Critical Review founder and editor Jeffrey Friedman has written a short piece on Richard Cornuelle, famous for his book Reclaiming the American Dream, and a devout civil societarian. Cornuelle died on April 26th. He and Friedman share(d) a distrust of Rand-Rothbard style libertarianism:
Early on, Dick had been a doctrinaire free-marketeer and a member of all three of the early libertarian “circles” in New York in the late 1940s and 1950s: those of Ludwig von Mises, Ayn Rand, and Murray Rothbard. But he came to think that “there was a screw loose” in libertarianism, as he put it in a 1993 Afterword to his most famous book, Reclaiming the American Dream (1965). Dick first stumbled on the loose screw when he wrote an article attacking a three-day work week decreed by the coal miners’ union. The aim of the three-day week was to preserve jobs in a declining industry. Dick took the standard economists’ line: If an industry were on the wane, it would and should be liquidated so its unneeded workers could “disappear.” His editor suggested that he actually meet some disappearing coal miners, and Dick went to Kentucky and found people who, through no fault of their own, desperately needed help.
Rand and Rothbard had created versions of libertarianism for which any humane consequences of capitalism were secondary. In these libertarianisms, the inviolate right to private property reigned supreme—regardless of the consequences. As Dick wrote in 1993, libertarianism constantly forced him to make “haunting, morally intolerable midnight choices between liberty and community.”
“Midnight choices”? I like that, whatever it means.
Read the rest here.
Entitled to an Opinion 
May 9, 2011 at 9:25 am
Those statements require translation.
“haunting, morally intolerable midnight choices between liberty and forcing people to do what I want.”
That’s better.
May 9, 2011 at 11:29 am
It’s hard to miss the “To a gas chamber, go!” element in Rand-Rothbard style libertarianism.
Although in fairness to Rothbard, his views varied widely during his lifetime. It’s also true that Rand-Rothbard style libertarianism preceded Rand and Rothbard by at least a century. When Dickens has Scrooge say of the poor, “If they would rather die, they had better do it, and decrease the surplus population”, he is not engaging in parody. Many of the classical liberal economists of the day spoke EXACTLY like that.
For instance, during the (government caused) Great Famine in Ireland which killed over a million people, The Economist magazine editorialized that “It is no man’s business to provide for another .. if left to the natural law of distribution, those who deserve more would obtain it.”
May 9, 2011 at 3:13 pm
The “humane consequences” of capitalism far outweigh those that might be called “inhumane.” This is why, for all the sins against the poor and downtrodden ascribed to American capitalism by the international left, the United States is still a country to which poor people wish to come. They are not flocking to Cuba, Venezuela, or other states where collectivism reigns.
I am by no means a Randian, but in fairness to her, it must be said that she well described the inhumane consequences of collectivism. The poverty and squalor resulting from laws and directives intended to prevent “discrimination” and “destructive competition” are omnipresent in “Atlas Shrugged,” as is the self-serving behavior of the types of politicians who mouth pieties about fairness and the needs of people as a cover for delivering rent-seeking opportunities to their cronies in business.
Scrooge’s remark, as quoted by flenser, is not so much classical-liberal as it is Malthusian.
May 11, 2011 at 2:44 am
I thought of Malthus as descriptive rather than (social darwinian) prescriptive. Am I mistaken? I also thought of the modern inheritors of Malthus as technocratic paternalists (like the PRC and their one-child policy).
The poor starving to death is the default. Population planning to prevent descriptively Malthusian outcomes would be the policy adjustment that incorporates Malthus’ social science theories. At least in my understanding.
May 14, 2011 at 8:16 pm
“A man who is born into a world already possessed, if he cannot get subsistence from his parents on who he has a just demand, and if the society do not want his labour, has no claim of right to the smallest portion of food, and in fact, has no business to be where he is. At nature’s mighty feast there is no vacant cover for him. She tells him to be gone.”
“no claim of right … no business to be ..”
I’d call that prescriptive rather than descriptive, although the line between the two is not always clearcut.
What’s amusing is that Michael has so much more in common with Mathus than he knows.
May 16, 2011 at 2:54 am
Given the distance of time, I’m not sure from that quote whether it’s descriptive, prescriptive, or purposely ambiguous. It is descriptively accurate (although needlessly poetic) to say that offspring have an easier claim to make for “positive rights” on their parents than on the larger natural world. Beyond that I’m not sure if Malthus is going for the ultimate status quo bias here, if he’s claiming that we need to grapple with the repugnant in order to come up with rational policy, or if he’s just wearing his poetic natural scientist hat.
May 9, 2011 at 3:58 pm
Malthus was a classical liberal. He was as classically a classical liberal as it’s possible to get, a friend of David Ricardo and John Stuart Mill.
May 9, 2011 at 7:24 pm
Malthus may have been a classical liberal, but it is not for his liberalism that he is remembered. It is for Malthusianism, the prophecy (which has not come true) of an overpopulated world in which most live at a level of bare subsistence, shortages of food and other vital commodities are common, and starvation for many inevitable. The Malthusian premise has since his time mostly been seized upon by dirigistes (e.g., Paul Ehrlich) as a rationale for their schemes, and rejected by classical liberals.
May 10, 2011 at 10:03 am
Remembered by who? You’ve never read a word Malthus wrote, you merely know his name at second and third hand.
May 10, 2011 at 12:20 pm
I do not know how you divine what I have or haven’t read of Malthus from what I have written. We are speaking not of what he actually wrote but of that for which he is remembered, and indeed he is remembered almost entirely for his observation that supplies of food increase arithmetically while populations increase geometrically. Perhaps the memories of most Malthusians today are at second or third hand, but that hardly matters to the adoption of the premise for which he is remembered by advocates of a dirigisme that he did not advocate. By contrast, the Malthusian premise hardly matters to modern classical liberals like Hayek.
May 14, 2011 at 7:53 pm
indeed he is remembered almost entirely for his observation that supplies of food increase arithmetically while populations increase geometrically.
Who is doing this particular remembering? I’m not. If you are, just say so and drop the passive voice.
May 16, 2011 at 12:02 pm
Can we agree that (for example) Merriam-Webster’s New Collegiate Dictionary is a reasonable standard of ordinary parlance? Here is its definition of Malthusian:
“Malthusian, adl. Of or pertaining to the political economist Rev. T. R. Malthus, or to his views; as, *Malthusian* theories. Malthus held that population tends to multiply faster than its means of subsistence can be made to do, and that, unless an increase in population can be checked by prudential restraint, poverty is inevitable. – Malthusian, n.”
If you do not agree with Merriam-Webster, I suggest you argue with them and not with me. I’m willing to take their word as to what Malthusianism means in its normal usage.
May 9, 2011 at 6:34 pm
I’ve always found it a bit strange that many libertarians chose to rally around protecting private property instead of protecting the individual. Sure there is a ton of overlap between the two, but the former starts to look and sound a lot like selfish protection of accumulated wealth.
May 9, 2011 at 7:32 pm
How do you protect the individual if you don’t recognize his rights in private property? Societies that haven’t done so have been the greatest infringers of individual liberties.
Historically, it was Magna Charta which, by recognizing that private property belonging to a free man could not be taken from him without due process of law, for the first time gave legal foundation in English law to the notion of personal rights.
May 10, 2011 at 10:07 am
I agree there’s overlap but it seems many libertarians have lost sight of the goal of protecting individual liberties and replaced it with a goal of defending/protecting wealth.
May 10, 2011 at 11:25 am
The big split in libertarians is between those value liberty above all else and those who value wealth above all else. The second camp is the largest, and they have no problem with liberty being limited as long as they do well off of it.
A staple in the libertarian press is, or was until a few years ago, the glowing article descrbing Abu Dhabi as the libertarian paridise.
May 10, 2011 at 12:40 pm
The libertarians you characterize as valuing wealth above all simply believe that liberty for some is better than liberty for none. Egalitarians, by contrast, would rather that none enjoyed liberty than that only some did.
Liberty for the child, the dotard, the madman, or the fool, is problematical. What do we do about the 50% of the population on the left-hand side of the IQ bell curve? Better that they should be a servile class than a criminal one. It would be nice if everyone had the capacity to enjoy liberty, but some just do not. Are social arrangements always and everywhere to be designed around the lowest common denominator?
Guizot had the answer long ago, when egalitarians objected to the limitation of the franchise to the propertied: “Enrichissez-vous par le travail et par l’épargne.” Under such a formula, liberty is open to everyone who has the capacity. Were the bourgeois societies of the nineteenth century really worse for the proletariat than are the egalitarian regimes of Cuba or North Korea? Is Abu Dhabi today?
May 11, 2011 at 2:49 am
“Liberty for the child, the dotard, the madman, or the fool, is problematical. What do we do about the 50% of the population on the left-hand side of the IQ bell curve? Better that they should be a servile class than a criminal one. It would be nice if everyone had the capacity to enjoy liberty, but some just do not. Are social arrangements always and everywhere to be designed around the lowest common denominator?”
I’m sympathetic to this line of thought. Except I’m only interested in liberty (agent autonomy) to the degree that in consequentially improves our persistence odds.
May 14, 2011 at 7:48 pm
The libertarians you characterize as valuing wealth above all simply believe that liberty for some is better than liberty for none.
They also believe that “liberty for some” is better than “liberty for all”, as the rest of your remarks make very clear.
Liberty for the child, the dotard, the madman, or the fool, is problematical.
I love your implicit assumption that you will wind up in the camp of those judged to be non-fools. But I should not be too harsh, since you’re being helpful enough to confirm my initial point about many libertarians not being fans of liberty for those other than themselves.
May 16, 2011 at 12:09 pm
The libertarian would indeed allow liberty for the child, the dotard, (or die by) the consequences.
The consequences are why liberty for such people is problematic.
One definition of a fool is that he and his money are soon parted. Those who have not been parted from their money are not likely to be fools, which is one reason to restrict the franchise to the propertied.
Do not confuse me with a libertarian. I am a reactionary.
May 16, 2011 at 12:36 pm
Somehow a line was omitted from the first paragraph of my previous comment. It should have read:
“The libertarian would indeed allow liberty for the child, the dotard, the madman, and the fool – and allow them to live with (or die die by) the consequences.”
May 17, 2011 at 12:02 am
I don’t know if Michael identifies as a libertarian, who are commonly blamed for their Szaszian proclivities which resulted in the deinstitutionalization of many mental patients. Jacob Levy exempts such folks from liberty, I don’t.
May 17, 2011 at 3:56 pm
I noted above that I’m not a libertarian, but rather a reactionary.
I read your linked post about Jacob Levy, and its lengthy comment section. Do you acknowledge that there are different types of mental patients and mental disease? Many of the comments to that post appeared to consider as mental disease only such slippery concepts as (for example) schizophrenia or various kinds of neuroses.
It has been a long time since I read anything by Szasz, but I doubt that even he would argue that the dementia of the dotard, caused by Alzheimer’s disease or multiple cerebral hæmorrhages, is not a genuine disease, exhibiting mental symptoms caused by observable lesions of the brain. Similarly, microcephaly, cretinism, and mongolism are physical conditions with debilitating mental effects. Their victims clearly suffer from more or less severe limitations that render their full enjoyment of liberty impossible. Liberty, as historically understood (e.g., by the Founding Fathers), is the absence of restraint by the state, and its enjoyment presumes a capacity for self-sufficient living that the infant, the dotard, the madman, and the fool almost by definition lack. To set such a person at the liberty to which persons of normal health and intelligence are fitted would be tantamount to abandoning him to his death by starvation or exposure. This would be neither right nor conducive to the public peace and order.
May 17, 2011 at 10:29 pm
I am fine with abandoning people (though if other people personally want to save others, fine), as you might expect based on my Victims and sympathy post.
Szasz does indeed treat neurological/medical disorders with an identifiable lesion of the brain differently than mental illnesses. I don’t want the state overriding an individual’s decisions, but just as I’m fine with granting families unlimited authority over their children I can extend the principle to adults incapable of “homesteading” themselves.
May 18, 2011 at 9:24 am
Families in the past – the fairly recent past, indeed – had the primary responsibility for taking care of their members who were unable to manage on their own. Senile or crippled grandpa or grandma came to live with their children rather than being shuffled off to a nursing home as is so often the case today. Similarly, crazy aunts or idiot children were kept at home.The welfare state has subverted these natural arrangements, and it would certainly make sense to restore them.
The church also used to have its part in dealing with what now has become a function of the state, and probably did a better job of it. This could also well stand to be revived.
My disagreement with a certain type of libertarianism is that in its concentration on the individual, it fails to take account of the importance of mediating institutions such as family and church. If the state is ever going to be cut down to the size it should be, strong mediating institutions are vitally necessary, for they must be ready to reclaim the functions the state has usurped from them.
May 19, 2011 at 1:26 am
Michael,
My sense is that empirically your systemic philosophy is a bit destroyed due to the quality of life and economic efficiency in wealthy nations with selectively socialized sectors of their economy (healthcare). It’s sort of the “Sweden exists” argument.
May 19, 2011 at 9:48 am
Sweden exists, indeed; but I, for one, would not care to live there, health care notwithstanding.
Someone once said that Regency England was Elysium for the rich and Tartarus for the poor. Modern Sweden is Elysium for the bureaucrat and Tartarus for the entrepreneur.
May 19, 2011 at 11:56 am
I think the expert (and ironically perhaps bureacratic)assessment is that Sweden is not Tartarus for the entrepreneur.
May 19, 2011 at 3:59 pm
Sweden is no. 22 on the economic freedom index, as compared to 8 for its near neighbor Denmark. The U.S. is at 9, while Switzerland is at 5, New Zealand at 4, Australia at 3, Singapore at 2, and Hong Kong at 1.
Sweden isn’t bad compared (say) to Kazakhstan (78) or Madagascar (81), but that’s like saying the second circle of the Inferno, where those who have succumbed to lust are subjected to its rain, wind, and hail isn’t bad compared to the fifth bolgia of the eighth circle, where those guilty of barratry are submerged in boiling tar, and if their heads pop up above its surface, are forced back down into it by demons with muckforks.
Sweden is a country that is currently living on the capital built up by past generations. The population is small, the native-born are not reproducing at a sufficient rate to replace themselves, and there is an increasing number of non-assimilable Muslim immigrants draining its generous social welfare programs. Sooner or later the Swedes will have pissed away their inheritance – then what?
May 20, 2011 at 12:56 pm
Without snark or irony, I think that ceding a main point with face-saving niggling caveats is a good norm to promote and it’s to your credit that you’re choosing that route.
May 20, 2011 at 7:58 pm
What sort of a rejoinder is that? What is “face saving” or “niggling” about my points?
Sweden is basically inhospitable to entrepreneurs and men of property. Taxes are high and regulations burdensome. Its only possible benefit is that it’s a little more capable of maintaining public order, because it still has some wealth, than are utterly dysfunctional countries that tried to redistribute wealth before they had accumulated any. Its native peoples, who built that wealth in the past – the Swedes, the Wends, and the Goths – are committing a gradual ethnic suicide through birth control and abortion. They are not resisting the takeover of their country by alien peoples who lack the capacity to maintain its wealth and civilization. It is in decline, like the Roman empire of the West in the fifth century A.D. I would not call the observation of these phenomena a niggling concession to your point.
May 21, 2011 at 2:22 am
You responded to this
My sense is that empirically your systemic philosophy is a bit destroyed due to the quality of life and economic efficiency in wealthy nations with selectively socialized sectors of their economy (healthcare).
with this
on the economic freedom index … 8 for … Denmark. The U.S. is at 9, while Switzerland is at 5, New Zealand at 4, Australia at 3, Singapore at 2,
and no dispute about the greater efficiency of a socialized healthcare sector.
Instead you chose to niggle about Sweden -I’m not bashing you for it, I’m commending you.
May 21, 2011 at 8:31 am
You haven’t offered anything but a bald assertion that the Swedish health care system is more efficient than those of countries higher on the economic freedom index, either, have you? How long does one have to wait for a hip replacement in Sweden, say, as compared to the United States? Or Singapore?
The social welfare system in Sweden, as it turns out, does not even raise the standard of living of the lowest ranks of society measurably. Reihan Salam, writing in the Spectator (the British one) some years ago, noted that in the U.S., the bottom decile of the population enjoyed an average income that was roughly 40% of the median. In Sweden and Finland, the average income of the bottom decile of their populations was the same – roughly 40% of the U.S. median. The high marginal income tax rates in these countries also do not raise enough revenue by themselves to pay for the state’s extensive social welfare programs. There is, accordingly, a high value-added tax, which, as such taxes inevitably do, falls hardest on the poorer citizens. When all this is taken into consideration, the benefit of the vaunted Scandinavian social-welfare state does not help the poor very much, by the standards of well-developed countries – even as it attracts illiterate and superstitious lumpen elements from backward countries that cannot afford social-welfare systems, as spilt sugar attracts ants, to scavenge up the wealth it accumulated in its past.
May 10, 2011 at 2:07 pm
[…] this post by mupetblast at TGGP’s Entitled to an […]
May 11, 2011 at 12:08 am
I recall Jeffrey Friedman being critical of Charles Murray’s communitarianism, saying it wasn’t based on any evidence.
I think Malthus gets a bad rap. He was right about history up until his own time, and the logic of evolution says the future will come to resemble his vision.
melendwyr/Caledonian commented on this post, and I referenced two different takes on Scrooge here (my comment is currently in moderation). I for one have no interest in claiming Dickens for my side. To hell with moralizing fiction.
Libertarians favor property because that’s of their defense of individuals (generally rooted in self-ownership). Those complaining here should specify what exactly they see as the tension between the two. Unless libertarians are privileging a collective over the individual (some might claim that for corporations, but it would take some argument) you’re left with complaining that libertarians side with the claims of particular individuals over others.
Roderick Long gives a left-libertarian defense of strong property rights here:
http://aaeblog.com/2011/05/05/the-paradox-of-property/
Michael, this is an english speaking blog. Try to avoid posting in other languages without translating. One can always use google translate, but if you’re commenting here it’s your responsibility to make yourself understandable.
May 11, 2011 at 3:05 am
“Michael, this is an english speaking blog. Try to avoid posting in other languages without translating.”
How provincially American of you, TGGP.
And I think Michael bent over backwards to make sure non-french readers understood his entire post.
May 11, 2011 at 1:44 pm
My apologies. I assumed the comment section was being read by educated persons. One should never assume.
May 11, 2011 at 9:10 pm
“To assume makes an ass of u and me.” — Voltaire
May 14, 2011 at 7:40 pm
Libertarians favor property because that’s of their defense of individuals (generally rooted in self-ownership). Those complaining here should specify what exactly they see as the tension between the two.
I’d have though the tension between the two is obvious. Everyone is an individual, rich and poor or weak and strong or smart and stupid alike, but property is not distributed on an similarly equal basis.
So in some extreme cases all the property is owned by a tiny handful of individuals. For example, the royal/aristocratic families of England owned essentially all the land in Britain up the the 19th century. In cases like this property rights were not a defense of individuals.
Perhaps once reason why Jefferson mentioned the right to “the pursuit of liberty” rather than “property” was that the Revolutionaries intended to abrogate the property rights of British landholders in the Americas.
May 16, 2011 at 11:58 pm
Propertarianism conflicts with egalitarianism, but that’s not the same thing as individualism. A defense of property rights in England would be a defense of individuals: those small numbers of individuals owning the property. I must plug Nick Rowe’s avatar analogy here. Thinking about it now, we might also use the analogy from the Caplan-Hanson debate on free speech for atheists. If the religious really hate atheist speech sufficiently (and form a large enough majority), it is utilitarian to prohibit such speech even though that conflicts with the individual rights of atheists.
Many landowners pushing the American revolution were heavily indebted to folks in England, and they repudiated their debts on the revolution. Their descendants subsequently had a hard time borrowing money when the south seceded from the north. I don’t know if that had anything to do with the phrase though.
May 17, 2011 at 8:31 am
I believe “the pursuit of happiness” was substituted for property in Locke’s formulation of life, liberty,and property, because whereas life and liberty are birthrights, property is not – it must be got somehow.
The thesis that American property owners, heavily indebted to English moneylenders, fought the Revolution to repudiate their debts, was (if I recall correctly) a contention of the historian Charles Beard. But if this may have been true of some Revolutionaries, it was not of others. The Randolph properties inherited by John of Roanoke came to him encumbered by debt incurred by his ancestors, which he labored to pay well into the early nineteenth century, and which he succeeded in paying fully only a few years before his death.
May 17, 2011 at 9:27 am
“The Randolph properties inherited by John of Roanoke came to him encumbered by debt incurred by his ancestors, which he labored to pay well into the early nineteenth century, and which he succeeded in paying fully only a few years before his death.”
The first thought that comes to mind is, “What an idiot.”
May 17, 2011 at 12:15 pm
I suspect the debt was reaffirmed by his parents and not by him (Randolph was born in 1773; his father died in 1775, but he did not come into control of his inheritance until he was of age) . It would be curious to know how many others similarly reaffirmed his debt. Probably more did than did not. The Southern preference was to trade tobacco, cotton, indigo, etc., for goods of English manufacture; any planter of substance had an agent in London, and could not have traded there if judgments were outstanding against him. Beard’s hypothesis has always struck me as too facile to be entirely correct.
May 11, 2011 at 3:00 am
By the way, I really like Mitch Daniels.
Being the credentials nerd that I am, I really like that:
1. He graduated the top male high school student from Indiana.
2. He graduated from Princeton, with Honors, in Public Policy.
3. He graduated from Georgetown Law School, with honors.
4. He is a former OMB director.
5. He’s a 2 term governor.
Also, it’s good for the global pageantry that he’s part Syrian (although he’s not Lebanese, he reminds me of the impressively accomplished Lebanese diaspora).
I think a Daniels-Romney ticket would be very strong and technocratic for the Republicans.
May 11, 2011 at 8:03 pm
Of the GOP candidates with a chance of winning the nomination, Daniels is my favorite. Let’s hope the GWB track of competent governor -> incompetent president doesn’t repeat itself. But Intrade has Obama to win. Maybe Daniels should wait for 2016.
The GOP is known for giving the nomination to those whose “turn” it is. So Romney is more likely than Daniels this time.
May 12, 2011 at 2:32 am
Does that break in the direction of innovated inclusion (Mormons, this time)?
May 12, 2011 at 7:59 pm
I don’t quite get your question. A Mormon presidential nominee would be a new thing, but that’s sort of common knowledge rather than a question.
May 13, 2011 at 2:15 am
You said the GOP is known for giving the nomination to those whose “turn” it is. But they’re also known for not being the party for that makes inclusion pageantry part of their candidate selection process, in contrast to the Democrats. Democrats in recent times nominated first catholic, woman, jew, and black to their national ticket (I think a catholic was actually nominated a long time ago by some party, but I mean recently) -maybe Dukakis was even part of this trend as a Greek American.
Since I think a sort of prejudiced narcissism is the prime motivator of Republicans these days, the more different the candidate from the base or archetypal notion of a conservative american, the harder time I think they’ll have to be nominated. I think this is the (only?) source of Governor Huckabee’s strength. Southern, Protestant, straight, white, male.
May 13, 2011 at 7:54 am
Al Smith was the first Catholic to run for president on a major ticket, and it was again the Democrats.
Democrats have been known to have such “firsts” on their tickets, but those also tend to be groups they have an electoral advantage with (married women being a possible exception). Mormons are a pretty solidly Republican demographic (with Utah being the reddest state in the country). Interestingly, Dukakis was the second Greek governor in the U.S, with Spiro Agnew being the first. And Walter Mondale was apparently determined to set a precedent with his vice presidential pick.
May 14, 2011 at 3:16 pm
I cringe that Daniels claims he would like Condoleeza Rice as his vice president. I’d say that I’d like her to run for governor first, but really I’m put off by what I think are suspect intellectual credentials.
http://www.realclearpolitics.com/articles/2011/05/13/getting_to_yes_for_the_danielses_109852-3.html
May 16, 2011 at 11:47 pm
Not happy about the Rice endorsement either. I suppose the best spin is that her reputation as technocrat rather than politician (she’ll never be a governor) marks this as the homage ignorance pays to expertise.
If you’re still reading here, thought you might find this on the inner workings of ChiCom government to be interesting:
http://chovanec.wordpress.com/2011/05/08/primer-on-chinas-leadership-transition/
Hat-tip to Brown Pundits.
May 17, 2011 at 9:28 am
I would find it interesting (and I note it’s from the excellent brown pundits), I hope I get to it.
May 21, 2011 at 9:32 am
“You haven’t offered anything but a bald assertion that the Swedish health care system is more efficient than those of countries higher on the economic freedom index, either, have you? How long does one have to wait for a hip replacement in Sweden, say, as compared to the United States? Or Singapore?”
Am I way off? I thought all the countries you listed as above the US on economic freedom had health care socialized to a much greater degree than the US. I thought you were ceding the point, but I guess not.
May 21, 2011 at 7:21 pm
Health care in Hong Kong is a mixed economy, much like that in the U.S. In Singapore the state runs the insurance scheme through compulsory savings and the private sector delivers the care. There are choices available to patients at various levels of costs and services; it appears the Singaporean program is patient-directed somewhat like our HSAs or FSAs. Switzerland, Holland, and Germany require citizens to buy insurance from private-sector vendors, rather like Medicare Advantage in this country. They, and the U.S., all stand higher on the economic freedom index than Sweden, which has a state-run system not unlike Britain’s NHS.
The U.S. has medical care socialized to a greater extent than you appear to believe. Medicare takes care of the aged; Medicaid the indigent. In my state, there is a medical insurance pool from which people below 65 years of age, and above the eligibility cut-off for Medicaid, may buy health insurance if they cannot get it from other sources. In principle it is rather
Ike the state insurance pools available to motorists who can’t get private insurance. There is no reason why any resident of my state can’t have health insurance unless he chooses not to have it.
The U. S. health care system also has a system of indirect price controls of which most people are unaware. It operates through Medicare. No physician or other provider that accepts Medicare patients may charge other patients according to a different fee schedule than that which it offers Medicare. In practice this has led to an inflated fee schedule from which Medicare and private insurance carriers negotiate discounts with the providers, and different actual fees end up being paid depending upon the discounts. The result is rather like what we see in the hotel or airline businesses, in which almost everyone gets some sort of discount, and very few pay the rack rate or full fare. Insurers typically pay about 60 – 70% of the scheduled fee to primary caregivers, and less for many procedures. Medicare pays less than private insurers. All take on average 90 days or more to pay. The only exception is the cash customer, who must pay 100% of scheduled fees, on the day of service. This is the true plight of the uninsured, and is very seldom mentioned. Too much dirigisme, rather than too little, is the problem.
It’s also not surprising that the only real price competition we see in the delivery of health care is in specialties that are not covered by Medicare and private insurance, such as laser surgery for the correction of vision. If this country could stand to make any change in its system of medical care it would be to make it more, rather than less competitive. HSAs work very well in this regard. I’ve offered them to my employees with good results in cutting costs. When people know they are spending their own savings, they look for better deals. Singapore, not Sweden, is the example to follow.
May 22, 2011 at 12:42 am
So you disagree that the countries with the most efficient health care sector (many healthy years of life, lowest spending on healthcare as a percentage of gdp) are the ones with a much higher level of socialized healthcare?
I’d like to see you debate this in depth with Mr. David Shor. My sense is your side of the argument is weaker, but my overall literacy on this topic is still fairly low.
May 22, 2011 at 7:14 pm
Life expectancy is substantially dependent on genetics, not on nationalized health care. Once a country has put in place such basic public health measures as sanitary water supplies and sewer systems, and childhood vaccination against contagious diseases, it has achieved the lion’s share of extension in life expectancy that can be brought about by medical means. Another substantial contribution to life expectancy is the simple availability of sanitary facilities and trained personnel for the delivery of babies. All these things, none of which constitute high-tech medicine, existed long before the advent of socialized medicine in Northern European countries. It should be no surprise that people having good genetic stock and naturally
healthy constitutions, given these conditions, have long life expectancies and spend less on doctors’ bills. They would do so regardless of the arrangements for medical reimbursement.
Given this, a better measure of the quality of medicine than life expectancy or percentage of GDP spent on health care might be the average time that a patient has to wait for the performance of a non-emergency procedure after the need for it has been
determined. Here’s an illustration from an article by David Gratzer, M.D., in yesterday’s Wall Street Journal:
“Single-payer countries… keep costs below U.S. levels by rationing care, not by being more efficient. Several weeks ago, the government-run, government-appointed health authority in the Canadian city where I was born admitted that a dozen
patients died in the last three years while waiting for routine cardiac surgery. None was classified as an emergency case. In Canada’s system, that made them ‘elective’ surgery patients, triggering wait times that can delay treatment for weeks or even months. Yet single-payer activists persistently claim that ‘death by rationing’ is a myth invented by insurance lobbyists.”
Of course, those dozen deaths are probably statistically much less significant in their lowering of Canadian life expectancy than the ethnic/genetic profile of the Canadian population – which is much more north European than that of the U.S. – is in raising it. Still, I’d not want to be one of those who needed a bypass procedure and died while waiting for it. Canadians with money come to the U.S. for treatment they can’t get timely done in their own country. You’d know this if you ever visited the Mayo Clinic.
Our ethnic profile increasingly resembles that of a third world
country. Should we be surprised that the life expectancy of the
people who have made it so, pulls down our average? Some years ago, a family friend, then a doctor at a hospital in eastern Texas, commented to me on the high incidence of tuberculosis amongst Hispanic immigrants. Thirty years ago, TB sanitaria all around the U.S. were being closed. TB was thought to be a thing of the past. It isn’t, now, thanks to open borders. It’s a disease characteristic of the poverty and lack of sanitation in the countries whence these immigrants come. We now have less protection against this contagion than we did when Ellis Island was in operation, and diseased immigrants were quarantined. Bedbugs, once thought annoying but harmless, are now abundant in New York, where they were formerly extirpated. They are now thought to be important carriers of Gram-negative bacteria such as methicillin-resistant Staphylococcus aureus. How did they get there? By hitch-hiking in the baggage of persons from insalubrious backward countries.
Until now, many of the countries with socialized medical care
have been naturally sheltered by their location from the public
health problems brought about by that golden calf of
progressivism, “diversity.” They won’t be much longer.
According to a paper by David Dodge, Canada’s former deputy minister of health, and a former governor of the Bank of Canada, Canadian health-care costs are growing so fast that they should consume 19% of GDP. I wouldn’t be surprised if the same trend may be observable in Scandinavia – and that it is attributable to the same unfortunate combination of an aging native-born population and an influx of alien peoples from impoverished and pestilential third-world countries.