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Your Worst Nightmare – Libertarian Health Care?by
Richard C.B. Johnsson
When thinking about or discussing what a libertarian society would possibly look like, I often encounter assertions like: "nobody would take care of the poor." Once, at an academic seminar, I put forward some crazy ideas about the financing of roads.1 My ideas were met by a more or less unanimous outrage from the other attendants. After having made the correct generalizations, they couldn’t refrain themselves from asking me what would happen if a poor fellow without insurance became critically ill in a society where everything was private?2 The suggested answer was, of course, that in such a libertarian society, the poor fellow would have to suffer and even perish, as any hospital clearly would refuse to treat him. Appalled they were, but in courtesy towards these critics, I now put forward four even better fictive examples of this kind of nightmarish libertarian society. The examples are indeed scary and hopefully these critics now can sleep well at night, knowing that nobody ever possibly could argue in favor of a system that produces the atrocities of the following examples: 1. A man got his leg amputated because a hospital failed to treat him in time. The man, who suffered from diabetes, received no treatment despite the obvious risk of gangrene that followed from his poor blood circulation. The subsequent investigation, set up by the hospital’s owner, put out a warning to the two doctors involved, stating that the man would still have his leg had he been treated in time. Comment: Here we see how in the libertarian society a hospital can cut off somebody’s leg and the only thing that happens is that the owners blame the workers! 2. A hospital has on its own account investigated into the possibilities of premature deaths among patients waiting in line for a by-pass surgery. For those that aren’t lucky enough to end up in what the hospital determines to be the "fast lane," the waiting time is about 4½ months. It was found that during the 4 years of 1995–1998, 77 patients died while waiting in line. The conclusion of the study was that perhaps the hospital needs to coordinate its activity on a national level with other hospitals of the same ownership. In that way, they would be able to better judge who were going to end up in the fast lane (and, thus, who wouldn’t). Comment: Here we see how hospitals in the libertarian society would refuse to treat people, putting some people with connections in front of others, letting the little guy vanish. What would happen if somebody died, like the 77 in the example? The hospital would say that they would look into their routines, that is all! 3. After having had to wait for a long time, a man was told by a hospital that he had cancer and that the tumor was malignant. It could neither be treated by surgery nor in any other way. – This tumor will kill you, he was told. He was offered the necessary pain relief. Fortunately, the man was very wealthy. He just got on a plane and flew to a place where these kinds of tumors could be treated. He had surgery in a couple of days, and instead of the prospect of death after only 45 days in the care of the first hospital, he now can look forward to many more years of living. Comment: Here is a good example of how the heartless hospitals in the libertarian society would give people an aspirin instead of curing the cancer, although it obviously was curable! 4. When it was time to give the twin birth, a pregnant woman and her husband, living in a small town, were told that there were no beds available at the hospital. This particular hospital was in the neighboring town, since they had already earlier been refused to give birth in their hometown. However, the hospital had made a general promise that they should be able to give birth somewhere. They were taken to the famous hospital in a larger city about 150 km away, but also there they were refused to give birth, despite the fact that it had the same owner. Instead the hospital sent them abroad by helicopter to another hospital with a different owner, but with which the first hospital had some kind of agreement. When they finally arrived, it turned out that the twins were stillborn. After this tragic event, the hospital refused to fly the couple back to their home country or hometown. The hospital only arranged for helicopter in emergencies, and when the necessary care in relation to a child’s birth is finished, the hospital has no obligations, they where told. Instead, the unfortunate couple had to arrange with flight tickets back home. Normally, deceased persons are generally transported in a sealed zinc coffin in the trunk of the airplane, but as the couple didn’t want it that way, they instead were provided a small coffin that was put in a bag. The airline company, that happened to be the property of the owner of that foreign hospital, acted courteously and left two rows clear in front of the grieving couple. Well back home, the hearse the hospital had promised didn’t arrive, so the couple had to take a taxi to get all the way home. The subsequent investigation, set up by the hospital’s owner, reached the conclusions that the behavior of the hospitals, from a medical point of view, had been correct. In retrospect, the investigation could also conclude that the quality of the reception when the couple arrived back home with the flight could have been better. Another conclusion was that the outcome of the birth itself wasn’t affected by the fact that the couple had been sent to a hospital in another country, but that this admittedly must have been strenuous for them. Finally, the investigation stated that the hospital had to find new routines for how to handle complicated international flights in general. Comment: Here is the perhaps best case of how nightmarish hospitals in the libertarian society would act, while all that would happen is that they say that everything was done in a correct manner, save some minor routines that have to be checked! These examples clearly outline how heartless and terrifying the health care system would be in a libertarian society. I hope the critics will remember these examples the next time we meet. Now to the real nightmare – these stories are true. They all happened in Sweden in the last couple of years.3 But hold on, Sweden is not an example of a libertarian society, is it? No, Sweden is rather known for its fabulous middle-of-the-road politics, as the Welfare State par excellance, the place on earth that is so equal and great for the poor. And where health care is free of charge. Still, it is a fact that these examples occurred in Sweden, where the government finances, owns, regulates and runs everything related to health care.4 And still, the stories are indeed nightmarish. Let’s study the government involvement a bit closer. In the first story, one branch of the government cuts of a man’s leg, while another states that its employees were to blame. In the second story, we see a clear example of how terribly chaotic government bureaucracy is, with price fixing (at zero) creating long waiting lines and how the survival of a particular patient finally depends on the ability to get ahead of others in a true Darwinist race against death, man against man. In the third story, a man was told that he was going to die and was offered pain relief. Because he was wealthy, he could fly to somewhat less statist Germany to get treatment within days. Finally, the forth story is so sad that I don’t know what to write (I found it especially hard also because I myself have had some kids in the last couple of years). It is amazing how these kinds of stories can exist while people all the time are complaining about the threat of the free market, and while they continue to cherish the government. For some reasons, people apply one standard to the activities of the government, and another to the private activities. Because if it really were fully private hospitals that produced these atrocities, most people would clearly and rightfully be outraged. The hospitals would go bankrupt within days or at least lose plenty of customers and employees. The only way they could continue to exist would be if they have some kind of legal monopoly, i.e. if the government in some way was involved. But such a thing wouldn’t exist in a libertarian society, would it? The Bogeyman of the nightmares is already here and it’s called the government. Now we know where those critics got their nightmares from – from the real life result of their own ideas. It is time to stop feeding this real life monster, to get rid of it! One of these days, it could be you who wake up without a leg, die in a line, are offered pain relief against cancer, or worse. And as I said, I hope those critics remember these stories. One would at least hope for that kind of honesty.
March 12, 2004 Richard C.B. Johnsson [send him mail] is an economist born, raised and still living in Sweden. Visit his personal website for more. Copyright © 2004 LewRockwell.com
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