Debates over health care policy break down into empirical questions (Is Obamacare increasing the number of Americans with insurance?) and philosophical questions (Should government spend trillions of dollars to increase insurance coverage?). Earlier this week, I wrote about a study providing empirical ammo to the liberal argument that increasing health insurance reduces mortality rates. But I noted, briefly, that such a study couldn't answer philosophical questions about the role of government and the implications on human liberty. This provoked a thoughtful response from Bill Gardner on the Incidental Economist health care blog.
In his post, Gardner argues that expanding health insurance coverage increases positive freedom: “Many people who were excluded from the insurance market because of pre-existing conditions, or who could not afford it, will now have an option to purchase it. For those who have obtained their insurance through their employer, the ACA may give them greater freedom to change jobs or retire. Finally, getting insurance may provide people with access to healthcare that restores their capabilities and prolongs their lives, thereby expanding their positive freedom.”
The problem is that the potential gains in positive freedom he identifies require the violation of the negative freedom of others, a point he readily acknowledges. That is, individuals are not only denied the freedom to go without insurance without being subject to tax penalties, but they are forced to purchase a specific type of insurance that’s approved by the federal government.
Because lawmakers wanted to increase the “positive freedom” of one part of the population by ensuring that every policy provides a certain set of benefits, it meant that another part of the population had to purchase those benefits, regardless of personal preference. That’s just to name one of many examples in which Obamacare infringes on liberty.
The key distinction is that a free society allows Person A to purchase any amount of insurance he or she wants (or none at all) without legally preventing Person B from obtaining insurance. But Obamacare, in the name of making insurance more accessible to Person B, forces Person A to purchase a specific amount of insurance.
As another example of policy with tradeoffs on freedom, Gardner points to child labor laws, which restricted freedom of children and businesses, but, he writes, “allowed children to develop their full capabilities and therefore represented an expansion of positive freedom that more than compensated for the infringements on negative freedom.”
I don’t think the analogy works here, because child labor laws raise a different issue. Many arguments about liberty are rooted in the belief that individuals should be free to make their own choices, and government shouldn’t assume the role of a parent forcing them to do what’s best for them. But at what point are people old enough to properly evaluate the consequences of their actions and make decisions? That’s the reason there are age of consent laws, minimum drinking ages and so on. Now, there can be a vigorous debate on where that cutoff should be — most people would agree that three-year-old children shouldn’t be allowed to walk into a bar and buy whiskey, and many would agree that 19-year-olds should be able to. Similarly, there’s a distinction between saying a 7-year-old can’t work in a factory and preventing an 18-year-old from doing so. The point is, child labor laws just raise a different set of issues from health care policy.
Supporters of the health care law argue that restricting freedom is a worthwhile tradeoff to expand benefits. Many advocates of the health care law will argue, quite passionately, that those who oppose such an idea — or other policies aimed at achieving universal coverage — are actually immoral. That, in fact, opposing encroachments on freedom in the name of expanding coverage is tantamount to actively harming those in need.
To be clear, many free market reforms that I support would bring down health care costs and expand access without necessitating the violation of freedom. But I’d readily acknowledge that such policies wouldn’t expand comprehensive coverage by as much as policies that mandate everybody has health insurance, and then spend trillions of dollars trying to get people insured.
As I’ve noted many times before, I measure compassion on the basis of how people treat one another as they go through their lives. I do not define compassion as a willingness to impose burdens on some in the name of reducing burdens on others, with government as the arbiter.