A Libertarian Case for Socialized Medicine

In a recent article I announced that I had lost my faith in libertarianism. In retrospect this is not entirely true, for I have not lost my faith in liberty itself. I think that America would be far better off if it were freer. There are many areas where government has taken far too much power over our lives in my humble opinion. I think it is absolutely ridiculous that government thinks it deserves the right to ban smoking in privately owned restaurants, outlaw marijuana, regulate gay marriage, and mandate seat belts. In many areas of economics as well I see government as being much more intrusive than it is worth. I think the Obama administration's recent attempt to ban Boeing from opening a plant in South Carolina because it is a right to work state borders on Soviet style communism. I think people should be able to invest some of their Social Security money into private investments at least, and indeed we must allow this if Social Security itself is to remain solvent. I think a particularly egregious area of government overstepping its realm in the economy is the myriad of licensing laws which mask protectionism for established business in the cloak of "professionalism." To say that abandoning libertarianism has made me a supporter of authoritarian politics is a false charge, as an America where I had full control over the laws would be a much more libertarian America than it is currently even if it would not do enough to satisfy the ideologues (but then again, nothing ever will).

There is one issue where I must digress from the libertarian line of thinking and it is an issue that libertarians get incredibly inflamed about in this day and age. That is the issue of socialized medicine, which I support. I do believe that private clinics can and should exist but at the very least the centralized government ought to be the single payer, not the mere moderate corporate giveaway known as "Obamacare." This would certainly cost the taxpayers a large sum of money. If I were a benevolent dictator I do not think taxes would go up since I would cut in so many other areas like military spending but under the current system taxes certainly would go up. I would gladly make the wealthy pay higher taxes for socialized medicine, but I would agree to pay higher taxes myself. Libertarians (and conservatives) probably wonder where I am going as they live by the simple equation that more taxes = less freedom and less taxes = more freedom no matter what. How can I seriously argue a libertarian case for socialized medicine?

Let me start out by saying that historically there are two general concepts of liberty in historical political thought, two concepts of liberty. Isaiah Berlin wrote an entire book about the two concepts of liberty, actually titled Two Concepts of Liberty, though he did not originate them himself. Negative liberty and positive liberty are the two concepts. Negative liberty means mere freedom from restraint but positive liberty means the ability to be able to do something. For instance, I may be free to do X in that no third party is physically preventing me from doing so, but I may not be able to do X because of some other reason, for instance there may be a giant wall in my way or I may not have sufficient funds. To merely be free to do X is negative liberty, but to be able is X. Thus positive liberty has a different conception of freedom from negative liberty in that positive liberty says that true liberty is much more than being merely left alone, true liberty is to have the ability to fulfill our full potential. The ideology we in America call "libertarian" is best described as "negative libertarianism" in that it almost completely and purely focuses on negative liberty. Thus my libertarian case for socialized medicine relies on a positive libertarian paradigm. I simply present this as an example in order to get many of my libertarian friends thinking about the limitations of their philosophy and whether it represents true freedom.

Let's put up a hypothetical situation. You have some great ideas, some true entrepreneurial spirit. You really want to strike out on your own and be your own boss. Being your own boss is true freedom, even if your boss doesn't force you to work the fear of starvation makes you work and makes you follow your bosses' rules, whether those are good or bad rules. True freedom is making a living on your own with no other person's rules to follow. So you have a job and you want to leave it to start this new enterprise but ultimately there is an eight hundred pound gorilla in the room. You look at the cost of health insurance and it is absolutely astronomical, you probably won't be able to afford it just starting out. You are not being prevented from leaving your old job by force but in the end you have a choice, accept the risk of going without health insurance or simply remain under your boss's control. In the end you are free in a negative sense but not a positive sense since lacking health insurance can be a very dangerous thing. We can debate why health insurance costs so much but tax law and the way insurance works makes it much more suitable for business to cover their employees. This is one of FDR's unfortunate legacies, he created employer based insurance tax incentives during World War II thinking he was making progress toward universal coverage but he may have done more to harm that cause than any person in America. In the end though, whatever happened seventy years ago doesn't matter. Negative libertarians will say, "Well you can do it anyway, freedom is freedom, not entitlement." Yet it isn't as simple as that.

We as humans organize ourselves into societies because we have a bigger range of choices together than apart. Don't believe me? Go live in the wilds of Alaska alone building your own log cabins and spears with which to hunt the elk you use for clothes and food. You will be completely free in the negative sense, in that I doubt Obama is going to declare some guy hidden in the middle of the Alaskan wilderness Public Enemy Number One for failing to live up to his health insurance mandate. Yet you will lack a wide range of choices. You will not have grocery stores or McDonald's or any of the other things we have in our society. Yes, in one sense of the word you are freer in the wilderness, in the mere sense that (most likely) nobody is going to try to bother you. Yes there really are portions of the western USA and Canada where you probably could disappear into the wilderness and Big Gummint could never find you. Yet in the end you probably want a different type of freedom, a type of freedom that goes along with living in society, freedom of choice. The paradox of society is that it gives us a wider range of choices but at the same time requires that we give up some of our negative liberty to have it. Freedom really isn't free, even if the bumper stickers seem a bit hokey.

This brings us up to socialized medicine. Virtually everybody wants health insurance, there may be a small minority of people like Christian Scientists who don't and these people should not be forced into medical care they don't want but the basic fact is that medical care is a need, not a want. Yes I know the far right will say, "Well why don't we socialize food?" and what I say is that you don't insure yourself for food since food is something you need at all times whereas health care is something you need some of the time. Insurance becomes expensive since medicine requires high overhead and so on and so forth. The bottom line is that health insurance is out of price range for many people in the individual market. Now if you make money you are probably going to have to pay taxes, that is an accepted fact. There will also probably come a time when you need medical care and God forbid it come when you have no insurance. Insurance will cost money. You are paying your taxes already and paying your health care costs on top of this which brings me up to something I've noticed about the right, they worry about money when it is in the form of taxes but nothing else. Under socialized medicine you may pay 5% or 10% more taxes per year but this increase will offset the amount you will save on health care. The right just doesn't get it. I do. If ultimately the issue is about money then socialized medicine is in the self interest of something like 90% of the population, maybe even more. In fact, I'd argue that it is in the self interest of all those who are not independently wealthy. Why should the vast majority of a population sacrifice our economic self interest for a wealthy minority? We can turn Ayn Rand on its head and argue reverse altruism on this one. So should I altruistically sacrifice so the poor little rich folks don't have to pay 5% more in taxes? Should I altruistically empty out my pockets to pay for insurance because it is somehow "punishing" the wealthy to have a progressive tax system? The answer for me is no.

So what about liberty? There is no doubt about it, if we had socialized medicine it would increase all of our positive liberty! We would not have to worry about losing our insurance and we would be able to choose the career path of our choice without being slaves to our jobs for fear of losing our employer based coverage. Not only would it make us freer but it would add needed dynamism to the economy since there would be many entrepreneurs out there leaving behind old dinosaur industries to launch new enterprises. Yes we would probably have to give up a small, tiny, insignificant amount of negative liberty (perhaps pay insignificantly higher taxes) but in the end the positive liberty we would gain would be tremendous. Those who claim to love liberty need to learn to see beyond the tip of their nose. Once this happens one begins to recognize angles to issues you never thought of before. Once I simplistically viewed the socialized medicine issue as a matter of freedom versus control. I've moved beyond that, my views have evolved and by evolved I mean they have advanced into something much newer and better.