Dan Popp
We don't need a healthcare system
By Dan Popp
March 1, 2010

All systems either of preference or of restraint, therefore, being thus completely taken away, the obvious and simple system of natural liberty establishes itself of its own accord. Every man...is left perfectly free to pursue his own interest in his own way.... The sovereign is completely discharged from a duty, in the attempting to perform which he must always be exposed to innumerable delusions, and for the proper performance of which no human wisdom or knowledge could ever be sufficient; the duty of superintending the industry of private people, and of directing it towards the employments most suitable to the interest of the society. — Adam Smith

We don't have a problem with health care in this country. We have a problem with system. I don't mean that our current system is defective, and should be replaced by another system. I mean that we don't need a system at all.

The biggest obstacle to the Marxist Welbys on Capitol Hill ("I'm not a doctor but I've berated one on TV") is that most Americans are happy with the quality and quickness of the medical care we get. The motto in Washington seems to be, "If it ain't broke, break it."

Before the government began to turn ad hoc healing services into a system in the 1960s, health care in America included such things as family doctors and house calls. Now we have the hated HMO's, and the beloved but insolvent programs like Medicare, Medicaid, and SCHIP — all inventions of our beneficent Godvernment. We can still get good, fast care, but the costs are "out of control." The larger and more grotesque the government system has become, the less health care we've received for our money.

If you saw any part of Dr. Obama's Patent Medicine Show last Thursday, you saw why top-down systems are incompatible with popular sovereignty. You may not have realized it, but you were watching living proof that "democratic socialism" is an oxymoron. In his classic book The Road to Serfdom, F.A. Hayek asserts that democratic* governments can only legislate in a few broad categories on which there is widespread agreement. Central planners, on the other hand, must make decisions in ever-smaller areas in which there is no majority opinion. Hayek wrote:

    It is the price of democracy that the possibilities of conscious control are restricted to the fields where true agreement exists and that in some fields things must be left to chance. But in a society which for its functioning depends on central planning this control cannot be made dependent on a majority's being able to agree; it will often be necessary that the will of a small minority be imposed upon the people, because this minority will be the largest group able to agree among themselves on the question at issue. Democratic government has worked successfully where, and so long as, the functions of government were, by a widely accepted creed, restricted to fields where agreement among a majority could be achieved by free discussion....

The "Health Care Summit" was a display of what happens when the pavement of popular support ends, and the collectivists hit the gravel. Now it's critical that you not misunderstand me here — I'm not making a partisan statement about whether Republicans or Democrats were serving "the will of the people" in that meeting. I'm saying what I think Hayek would say: since there is no majority view of a way forward on health care delivery in this country, there is no democratic mechanism to move in a certain direction.

But this is not "checkmate" for the Command Medicine quacks. When there's no majority support for its "reform," socialists delegate control to unelected agencies or czars. We've seen plenty of this, going back a hundred years or more. The shift from democracy to socialism thus places more and more power in the hands of fewer and fewer people. Finally, Hayek says, "Planning leads to dictatorship because dictatorship is the most effective instrument of coercion and the enforcement of ideals and, as such, essential if central planning on a large scale is to be possible."

If you watched any of the Olympics, you observed the end product of a different mechanism. You saw excellence. You saw almost super-human effort. You saw records being shattered. And four years from now, Lord willing, you'll see some of the new records broken. Why?


The spectacle in Vancouver was the result of messy, uncoordinated, free-market-style competition. Central planning produced the broadcast from Blair House.

The best reform of our health care system would be to break ourselves of the idea that health care needs a system.

*In a recent article I pointedly distinguished democracy from republicanism. Hayek uses "democracy" to stand for any kind of government-by-consent-of-the-governed, as opposed to totalitarianism. I follow his lead and use the broad sense of the term in this article.

© Dan Popp


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