeopardy of life or limb; nor shall be compelled in any criminal case to be a witness against himself, nor be deprived of life, liberty, or property, without due process of law; nor shall private property be taken for public use, without just compensation.
The reason the law was upheld, is because the law only applies to hospitals which voluntarily work with Medicare. So the court ruled that their participation was voluntary, while the plaintiffs argued not taking Medicare is an undue financial burden, and therefore not really a choice. (Almost all hospitals accept medicare, because they’d have a hard time making a profit if they rejected all those who are on it). Government often gets so involved, that they create the problem by virtue of their intrusiveness in the marketplace.
Moving past EMTALA, if we assume that the doctors help someone voluntarily, and expect to get paid by government, then the second issue arises that the taxpayer and/or fellow healthcare consumers, end up footing the bill.
What logical argument can one make to indicate that person A is responsible for person B? While it’s certainly altruistic in its intent, and I understand the idea that if we all band together to help those in need, society is potentially better off because of it; that’s still a moral judgement you’re making that others may not share with you.
There’s also a rather large hypocrisy in play for these beliefs. Speaking to a doctor who promotes a single-payer system, my argument was that at some point, that doctor expects to retire. While my taxes help pay for health care, my dollars don’t cure anyone. My dollars pay a doctor who then cures someone.
So if a doctor chooses to take a day off, or retire, they have opted to not help someone who could have used help. If I were to tell those doctors that now the government gets to dictate how many hours they work, and what time they may take off, they’d be apoplectic. Yet I do not get to choose how much of my paycheck funds the health care of another.
Much like mass and energy are interchangeable because one can be transformed into the other, so are labor and money for the same reason. Forcing someone to give up their money to pay for services they’re not receiving is no more moral than forcing them into servitude for the same purpose.
As much as it may seem heartless not to do it, you cannot divorce that fact from the equation.
This brings me to the “are you just going to let them die” argument, that is often bandied about as justification for forced medical care.
The number of visits to a doctor that are life threatening vs just quality of life issues are very small. Even Emergency Room visits, according to one government study puts the number of visits that could have been treated by a normal doctor or Urgent Care facility vs the emergency room at somewhere between 13.7 and 27.1%. That doesn’t include all the times people just went to their doctor, or an Urgent Care facility. So it is more than fair to assume that less that 10%, maybe even less than 1% of all medical care required is non-life-threatening.
If that’s true, then most of the time care may be refused, it is not about letting someone die at all.
But also, if we go back to labor and money are interchangeable, arguing that myself or anyone else is “just letting someone die” assumes that we owe them their life. Which again means that the government would get to decide when a doctor may retire or otherwise not work.
While it’s easy for those of us who aren’t medical doctors to sit at home, and say “someone should help those people” (referring to those who can’t afford to pay for health care), the fact is that any government requirement for them to be helped requires violating the actual enumerated constitutional rights and largely accepted human rights of a number of people, in order to preserve a non-enumerated right of one person.
If you want to help people, you should volunteer to help. Go to school to learn medicine, and do the good deeds you want done. But the moment it becomes compulsory for you or anyone else, it is no longer moral.
With the number of charities that were doing great work to help the less fortunate before laws like this were passed, the idea that such people didn’t get help, is misguided. While there were some people who did not receive care, there were a good number who did. But more importantly to libertarians like me, liberty remained in tact, and not one right was violated.
The Logical Libertarian™ 
I’ve enjoyed reading this article. I appreciate your reliance on logic and first principles to develop sensible arguments in relation to law and government policy.
As an individual,trying to figure out my position on these issues, it is useful to see the way other people think.
One question I have, with the regards to your above argument relates to the following:
“Healthcare requires goods produced by the pharmaceutical industry and medical equipment from manufacturing companies, as well as the efforts of a medical practitioner like a doctor or nurse, it isn’t just something that exists in the ether for all to consume.”
My question is: is that necessarily true? After all, If government simply reimburses people for the health care that they receive, and that person then engages in a mutually consensual arrangement with a health care provider, where is the infringement of rights?
I actually agree that laws that require a doctor to do something are an infringement upon the basic principles of liberty. You mentioned the argument of disadvantage due to denying medicare. I think that this is more of a practical issue rather than a philosophical one. For example, the health care professional could choose to charge above an amount that government reimburses to the patient for that particular service, then the patient decides whether to pay the difference or else see someone who charges less. (Incidentally this is the system used in Australia, where I live).
The argument then becomes whether the state has the right to tax to provide this service to its citizens. I would be interested to hear your thought on this particular topic, particularly contrasting this issue with say policing, or military spending.
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Government doesn’t have any money. It gets its money by taking—by threat of force—via the tax system, from the citizenry. So for the government to pay for that, it has to take it from taxpayers like me who earned it, and give it to someone else. So my rights to property (the money I earned) have been violated.
Me and me alone should get to choose who I give my money to, in any charitable manner.
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Thanks for replying! I can definitely follow your logic. I agree that in matters of charity, the individual should have the right to choose if and when they give of their own property.
It seems that the principle by which can we justify raising taxes for policing and military defense (the core services under a limited libertarian government), is that the sole role of government is the protection of an individual’s basic liberties.
There remain two questions though in my mind:
1. Why is the abovementioned role of government the only role of government? What is the justification for that? In other words, by what principle is government only interested in the rights of its citizens, rather than in their responsibilities? If a state consisted of say twenty people, one person became very ill and had to be cared for, and there were only two members of that state who refused to provide care for the ill person, would it not be conceivable that the 17 remaining would ostracize or passively punish the two, and that this would be justified?
2. Even if we were to maintain the current libertarian view of government, could this not extend to provision of healthcare as protection of liberty from disease? As a hyperbolic analogy, if there were a large asteroid heading toward Earth that was expected to cause mass destruction, would governments not be expected to act to protect their citizens?
Thanks again for your consideration.
Regards
Mick
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Sorry, I don’t follow your logic. Liberty is about freedom from someone hindering you in your pursuit of happiness, not some thing hindering you, like a medical condition. So you lost me when you describe “liberty from disease.” Those two do not go together.
I’m also not sure how the asteroid issue relates to personal healthcare. Almost nothing in the healthcare industry is to assist you so you don’t harm all of humanity.
I understand your arguments, just don’t see how they relate to stealing from one person to pay for another person’s healthcare. That is not helping the collective, that’s helping several individuals individually who should be responsible for themselves, and more importantly, have no claim to what someone else has earned.
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Hi again. Great to get your thoughts. I don’t necessarily disagree with you, but trying to get a sense for the depth of the libertarian logic.
I’m sorry if that wasn’t clear. I was using liberty to mean “freedom” in general, rather than purely it’s modern political meaning of freedom from other people/authority (liberty tends to have a broader sense in philosophical circles). I’m happy to stick with your definition for the sake of simplicity.
In my example above about the asteroid, the analogy is between the asteroid and disease in general. In the same way that disease is oftentimes indiscriminate (granted not always, but that is a different discussion), and not within the control of the victim, so the asteroid would land and cause harm indiscriminately. Assuming that you’d expect government to act in protection of its citizens in this situation, then why not in matters of disease? All this to say that since we have now defined liberty to be purely from other people, you can ignore this analogy.
It leaves however some unanswered questions. It seems that given a particular scenario, you’re answering from the basis that “I’m libertarian, therefore…”. In other words libertarianism is your starting point. I’m attempting to work from more a first principles perspective- I.e. Why be libertarian in the first place? So, to the point about military spending; do you believe that taxation for defense is stealing? What about taxation for police and courts (limited to libertarian necessities that is)? If so, why is it then ok to steal sometimes and not others?
If, as I suspect, you don’t call taxation for these matters stealing, then again what is it about defense that means government has the right to raise taxes? I suspect your answer will be that this is the libertarian principle: that the role of government is to protect its citizens’ “freedom from someone hindering you in your pursuit of happiness”, and nothing else. But the question remains: why should that be the only role of government? Why not include freedom from disease? Or why not include freedom from disease for the vulnerable (e.g. Children or the disabled)? What is it about freedom from interference of other people that makes it unique in this regard?
Cheers
Mick
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I think we’re dodging the elephant in the room here.
Does it truly matter, on a societal level, if some–a few–of those people who can’t pay die as a result? People have always died because they were unable to afford food, or shelter, or medical care. In a civilization where some people are unable, or unwilling, to work to find a niche, there will always be people who suffer because of their poor decisions–it’s unavoidable, short of forcing everyone to subsidize everyone else at gunpoint.
That’s not a reason to force government theft, it’s a reason to drum a good work ethic into our children–because their only alternatives are slavery or death.
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Indeed we are all going to die. So healthcare isn’t a matter of life and death as much as it is about an extension of life before eventual death. While anyone who loves someone else would stop at nothing to extend that person’s life, and we of course have out own self-preservation instinct, I cannot make any fair argument to say an unwilling third party is responsible for that.
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Hi again. I’m enjoying the dialogue, and it’s been a good springboard for further reading.
There have been no answers to my former question about the reason for the arbitrary decision within libertarianism to enforce only certain rights and no responsibilities. But, since we’re focussing on the underlying moral/philosophical arguments, I’d like to pose a scenario:
If one were to walk by a toddler drowning in a wading pool, would one have a moral obligation to save that child from drowning?
If your answer is no, I’d be thinking very long and hard about the kind of world you want to live in. If you agree that the answer is yes, it’d be interesting to apply that argument further within a libertarian framework.
Regards
Mick
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This analogy is false for a couple of reasons. A helpless child is a very different thing than an adult who is often capable of helping themselves.
Single payer healthcare, as stated above in the article, is rarely about life or death situations as you describe here.
Also, what if the person is unable to swim, and the attempt to save the child is only going to get them killed with little chance of saving the child?
There are many reasons why your analog is poor for justifying healthcare as a right.
The bottom line is that I believe most people are moral and will do the right thing voluntarily. If not, then they might suffer the embarrassment of being shunned by the community, having no friends, etc.
But if someone does not wish to, or believes they’re unable to help someone, I will not condone the state putting a gun to their head and forcing them to do something others would argue is moral, but which that person may take issue with.
No one person or voting block gets to decide what is moral, and therefore what you must do to help others. Doesn’t the Sharia Law advocates in the Muslim faith for instance justify mercy killings of gay people? In the Sharia wing of the Muslim community, that’s considered moral, as if they’re doing the gay person a favor. Yet most non-Muslims would consider very immoral.
While this is an extreme example, the point is that morals are matters of opinion, not fact. And they will always vary from person to person.
This is why no group of people should get to decide for others what is moral. The only thing that is universally moral, simply by virtue of not being immoral, is leaving someone alone to live the life they wish to live, whatever that life may be. If you interact with them in no way, nor impose on them any action they must take, then there is no way you could do anything immoral to them.
So to answer your question, I would chastise, shun, shame, and otherwise show little respect to the person who chooses not to save the child. But I would not put a gun to their head and force them to do it. If anything, I’d attempt to save the child myself.
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I think this post lacks all humanity. I’m British, I was born into and raised with the NHS. I’m overgeneralising here, but it’s public healthcare paid for by general taxation.
When my wife was 30 weeks pregnant, she had a checkup. They found a problem and our daughter was delivered by c section. She spent 7 weeks in neonatal care and thankfully everyone is now doing well.
Without the NHS, my wife and child wouldn’t be here today. There’s no way we would have been able to afford the costs on our own. Are you prepared to tell me that my wife and child should have died? Because that would’ve been the reality without universal healthcare.
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I’m sorry you went through such a trying event. I’m relieved to see it ended up well. But that doesn’t negate the points I make in the post. No one person has a right to take by force the labor or money of another. I’m glad some good came out of such a theft or property and labor, but that doesn’t make it moral. A moral transaction is one where people voluntarily help you, not one where that help is taken by force with the threat of violence looming over the person it was taken from.
At the end of the day, you and only you are responsible for you. I am not, no other tax payer is, and no doctor is. If you want my money (I’m quite poor—well below median income—but I do pay taxes) or their service, you have a right to ask for it. But you do not have the right to put a gun to our heads and demand it “or else.”
I know you think that is somehow hyperbole, but if we don’t pay our taxes, or do things we don’t want to do, which government makes us do, that’s exactly what eventually will happen. People will show up who carry guns, and they will force us to comply.
All that being said, it is rather insulting and immoral that you think you get to be the arbiter of what is moral (or humane), but people like me who happen to have a different opinion based on what I wrote above (it’s certainly not just me) have no right to call ourselves moral/humane if we don’t agree with you.
Now, let’s talk about all the people in your universal system that don’t get help. Like the family who want to bring their terminally ill child here to the US for an experimental treatment, but your government won’t let them? It’s their child, and they raised the money for the treatment, and only want the government to let them come. Does that seem moral to you?
What about older people who need a life-saving treatment, but because the government considers them too old to justify an expensive life-saving treatment that might save them, get refused that treatment. Here, if you have insurance, you get the treatment. That sure seems more moral to me if they earned money, bought their insurance, and therefore get treated. Your people worked their whole life, paid into the tax system, then got refused treatments all the time.
I know someone who was suffering from carpal tunnel syndrome. It was uncomfortable, but not life threatening. Your government wouldn’t treat her because it wasn’t that severe yet. So she came to America, paid for the procedure, and went back home to the UK so she wouldn’t have to suffer.
I’m sorry, but stories like that are immoral and lack humanity just as much as what you described.
Your opinion is important, but so is mine. If you are going to demean my opinion as less important or humane than yours, then I’d say I have the moral high ground here. Because I’m willing to admit that reasonable people can have competing opinions, and that’s OK if we don’t agree. I don’t have to insult you or your opinion doing it.
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But very many of us in Britain are happy to help fund the necessary health-care others require. It is not a burden but a moral responsibility. How can a person feel truly content in a system which offers no help to the most marginalised people? I find libertarianism and alien and ruthless philosophy. I do not seek to invalidate your views, but I do mean to critique them from the perspective of ethical altruism, claimimg that individuals have a moral obligation to help, serve or benefit others, if necessary at the sacrifice of self interest.
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Hi, Jed. Thanks for commenting.
I understand that mentality, but I have to respectfully and vehemently disagree based on a couple points. I promise, I’m not trying to be mean-spirited here, just logical, as the name of my website implies. So please don’t think I’m trying to insult you in my response. I know it may come off that way.
A) Your argument assumes that if government did nothing, no one would get help. But charities help people all the time. And they could help more people if more people had their tax dollars back, and could afford to give more. But in general, anything done by force is immoral in my opinion.
B) A moral responsibility is an opinion you hold, but not a fact. So you have to acknowledge some other people would hold a different opinion. Why are you right and they’re wrong? The short answer is, neither are, because it’s an opinion—not a fact. And I suspect you often violate it, yourself. For instance, how much money do you spend a year on things you don’t need, that could help people in dire straits. Unless you live like a monk, modestly with no extraneous possessions, and instead give all your money to people around the world who need it more than you, your opinion is hypocritical, is it not? Think about it. I mean really think about it. Your opinion, taken to it’s logical conclusion would mean no one should have any material possessions until there’s zero suffering in the world. Otherwise, you’re doing what you claim I’m doing, and being ruthless to people who need help. You’re just drawing some made up line you think is fair, but the person just outside your line probably thinks isn’t fair.
C) In my opinion, you don’t get to claim moral high ground for voting to take other people’s money by force to help people you think should be helped. It’s only moral if you help them yourself. If I am low income, and still paying my taxes, what if I decide I need that money to feed my family or something? If I stop paying, people with guns are coming to make me pay. That’s not moral, in my opinion, and you don’t get to take that out of the equation.
D) Your argument assumes everyone who needs help has no responsibility in the matter. So if I work hard and do all the right things, I’m to have government put a gun to my head, and pay for the medical bills of some person who refuses to work hard and save money, but then goes out and does something like rides a motorcycle really fast and gets in an accident as a result? Why is his laziness and stupidity my responsibility? And how is that moral making me pay for him?
E) I take serious offense that our position is ruthless. Claiming that I am responsible for me, and you are responsible for you, is literally the only fair system. Your system is ruthless because it takes from me by force, something I’ve earned and gives it to someone who didn’t earn it. I’d be ruthless if I stole from people to help myself when I’m struggling, so why isn’t it ruthless when government does it?
F) Has anyone you disliked every asked you to borrow money, and because you didn’t like them, you declined to help them when you could have helped them? Why is that OK if they needed it and you had it? So you exercised your right to decide who you help and you don’t, which is what I want to be able to do. My position is the only one that is ideologically consistent and fair.
G) Will some people suffer as a result? Yes. But the world has people suffering everywhere, and we can’t save them all. It is a truly untenable position. So your system draws lines and decides to steal to help person A, but not person B, which by your own argument, is ruthless to person B. But again, my system is consistent, fair, and doesn’t violate one person at the hands of another. Even if a person gets cancer through no fault of their own, I didn’t cause them to get cancer, so I don’t owe them a cure. I will help them if I can, in a charitable way, but putting a gun to my head and making me help them, (which is what government inarguably does) is not, nor ever will be moral in my opinion.
H) This is more just a general statement. But different cultures are different. Some countries have that socialist mentality, and if they like it, that’s great. Our country is obviously founded on the idea of liberty. So if you were conditioned to think socialism is good, that’ll be your opinion, and if I’m conditioned to believe freedom is good, then I’ll be predisposed to think that way. You have to be able to challenge your own beliefs if you’re ever to consider yourself fair-minded. But also, at some point, you have to accept different cultures think differently, and that’s OK.
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I know my tone is harsh here, but I wanted you to feel the same level of disrespect you showed me by saying my opinions lack all humanity, as if to say I’m some sociopath.
You have skeptic in your handle, so if that’s true, you should understand that humanity as a concept is subjective. What you consider humane, I may consider not humane, and vice-versa. Neither of us are right and wrong in our opinions, by definition. But my post lays out facts and opinions both, and my facts aren’t incorrect. I also don’t think you’re being a true skeptic, in that you’re not even questioning your own sacred cow, here. That government must help others who cannot or will not help themselves.
You can certainly define health care as a right in your opinion; rights are matters of opinion after all (they’re not testable, so they’re not science). But if health care is a right, then you must remove property rights and remove the right to not be forced into servitude (forced to do labor you don’t want to do). Which is a concept I’m uncomfortable with, and I imagine you would be do if you were poor but healthy and had to pay for the medical care of others by force, or were a doctor and were told you had to help someone under threat of force.
My opinion is based on the simple notion that you are a free person. And your freedom is sacrosanct, so long as you don’t encroach on the freedom of someone else doing it. Or simply that you must be personally responsible for you. Anyone else you wish to help must be voluntary.
All that being said, I believe there is nothing but altruism in your intent, and I truly do respect that. But I do not believe that violating a doctor and a taxpayer’s rights to help someone who is ill is more moral than telling people they are personally responsible, and I will only help them if I’m able.
I should also point out, that my country, unlike yours, is founded on the concept of freedom. Yours has slowly started to embrace it over time, since you have free and fair elections now, and such. But our cultures are still quite different in many respects, as we treat freedom with a little more reverence here. I don’t expect you to fully understand that, but you should at least show a little humility and respect for our culture, if you want us to respect yours.
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I find tragedy-based arguments for autocratic solutions to be tiresome in the extreme; most people invoke a tragedy, hypothetical or otherwise, personal or otherwise, primarily to manipulate the other party through “guilt-tripping.” The flaw of over-sentimentality is, regrettably, all too common among conservatives, perhaps even to a greater degree than our liberal friends. But once one removes himself from the equation, correct answers become obvious.
It is entire possible that, without your NHS, your wife and child would have died, just as it’s entirely possible that they would have survived. It is of no consequence either way. I believe that it is possible, even likely, that had you lived under the benefits of a fully privatized system, your family would have received a superior level of car to what you actually received–and without burdening your fellow citizens with the expense. But regardless of the hypothetical outcome, it is not a reason to condone theft through the gun of a hostile government.
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These dopes who claim that health care is a right are not worth paying attention to.
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