Against Ayn Rand, Vol. 1: Healtchare

Having just concluded reading a pair of essays by Ayn Rand, "The Objectivist Ethics" and "The Nature of Government," I will begin tonight a series of posts that seek to present problems with the thinking of Rand presented in these essays. While at times I confront Rand at her own game, arguing against her from within her own framework, at other times I argue against the framework as a whole. At neither time should the choice to argue from one perspective or the other be an indication that I concede any point articulated by Rand. At times, these posts are designed explicitly to argue against Rand. At other times, such as this one, the post is peripherally related.

At a very simplistic level, the economic theory espoused by Rand is a hard-core libertarianism. Privatize, privatize, privatize is the theory of choice - an extreme laissez-faire capitalism that has complete separation of economics and government. It is my belief that the issue of medical care is enough to persuade many people that such a scenario does not work. Unless you believe that those people who cannot afford medical care should not receive it, it is unlikely that you would consent to Rand's position being superior to one in which the government is involved.

If health insurance were entirely left up to the free market, there would be many people who could not afford to purchase it for themselves. These people would, therefore, be denied coverage. The case of the person who has survived multiple heart attacks is a good example. The preexisting condition of heart instability would mean that the cost of insuring such a person would be quite high. So let's suppose that this person does not have the money to purchase a health insurance plan that will cover him in the event of another heart attack. Well, the chances are that he'll have another heart attack, so let's suppose that he does. He is rushed to the emergency room where doctors are obligated by their code of ethics to help in whatever way they can. The medical bill may well reach six figures, but of course, the man has no insurance because he can't afford it, so there is no way he can pay the medical bill.

There seem to be four options here. 1) The medical field could rewrite its code of ethics so that they are not obligated to help patients who cannot pay. 2) Hospitals raise prices for everything to offset the cost of treating those patients who can't afford it. 3) The government could reimburse the hospital for the emergency cost. 4) The government could ensure that the everyone has health insurance, either by mandating that health insurance providers cover everyone or by running the system itself. If you find option one unpalatable, as I do, then the Randian system is unacceptable. As for the second option, it drives the price of health insurance up even higher, meaning even more people can't afford it. This is, more or less, how the system has worked for some time now, and it has proven to be radically inefficient.

Regardless of which scenario other than the first we are examining, the Randian will argue that it is inherently unfair because it penalizes people who can afford healthcare because others cannot. So the question we should be asking is not about whether or not the government should be involved in healthcare. Such a question is aesthetic not economical; it is based on preference not on efficiency. Instead we should ask what way of organizing the system is the most efficient. How can we, as a society, pay for the medical care of people who cannot afford it themselves in the most efficient way possible?

Unfortunately, such a discussion is difficult to have. The fire-branding rhetoric of the right will accuse any government intervention in the world of healthcare as being a foray into the experiments of socialized medicine. But the current system is broken. The US ranks below Chile, Colombia, Saudi Arabia, Dominica, Costa Rica, and Cyprus (among many others), in the WHO's ranking of healthcare by country. Nevertheless, the US total expenditure on healthcare per capita is almost double that of all of the other nations of the OECD, and even its public expenditure ranks among the top two or three nations in a system that is almost entirely private.

We must fix our way of providing healthcare for our society. It is inefficient and weighs down business and government. The debate should not be decided by the means to make the system more efficient, but rather by which method makes the system most efficient.