against Hillarycare in 1994; his article is also relevant to Obamacare
standard media clich about the Clinton health plan is that
God, or the Devil, depending on your point of view, "is
in the details." There is surprising agreement among
both the supporters and all too many of the critics of the
Clinton health "reform." The supporters say that
the general principles of the plan are wonderful, but that
there are a few problems in the details: e.g., how much will
it cost, how exactly will it be financed, will small business
get a sufficient subsidy to offset its higher costs, and on
into the night.
critics of the Clinton Plan also hasten to assure us that they too
accept the general principles, but that there are lots of problems
in the details. Often the critics will present their own alternative
plans, only slightly less complex than the Clinton scheme, accompanied
by assertions that their plans are less coercive, less costly, and
less socialistic than the Clinton effort. And since health care
constitutes about one-seventh of the American output, there are
enough details and variants to keep a host of policy workers going
for the rest of their lives.
But the details
of the Clintonian plan, however diabolic, are merely petty demons
compared to the general principles, where Lucifer really lurks.
By accepting the principles, and fighting over the details, the
Loyal Opposition only succeeds in giving away the store, and doing
so before the debate over the details can even get under way. Lost
in an eye-glazing thicket of minutiae, the conservative critics
of Clintonian reform, by being "responsible" and working
within the paradigm set by The Enemy, are performing a vital service
for the Clintonians in snuffing out any clear-cut opposition to
Clinton’s Great Leap Forward into health collectivism.
Let us examine
some of the Mephistophelean general principles in the Clintonian
reform, seconded by the conservative critics.
GUARANTEED UNIVERSAL ACCESS. There has been a lot of talk
recently about "universal access" to this or
that good or service. Many "libertarian" or
"free-market" proponents of education "reform,"
for example, advocate tax-supported voucher schemes to
provide "access" to private schooling. But there
is one simple entity, in any sort of free society, that
provides "universal access" to every conceivable
good or service, and not just to health or education or
food. That entity is not a voucher or a Clintonian ID
card; it’s called a "dollar." Dollars not only
provide universal access to all goods and services, they
provide it to each dollar-holder for each product only
to the extent that the dollar-holder desires. Every other
artificial accessor, be it voucher or health card or food
stamp, is despotic and coercive, mulcts the taxpayer,
is inefficient and egalitarian.
"Guaranteed universal access" can only be provided
by the robbery of taxation, and the essence of this extortion
is not changed by calling these taxes "fees,"
"premiums," or "contributions." A
tax by any other name smells as rotten, and has similar
consequences, even if only "employers" are forced
to pay the higher "premiums."
Furthermore, for anyone to be "guaranteed" access
to anything, he has to be forced to participate, both
in receiving its "benefits" and in paying for
them. Hence, "guaranteed universal access" means
coercing not only taxpayers, but everyone as participants
and contributors. All the weeping and wailing about the
37 million "uninsured" glosses over the fact
that most of these uninsured have a made a rational decision
that they don’t want to be "insured," that they
are willing to take the chance of paying market prices
should health care become necessary. But they will not
be permitted to remain free of the "benefits"
of insurance; their participation will become compulsory.
We will all become health draftees.
EGALITARIAN. Universal means egalitarian. For the dread
egalitarian theme of "fairness" enters immediately
into the equation. Once government becomes the boss of
all health, under the Clinton plan or the Loyal Opposition,
then it seems "unfair" for the rich to enjoy
better medical care than the lowest bum. This "fairness"
ploy is considered self-evident and never subject to criticism.
Why is "the two-tier" health system (actually
it has been multi-tier) any more "unfair" than
the multi-tier system for clothing or food or transportation?
So far at least, most people don’t consider it unfair
that some people can afford to dine at The Four Seasons
and vacation at Martha’s Vineyard, whereas others have
to rest content with McDonald’s and staying home. Why
is medical care any different?
COLLECTIVIST. To ensure equality for one and all, medical
care will be collectivist, under close supervision of
the federal Health Care Board, with health provision and
insurance dragooned by government into regional collectives
and alliances. The private practice of medicine will be
essentially driven out, so that these collectives and
HMOs will be the only option for the consumer. Even though
the Clintonians try to assure Americans that they can
still "choose their own doctor," in practice
this will be increasingly impossible.
CONTROLS. Since it is fairly well known that price controls
have never worked, that they have always been a disaster,
the Clinton Administration always keen on semantic trickery,
have stoutly denied that any price controls are contemplated.
But the network of severe price controls will be all too
evident and painful, even if they wear the mask of "premium
caps," "cost caps," or "spending control."
They will have to be there, for it is the promise of "cost
control" that permits the Clintonians to make the
outrageous claim that taxes will hardly go up at all.
(Except, of course, on employers.) Tight spending control
will be enforced by the government, not merely on its
own, but particularly on private spending.
One of the most chilling aspects of the Clinton plan is
that any attempt by us consumers to get around these price
controls, e.g. to pay higher than controlled prices to
doctors in private practice, will be criminalized. Thus,
the Clinton Plan states that "A provider may not
charge or collect from the patient a fee in excess of
the fee schedule adopted by an alliance," and criminal
penalties will be imposed for "payment of bribes
or gratuities" (i.e. "black market prices")
to "influence the delivery of health service."
arguing for their plan, by the way, the Clintonians have
added insult to injury by employing absurd nonsense in
the form of argument. Their main argument for the plan
is that health care is "too costly," and that
thesis rests on the fact that health care spending, over
recent years, has risen considerably as a percentage of
the GDP. But a spending rise is scarcely the same as a
cost increase; if it were, then I could easily argue that,
since the percentage of GDP spent on computers has risen
wildly in the past ten years, that "computer costs"
are therefore excessive, and severe price controls, caps,
and spending controls must be imposed promptly on consumer
and business purchases of computers.
RATIONING. Severe price and spending controls means, of
course, that medical care will have to be strictly rationed,
especially since these controls and caps come at the same
time that universal and equal care is being "guaranteed."
Socialists, indeed, always love rationing, since it gives
the bureaucrats power over the people and makes for coercive
And so this means that the government, and its medical
bureaucrats and underlings, will decide who gets what
service. Medical totalitarianism, if not the rest of us,
will be alive and well in America.
ANNOYING CONSUMER. We have to remember a crucial point
about government as against business operations on the
market. Businesses are always eager for consumers to buy
their product or service. On the free market, the consumer
is king or queen and the "providers" are always
trying to make profits and gain customers by serving them
well. But when government operates a service, the consumer
is transmuted into a pain-in-the-neck, a "wasteful"
user-up of scarce social resources. Whereas the free market
is a peaceful cooperative place where everyone benefits
and no one loses, when government supplies the product
or service, every consumer is treated as using a resource
only at the expense of his fellow men. The "public
service" arena, and not the free market, is the dog-eat-dog
So there we have the Clintonian health future: government
as totalitarian rationer of health care, grudgingly doling
out care on the lowest possible level equally to all,
and treating each "client" as a wasteful
pest. And if, God forbid, you have a serious health problem,
or are elderly, or your treatment requires more scarce
resources than the Health Care Board deems proper, well
then Big Brother or Big Sister Rationer in Washington
will decided, in the best interests of "society,"
of course, to give you the Kevorkian treatment.
GREAT LEAP FORWARD. There are many other ludicrous though
almost universally accepted aspects of the Clinton Plan,
from the gross perversion of the concept of "insurance"
to the imbecilic view that an enormous expansion of government
control will somehow eliminate the need for filling out
health forms. But suffice it to stress the most vital
point: the plan consists of one more Great Leap Forward
The point was put very well, albeit admiringly, by David
Lauter in the Los Angeles Times (September 23).
Every once in a while, said Lauter, "the government
collectively braces itself, takes a deep breath and leaps
into a largely unknown future." The first American
leap was the New Deal in the 1930s, leaping into Social
Security and extensive federal regulation of the economy.
The second leap was the civil rights revolution of the
1960s. And now, writes Lauter, "another new President
has proposed a sweeping plan" and we have been hearing
again "the noises of a political system warming up
once again for the big jump."
The only important point Mr. Lauter omits is leaping into
what? Wittingly or unwittingly, his "leap" metaphor
rings true, for it recalls the Great Leap Forward of Mao’s
worst surge into extreme Communism.
Clinton health plan is not "reform" and it doesn’t
meet a "crisis." Cut through the fake semantics,
and what we have is another Great Leap Forward into socialism.
While Russia and the former Communist states are struggling
to get out of socialism and the disaster of their "guaranteed
universal health care" (check their vital statistics),
Clinton and his bizarre Brain Trust of aging leftist grad
students are proposing to wreck our economy, our freedom,
and what has been, for all of the ills imposed by previous
government intervention, the best medical system on earth.
is why the Clinton health plan must be fought against root
and branch, why Satan is in the general principles, and why
the Ludwig von Mises Institute, instead of offering its own
500-page health plan, sticks to its principled "four-step"
plan laid out by Mises Institute Senior Fellow Hans-Hermann
Hoppe (The Free Market April 1993) of dismantling existing
government intervention into health.
N. Rothbard (19261995) was dean of the Austrian
School, founder of modern libertarianism, and academic
vice president of the Mises
Institute. He was also editor — with Lew Rockwell
— of The
Rothbard-Rockwell Report, and appointed Lew as
his literary executor.