The occasion for these sundry reflections is the September 25, 2006 report of the Citizens’ Health Care Working Group. This committee was mandated by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. Its 14 non-government members were selected from 530 applicants by the Comptroller General of the U.S., David M. Walker. The other committee member is the Secretary of Health and Human Services.
We can thank President Bush and his cadre of compassionate socialists, fascists, communists, or mercantilists — take your pick — for further undermining the health care market via the prescription drug benefit. Their aim then and now is to create a nationalized health care system or some version of it piecemeal. They wish to out-compete and pre-empt Democrats on this issue.
Mr. Walker hand-picked the members of the Citizens’ Health Care Working Group. He chose those with an interest in further replacing the free market with controls, bureaucracies, and regulations. His background tells us what his predilections are. He has been a public trustee for Social Security and Medicare. He has been associated with the Pension Benefit Guaranty Corporation as Acting Executive Director. He was Assistant Secretary of Labor for Pension and Welfare Benefit Programs. He has a great deal of business experience in major accounting firms. He is a technocrat. Technocrats like him are an important component of today’s American social democracy, at all levels of government. They do not believe in freedom or free markets or they would not be in positions of power within government. They, in fact, are enemies of freedom, no matter what their rhetoric suggests.
Mr. Walker could not by law choose government officials for the working group. He chose distinguished and qualified people with such occupations as a hospital administrator, a professor of public health, physician (3), nurse (3), health care advocate (2), the president of a labor union, a clinician specializing in government relations, a corporate benefits specialist, and a health economist. Their collective experience is substantial and cannot be doubted. There is no need to question their integrity, but we certainly can question their objectivity. Each and every one of them is a participating partner in the system they are being asked to expand.
The law forming this group charade instructs it "to examine…the capacity of the public and private health care systems to expand coverage options." This simply means: Go thou and return with recommendations on forcing everyone to participate in a national health care system with more coverage of more medical conditions. Return with a recommendation to expand the system either through (mandated) public means or through forcing private entities to conform to public mandates, which is simply another form of public control.
Mr. Walker and the law itself channeled and constrained their efforts in one direction and one direction only, toward more government meddling in health care markets. The results of implementing their statist recommendations are a foregone conclusion, namely, less and slower medical progress, less and slower medical innovation, more prolonged illness and death, worse and slower treatment of patients, more eventual regulation, lower quality and more costly health care, and more rationed and restricted health care. Every nation that has gone in this direction has experienced these predictable results of supplanting free markets with socialized medicine.
Sentenced to death
The democratic process that produces these results is reminiscent of Stalin’s show trials. The hand-picked judges go through the motions of trying the already condemned accused who stands battered and bewildered before them. Having been tortured, drugged, and deprived of sleep, the accused confesses his guilt and indicts others. The verdict of guilty is brought in and the human wreck is shipped off to Siberia or worse. In America, the same process and worse go on. The committee members know what they must do to try and sentence the health-care system. The accused, the victimized health-care system, is so amorphous and vague that it is hardly even present to defend itself. The court is filled with all prosecutors and hanging judges but no defense attorneys. The health care system is battered into whatever shape the accusers give it as they riddle it with criticisms. Its wobbly condition, like that of the prisoner in the dock, is never blamed on its torturers, the members of Congress and government itself who have already beaten and twisted it into an unrecognizable condition.
Americans are accustomed to inflicting torture and the slow death. They are its foremost practitioners, happy and smiling in their destructive work. We see this in many facets of American life. The result of such a Citizens’ Committee is no different from those during the French Revolution. The conclusion is foregone: a death sentence to free markets.
Even prior to meeting and making recommendations, this mandated group process already has replaced the free market. It has already obliterated the rights of individuals to choose. Merely choosing a select group of 15 people to engineer the health care system already supplants the market process. This group which has dutifully sampled American opinion, before recommending the socialism we knew it would, is the thinnest charade imaginable. American social democracy in action means covering the legal atrocities of Congress with a façade of public participation and consensus. American politics have adopted the focus group, the staged debate, the staged town hall meeting, and the biased soundings of American opinion as a substitute for freedom of choice. They are all cheap and phony methods to simulate and even generate public acceptance of laws that kill freedom. The public is brought into the staged trial as willing participant.
The only recommendation consistent with free markets is to repeal the legislation on the books now that restricts free markets in medical care. Any other of the infinite number of other recommendations can only confirm and extend the existing invasions of free exchange. The outcome of this revolting process is set in concrete before the ink is dry on the legislation that creates the citizens’ health care working group.
It should be obvious that the individual experiences and choices of millions upon millions of Americans who weigh the costs and benefits of their health choices are infinite. They cannot be distilled into a set of recommendations by any committee of experts, other than the advice to repeal the existing strictures. And no matter what rules and systems are newly set in place or confirmed by Congress or recommended by any experts, they cannot adapt to the future changes in values, costs, and prices that a market system is driven by. Technocracy and social engineering are a recipe for retrogression.
The kinds of actions that such a group would support are predictable. They merely have to go through the appropriate motions. The Congress knows this. Mr. Walker knows this. The group itself knows this. The reader also knows this, for he or she can make an accurate guess about the recommendations without ever reading them. This alone tells us that we are dealing with a rigged deck. The committee is a conscious tool of power-manipulation. The idea is to have a blue-ribbon panel make the suggestions so as to provide an aura of legitimacy. The idea is to concoct a blue seal stamp of approval that the recommendations are in the public interest. How could what these experts say not be what we the sheeple want when the committee members are our own doctors, nurses, advocates, clinicians, and educators? Easy. The ideas, values, and wants of several hundred millions of Americans can’t be packaged up in 6 easy recommendations. They can only be expressed in markets in which people choose what they want and reject what they do not want.
Americans are being enticed to accept the advice of experienced professionals who have surveyed thousands of their fellow Americans and supposedly assimilated vast amounts of information. They are being enticed to accept the resulting marching orders provided by Congress. They should accept neither. This would be very easy to do if we were free. We could accept or ignore any part or all of the advice of others as we preferred. We could make our own decisions and live our own lives, accepting the consequences and learning what is good and bad for us. We could learn what advice and counsel is useful and what is not.
But we are not free. Everyone at the outset is forced into a procedure whereby we must all follow one course established by Congress. Congress literally does not know what it is doing to or for us, the millions of affected individuals, when it passes such laws. The voting members of Congress only know what is good for them. Whatever they might think they are doing for us is a pale reflection of a vague aggregation of the many individual wants of close to 300 million Americans. This system of representational voting is bound to fail to do what it is purported to do. It is bound to accomplish the opposite. It is bound to decrease the general welfare.
When asked, Americans support socialized and universal health care. The results vary from poll to poll. In a Washington Post poll in 2003, 62 percent of those polled supported universal health insurance. In the polls conducted by the 2006 working group, the number went over 90 percent. The question read: "It should be public policy (that is, a public goal set out in federal or state law) that all Americans have affordable health care insurance or other coverage."
The working group’s first recommendation mirrors this result, asking for "a health care system in which everyone participates, regardless of their financial resources or health care status, with benefits that are sufficiently comprehensive to provide access to appropriate, high-quality care without endangering individual or family security." Congress is being urged to legislate a form of universal national health care.
When asked whether a person should pay for his own health care expenses ("We should all be responsible for setting aside enough money to pay for most of our health care expenses,") 61 percent of Americans polled disagreed. It is a staple element in polls that people demand something for nothing. This coincides with the working group’s statement that everyone should be provided with care "regardless of their financial resources." Congress will now pass a law giving us something for nothing, after which they shall cause the earth’s atmospheric temperature to decrease by one degree and prevent the Milky Way from encountering dark matter. No one in his right mind actually believes that Congress will make everyone better off without making anyone worse off. They only hope and believe that they will be in the former group and not in the latter. They are at least honest enough to express their hoped-for transgressions openly.
Polls seem scientific. They are viewed as a modern and scientific way of discovering what people want. According to the theory of beneficent democracy, the pollsters, the experts, and the Congress are after an aggregation of citizen sentiments so that satisfactory laws will result. According to this theory, they are intent on promoting the general welfare. Even if this theory were true, which it is not, the entire idea behind passing general laws for the good of everyone’s medical care is deeply flawed. And the entire idea behind using the polling process as a means of discovering the best laws is also deeply flawed. From start to finish, the whole project of social engineering is doomed to failure and doomed to produce perverse results. The entire idea of promoting the general welfare in the broad arena of health by passing federal laws is a fantastical and unbelievable idea. It is illusion. It is delusion.
Polls tell us what opinions are at a moment of polling. They may be more or less accurate as measures of opinion depending on sampling factors and how questions are phrased. But what is most important is that polls concerning health care and sundry other economic goods have absolutely no legitimate moral role to play in determining an individual’s choices. To take a poll in order for a legislator to decide who shall have what health care and who shall pay for it already goes against the concept of individual freedom and property rights. It already supplants the market process of exchange. It makes no difference what the poll results are. Making laws based on polls is mob rule, not freedom. It can only subvert justice.
And practically speaking, polls are not even rational guides to Congressional legislation, if such guides even exist. Trying to replace exchange markets with lawmaking based on polls is impossible. Polls do not directly involve market exchanges. They do not involve weighing costs and benefits. They completely sever the links between taking an action, paying for it, and being responsible for the results. One can say anything on a poll and not be held responsible for the result. This means that polls do not even come close to measuring the preferences that people in real markets might exhibit.
What happens in a democracy is the enactment into law of ignorance and prejudice. People will possess some general ideas about what they think is going on in the lives of other people based upon their limited experience. For example, they will think that there are 35 million uninsured who should be insured. They will have some general idea that this is an unfair or intolerable state of affairs that should be rectified by law. Maybe such a law will then be passed. But to think that one can know enough to tell 35 million other people what health care choices they should be making is obviously preposterous. It is as crazed as a physician or psychiatrist proposing to test every child for mental illness and standing ready with a drug prescription for millions of would-be misfits including boys who are daydreamers or those who are rambunctious or even those who point their fingers at others and say "Bang, bang." It is an attempt to dominate, control, and think for others by voting, and as such it is deeply immoral. Fortunately, the libertarian does not offer such advice. He only suggests that we all refrain from such craziness.
Or people will have some general idea that there should be some "minimum" level of medical services at some "tolerable" cost, while having no idea what they are really talking about or how this utopia can be achieved. Compared with the infinite number of actual medical exchanges that occur daily and which will occur in the future under changed circumstances of value, cost, and price, those who propose to poll and legislate these matters literally know nothing. It is as if they were to pass a law regulating where the fish swam in the Pacific Ocean and which fish ate which other fish by asking the seagulls where they last saw some fish; and this after some fishermen had attempted by edict to herd the schools of fish already into various categories by a Byzantine system of nets and traps. The seagulls would confidently (and foolishly) say "There are 35 million fish swimming by themselves away from the other schools of fish. They need to be moved around into the places where they belong." I imagine that Congress one day will legislate that the billions of galaxies alter their courses for the general welfare since too many are speeding to destruction. And after legislating the earth’s temperature, they will turn their attention to preventing the collision of the Milky Way Galaxy with the Andromeda Galaxy. Successfully (whatever it may mean) legislating market and non-market exchanges for hundreds of millions of people has about as much chance of success as these endeavors.
But of course matters are actually worse when it comes to controlling human affairs because Congress is capable of inflicting harm. It cannot make someone gain health care without making someone pay for that health care who otherwise would not. It cannot make someone do something they otherwise would not do without forcing them to do it. Every such forced action necessarily is an action that the coerced person does not prefer or choose and he will then attempt to avoid the imposition of the force arrayed against him. Most coercive Acts of Congress are tantamount to taxes that induce people to accumulate less capital that is exposed to tax, the result being retrogression.
And in its lawmaking, it is not as if Congress knows what effects its laws have on each and every individual. It can’t know and doesn’t know. Those legal scholars who worry about due process of law should understand that the economic impacts of Congressional laws violate due process of law routinely, widely, and incessantly. The volumes and volumes of present laws constantly are taking and giving without regard to individual rights. Congress does not and cannot measure the effects of its laws on individuals. The members of Congress know this. Anyone who thinks about the matter can see this fact. What this means is that there is in fact no longer any respect for the individual insofar as thousands of laws are concerned. People are treated by the laws as mere indistinguishable cogs in a vast machine. (At times they are viewed as belonging to various schools, like fish. Americans become hyphenated-Americans.) Conspiracy theorists anxiously search for the true machine masters. Meanwhile, in all probability, the machine masters or at least important numbers of them have themselves submitted their minds to their own rhetoric. They are as swept along by the concept of the machine as everyone else. They think they are running it when the Idea of the Machine is running them. They submit to it even as they make everyone else submit. In Kafka’s short story written in 1919 (In the Penal Colony), the Officer executes himself upon the machine used to execute convicts by inscribing the words "Be just" upon their naked bodies. He executes himself to prove the worth of a machine that tortures convicts to death.
The war on freedom
Freedom does not logically mean the ability to vote for legislators who have the power to quash freedoms such as the choice of one’s own medical care. That sort of ability is simply roundabout and disguised tyranny. The theoretical gold standard of American freedom was the freedom to vote for representatives who were empowered only to prevent invasions of life, liberty, limb, and property. Such an ideal was thought to be far superior to a tyrannical government that invades property rights, and so it might have been if the Constitution had embodied that ideal. But it did not. It allowed the wished-for gold standard to be transformed into today’s dross. Voting today is no longer an exercise of freedom. It is an endorsement of tyranny.
Having seen generations of Americans of all sorts and political parties again and again produce political outcomes that destroy America’s much-vaunted freedom, we are forced to question the ideas guiding their actions and to examine the processes by which these negative outcomes are manufactured. The continuing decline and invasion of the health care markets by political means is a case in point.
Statists are pushing for the gradual but effectively revolutionary death of freedom. They are trying to gain control of society through the existing political (or democratic) methods of American government. They have had a degree of success. The process is being supported ideologically by an indeterminate but no doubt large number of Americans. Americans in large numbers and their Congress continue to subvert property, rights, and free markets through their political system. Their problem is that their actions contradict the natural truths of life. The further their acts depart from the natural flow of life and liberty, the harder it becomes for them to justify or rationalize. More and more the enemies of freedom have to abandon restraint and reason as they attempt to justify their acts of violence, home and abroad, with false rationales and empty slogans. They have to hollow out what little is left of the institutions of freedom and create a new ideology that is fundamentally antagonistic to the old ideology and life itself. Their cleverness and the damage they can do should not be underestimated, even though they must and will fail. The logical goal of these determined antagonists of freedom is to continue attacking property rights until they control as much as they can. Why should they stop?
Statists are being fought by the natural processes of individual thought. They are fought by the everyday disbelief of individuals confronting the state’s inane edicts. They are fought by whoever is producing truth in their lives of any kind. They are fought by preserving, discovering, and spreading superior ideas. The statists view human beings as ants and society as an ant colony. Society to them is a machine. The term they prefer is system. They think of the individual as a known, controllable, malleable, and dispensable part. Duties can be constantly increased with adherence obtained by force, fear, pressure, and indoctrination. But society is not a system or machine even if it has basic rules and commandments that we live by or should live by. Beyond those rules and laws, there is no system. There is no single-minded unit weaving its way toward some common goal.
People are observers who think and create for themselves, not for a vague entity called society. The chink in the statist armor is their inability to control fully the communications and ideas of each of us. They try to succeed and they do succeed temporarily and on occasion, but the costs of controlling everyone’s minds create an inestimable and insurmountable barrier, one that they can never overcome, one that makes them fail. In the Soviet Union, the contradictions between the conditions of life and the propaganda were noticed and communicated by a unique black humor. Jokes helped undermine that tyranny. Even drunkenness and escapism played a role in the non-acceptance of the official line of thought. Today we have the internet. Today conspiracy theories are rife. Many are unbelievable, but they function to keep people skeptical of the official lines of thought. The expression of individual thought is almost impossible to suppress without the most draconian means. Freedom of thought and the idea of freedom will be standing long after the statists and socialist America are dead and buried.
The battle for freedom is ideological and at root it is ethical or moral. It is a question of right and justice, the ownership of one’s mind and property by oneself. The statists want the battle to be a question of plenty and of material goods, not because statism can deliver these goods — it can’t, not at all — but because the promise and delivery of bread, even stolen bread, is an important way to try to persuade people of the rightness of statism.
Within society, the battlegrounds for this continual conflict are everywhere we look. They are reported every day of the week. One very large battleground is the religious life of Americans. Here the moral element is paramount and the state seeks allies by appeals to the greed of the bread producers and the poverty of the bread consumers. The state wishes to deflect religion from its moral focus and destroy it as an effective anti-state entity by tempting it with bread packaged as morality. The state is sold as the new Deliverer who will facilitate the realization of ancient religious ideals.
Many millions of Americans profess belief in the Lord their God while also supporting the democratic socialization and communization of American life via political power. They have, in reality, forsaken the Lord. They are disobeying His Commandment not to steal. They are relying upon the state’s armory of force, not the spread of peaceful truth. The Lord their God has made clear that they shall reap the sorry results of their apostasy. By their own beliefs and actions, they will be held to account for their sins.
The Congress in 2006 is another battleground. It continues to supplant whatever is left of free markets in health care with socialized medicine. Its open, hypocritical, and unapologetic destruction of life, liberty, and property demonstrates once again with utter clarity that a country with Constitutional rule, and even a tradition of rights and justice, can by hook and crook transform itself into an authoritarian monstrosity.
Michael S. Rozeff [send him mail] is the Louis M. Jacobs Professor of Finance at University at Buffalo.