Saturday, March 10, 2012

The Libertarian Endgame

On September 12, 2011, during CNN’s GOP Tea Party express debates, Wolf Blitzer posed a hypothetical question to Republican candidate Ron Paul, asking who should foot the bill for a healthy 30-year-old man who chooses not to buy health insurance and then suddenly ends up in a coma with expensive medical bills? Paul responded that freedom is about taking risks and personal responsibility, and it is not about the government taking care of everybody. Paul is a libertarian and, as such, believes that government should be as small as absolutely possible and only interfere in people’s lives for basic protection from hostile enemies and criminals.

Blitzer then asked, should we just let him die? Some in the audience cheered, “Yes, let him die!”  Many left leaning groups and individuals used this as a glaring example of the hypocrisy of the right. Republicans are a party that claims higher moral ground, conservative family values, and pro-life agendas, and yet at a party debate some verbalized support for a person dying because he couldn’t cover medical bills.

Paul himself said that we shouldn’t let him die, but he offered only altruistic church groups and charities as the solution. In 2012, medical expenses account for 60% of American bankruptcies.  So, leaving this incredible financial burden for church groups and charities to shoulder means that, in reality, many people would die.

The day after the debate, news broke that Paul’s close friend and 2008 campaign manager, Kent Snyder, died of pneumonia at age 49 after accruing more than $400,000 in medical bills. Paul and his staff raised $50,000 towards the bills, but the hospital bill was never paid off. Apparently, libertarians think it is acceptable for the hospital to eat that bill. So they overlook an important point about our medical system: we pay these bills by a back-door financial policy. Hospitals make up for this kind of unpaid bill by the raising the cost of everyone else’s medical care.

This issue is a defining moment for the US because one could easily blame the high costs of healthcare on the Emergency Medical and Treatment and Active Labor Act (EMTALA), which says hospitals that receive taxpayer money cannot refuse care to people. Would libertarians propose getting rid of the EMTALA? Is this the kind of society we want to live in?

One other reason why healthcare costs are high is that the US political system allows corporations to get so powerful that they can steer government policy towards their own interests. Using their monetary influence, they can break down regulation and fix the game in their favor. If, as libertarians believe, government should be small and only used in defense and the like, who will be there to regulate these big corporations when they are in total control? Their default answer is the invisible hand of the market. But even Adam Smith, the great hero of capitalism, extolled the benefits of the invisible hand only when there is a general well being among all citizens. 

I agree that when it comes to government intrusion on lives of its citizens, I think we should look at policies with a libertarian eye and not make a policy without a good reason. However, there is very good reason to provide health care, both for moral reasons, like those above, but also economic ones. The libertarian stance claims that when government gets involved, costs go up. Ron Paul frequently makes this argument in his speeches. I am not sure where their evidence comes from. Data shows instead that healthcare costs are lower in single-payer health systems.

When the ethical and practical reasons for a libertarian position on healthcare crumble, why continue to cling to the hard line?


  1. PART I:

    I'm a little surprised by this post. The heart of the argument is really (1) a straw-man argument and (2) guilt-by-association. You fail to address the libertarian position at all.

    The straw-man you've set-up is that Libertarians want people to die: "You can't pay? Too bad... die in the street, you bum!" No serious thinker--Libertarian or not--wants to weed out the sick by who can pay or not pay. Said differntly, the libertarian position isn't simply that if you can't afford insurance, you are doomed to die. The libertarian position is not one of cold-economics.

    Second, it is a guilt-by-association. The man in the audience yelled out during RP's answer "Let him die." RP didn't say that or agree with that. Is this really the basis for an argument against a libertarian stance--what some non-thinking person said in the audience in a (let's hope) moment of brief idocricy?

    1. First, thanks for commenting. I made sure that RP's stance was recorded and did not implicate him to "let him die!" comments.

      But the point of my article is that it is not a moment of "idocricy" but a true conundrum for libertarians. EMTLA is a government regulation that impairs businesses. If libertarians are for this law then we are talking about degrees of government involvement. Then that changes the tone of the debate. Republicans, Ron Paul included, continue to blame the economic crisis on over regulation and increased government involvement. Where is the line in the sand?

      I brought up EMTLA as a way of creating a line on this continuum of government involvement. I think it is valid. My next essay is going to be on the debate on the affordable health care act (aka Obamacare) The constitution has a lot of gray written in and I am curious to see how the argument plays out.

    2. I'd encourage you to read all of my response, but just to respond here...

      I don't see how EMTLA is a conundrum. In PART 2, I lay out the libertarian position. First, it is not one of utilitarian ehthics.

      Second, in part 2, I also say that you're talking out of both sides of your mouth: you want more regulation and blame the problem on regulation that favors business. I agree w/the second part. The difference is that I (and the libertarian position) is consistent on regulations); you're not.

      Finally, in part 3, I acknowledge that intelligent people like yourself can disagree w/the economics of libertarianism (although, again, libertarianism is not a theory of economics). Even still, that prices are controlled must have consequences. Again, someone who knows as much about economics as you do knows this. You just choose to (1) either ignore this economic fact or (2) understand/believe that the benefits outwiegh these costs--the latter of which intelligent people can disagree about.

    3. So... let me clarify in response to your comments. I don't think RP would support EMTLA... and the point of my posts/comments is that it is not b/c (as many people frame it) that libertarians love to watch people die. As such, there is no conundrum.

      So, I believe you've created a conundrum that is not there. Perhaps, this is b/c there is some confusion about what you are seeing as Republican and what is libertarian. Don't confuse these. RP (and I'll speak for myself anyway) are libertarian and by this... I mean something VERY VERY different than replicanism... not a light bran of what Glenn Beck calls libertarianism that is hard to distinguish from REPUBLICANS

  2. PART 2:

    So, what is the libertarian position? The libertarian position is simply that unprovked aggression is not justified--period. That's it. The libertarian simply follows this position through. The libertarian says that the State necessarily employs aggression. To apply this to h/c, then, a universal, gov't run system that would, for example, require everyone to purchase health-insurance or force you to pay for someone else's heathcare (via taxes or something like this) or else you would suffer a penalty (fines, jail-time, and of course, with suffient enough resistance: death) is an example of how the state employs aggression.

    So, when RP says that he doesn't want to institute a gov't run system, he is saying that b/c he doesn't believe it is justified by USE OF FORCE to make person X pay for person Y.

    Your position, however, is that liberty should be preserved... except when it shouldn't. You say: "...when it comes to government intrusion on lives of its citizens, I think we should look at policies with a libertarian eye and not make a policy without a good reason. However, there is very good reason to provide health care, both for moral reasons, like those above, but also economic ones." You are okay w/the State's use of force when YOU believe that it justifies some greater end. You rely on utilitarian ethics. The libertarian relies on a broad principle(s) of justice; the libertarian position is really a theory about the use of force. So, in short, you believe that unprovked aggression is justified (at least in some cases--particurly, when you think it will benefit SOME people.)

    Now here's a key point: this is even more evident in your argument about the economics of the situation. It is interesting that you blame the LACK of regulation on the high costs of healthcare, but in the VERY same post point out that the reason that corporations (no doubt a buzz word that is supposed to send chills down one's spine) are able to make such large claims on price is b/c "corporations...can steer government policy towards their own interests." Are you kidding me? Do you not see that this is not a problem w/LACK of regulation, but regulation that favors one group over another? I (and all libertarians) would agree that corprate lobbies get the State to swing things in their favor. The difference in our solution is not to get rid of the people that provide the services, but get rid of the people w/the GUNS!: THE STATE--the ones who set the rules in their favor. We want the corporations to compete on fair grounds.

    Instead, what you endorse is that the FAVOR shouldn't be steered in the direction of the corporations (i.e., that force should be used in a way that benefits one group), but that the FAVOR SHOULD BE steered in the direction of the consumer (i.e., that force should be used against the corporations in favor of another party). Again, the libertarian position is that the favor shouldn't be on either side.

    So, to sum up, the libertarian position simply says that we shouldn't use unprovked force. So, if you want to mount an argument against the libertarian position, then do it there, not w/strawman (let everyone die!) or guilt-by-association (the audience member) as the basis.

    1. Canada has famously and successfully avoided the housing crisis we are experiencing here in the US by exactly the same process I discussed above. The one that made you ask rhetorically, "are you kidding me?"In Canada, the banks do not act without going through a central authority. That is why their dollar has been equal to the US for the past few years.

      It is also why in Switzerland, they offer universal health care coverage but through private insurers at lower costs.

      I understand your point about guilt by association and the semantics of this. However, we already know the endgame of a do nothing approach. The market does fail. It has failed. This is no surprise this is not theoretical failure. Everyone will eventually die, but some people die for nothing more than simply their station in life. Is life unfair? Yes! Do I want everyone to have everything split up equally? No! Am I saying that the government should pay for the highest level of health care for every poor person? No!

      I feel like libertarians take everything too far. This kind of purity doesn't exist not even in the actions of libertarians. I am sure there was once a better chance of living a libertarian lifestyle in the pioneering past. Society is so complex and interwoven. Public health is a key player in this discussion. Disease doesn't stop along philosophical barriers. Money and Social can slow it down but it can not stop the spread of epidemics. I would consider public health surveillance a public good and I would be shocked if any group would leave it up to a corporation. It would be akin to leaving national security up to a private corporation. Anyway, again this is being covered in my next post on public goods.

  3. PART 3:

    On the economic argument, RP's point is to say that a free system (a REAL free system--not the current or recent past US system) would bring lower costs and higher quality. I tend to think that this is where reasonable people can disagree. While I favor RP's position, I know that smart people--like yourself--can mount good arguments for certain "interventions."


    1). Your comparison of the US vs. French prices in the link you provide doesn't simply say that socialized (if you will) healthcare CAUSES lower prices, and you know this too. If that were the case, then why don't we socialize bread, juice, milk... EVERYTHING. If prices can magically go down when the gov't gets involved then I'm on board, but let's not stop at healthcare.
    2) Related to the first point: (and the reason we wouldn't want to just arbitrarily put caps or lower price by gov't fiat on EVERYTHING): Your also well-enough informed on economics to know that prices mean something. When you start lowering prices, there are consequences that come from that. (Again, whether you think the consequences are outweighed by the benefits of lower prices is where reasonable and intelligent people may disagree, but I know your smart enough to know there are consequences).

    1. This is really exciting debate. I wish we lived closer together. I will work on responses to the above Parts 2 later. They are more complex.

      Pricing is not so cut and dry. Capitalism is a great system but it fails in certain areas e.g. healthcare and other public goods. Therefore, some government involvement is essential. I think we all agree on this but how much is the key. It is not simply that France has less cost of health care, Canada does and many others as well. In fact, all developed countries has less cost of health except the US. Many experts agree that the cost of care is high for a number of reasons and many of those can be linked to weakened government regulations. Weakening government is the libertarian endgame. So after decades of crippling US government regulators you can't say government is the cause of higher prices of health care. There is a clear and direct link to Reagan downsizing and to healthcare pricing increases.

      That is why my argument about EMTLA is an essential one and one not discussed often. We are all trying to figure out where to land on this dimensional relationship between government involvement and markets. Once you enact EMTLA you are basically running up the deficit because the government can't force a loss on business without padding it. So we end up back in the budget. If we allow EMTLA then the government needs to get more involved and regulate pricing.

    2. I guess I'll just reiterate... there is no continuum for libertarians. There is no good reason for gov't intervention--in anything really. REAL Libertarians don't compromise on this. So, no we don't all agree on this, and the reason is for the libertarian principle, not a utilitarian point.

      Also, I'm not sure where you're getting the less regulations other than the talking points on the news. Surely, no serious examinations say that healthcare is getting less regulated. (Over the last--let's say 50 years--healthcare fields have LESS regulations? Seriously?!)

      Let's just take two examples in how regulation hurts cost: 1) Insurance companies can't sale across state lines and (2) Coverage requirements (minimum coverage components) in health insurance policies<--Don't take this to mean that I'm arguing these are the cure, but I'm just making the point that here's two good examples where regulation necessarily increases cost.

      But let's also stop thinking that high cost is the boogey-man. Might there be good reasons for high cost too? Is there a reason that iPads are expensive (or they are expensive in my puny wage-earning world, anyway ...:))?

    3. IF I CAN MAKE A REQUEST: I'd also love to see a post on "public goods."

      What is that? Aren't computers public goods? Don't we all (as the public enjoy and use and even perhaps need) computers? What about cars? What about milk? I guess I'd like to see you address this point too. If gov't intervention can reduce price w/o consequence, then why do we stop w/healthcare. If this can really happen, sign me up to the socialist party! I'd like to see gov't take over milk, gas, EVRYTHING. We'll live in a paradise w/low-cost everything in abundance...right?

    4. That is a great request! I will definitely address this. This is legitimate counter to where do we draw the line on the upper side. My EMTLA is an attempt to draw the line on the lower side of government involvement.

      One thing, I will say right now is that it doesn't have to be the all or nothing type of argument that you are making it out to be. Many stable democracies have social safety nets, stable currencies and market economies. I believe we need let the market work pricing out for IPADs and the like but for something that is failing the citizens government should step in.

      The most common cause of bankruptcies in the US is health care. If somehow IPADs were directly causing that kind of harm to our citizens we should have vigorous debate on how to solve that problem. But I will work on public goods!

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  5. So, if there is no continuum for Libertarians than my EMTLA argument is a legitimate point and the, "let him die" chant is part of the Libertarian philosophy? Please answer in the binary Yes or No before elaborating.

  6. YES: you are correct there is no contiuum.

    NO: "Let him die" is not the solution

    Your assumption is that if the gov't doesn't solve the problem, it won't get solved. I would argue this is the wrong premise.

    1. I agree that is my assumption but you do not offer any solution. RP said church groups and charities. My paper shows that is not going to cut it. Another option that is already in place is those donation cans we see alongside cash registers in many small businesses.

      One important point to remember is that hospitals who do not receive public money are not held to EMTLA. This whole things goes right into public goods. I am working on that right now. I will post it soon.

  7. What's the difference between Libertarian-ism and anarchism? Where do you draw the line? Is there a line to draw?

  8. @Adam: Great question. It probably depends on who you ask. Stephan Kinsella--a anarchist/libertarian scholar, for example, is an anarcho-capitalist (a "branch" of anarchism), and he uses these terms interchangeably and sees no distinction. See his article "What it means to be an anarcho-capitalist" ( and "What Libertarinism is" ( Others like Charles Murray, for example, talk about Libertarinism as something other than anarchy. He talks about "public goods" for example.

  9. These were interesting articles and I see the lack of distinction between the two as you indicated. I agree that they are similar philosophies and the terms can be interchanged.

    Is there such a thing as the "common good"? I believe these philosophies could work in a society or civilization, but it seems that there is no sense of nation or community. Do you think that the concept of the nation is contrary to the principles of Libertarian-ism?

  10. @Adam: For a Libertarian, there is nothing fundamentally wrong w/"common or public goods," per se. But for the Libertarian, a public good must be something that happens voluntarily. For example, in the neighborhood I live in, all our houses are back to back to each other. We have agreements in the neighborhood that there is a space of X Ft b/t properties that are "commnon". We use them as "right-of-ways" to, for example, transport our lawn-mowers from our front yards to our backyards. This is perfectly acceptable to a libertarian--that people mutually agree to "publically keep" a set of land for example is fine.

    This is NOT what people usually mean by "public or common goods," though. When someone calls healthcare, for example, a public good, this is the erroneous assumption that one's labor does not belong to him/her, but instead is equally or partially owned by otheres or that others have a right to make a claim to it. If h/c is public, it does not belong to you, but is aviable to everyone, and you can not dispense of that labor to whom or at what price you wish.

    Moreover, the idea of a public good--as it is spoken of today--is impossible (on practical grounds), for it is based on the fanciful assumption or guise of a "public interest," as if the public had one mind and wished to use the same land or labor, or other resource in exactly the same way. So, under the guise of freedom, the state uses "democratic processes" to determine the use of these so-called public goods to satisfy the majority (or the most powerful) despite the fact that some (whether that be the actual minority or the least powerful) would rather use the land/labor or other resource in some other way.

    1. Michael, don't you think your comment, "the idea of a public good--as it is spoken of today--is impossible...based on the fanciful assumption"is a bit extreme? Almost all of us rely on a coordinated infrastructure to eat and live!

    2. Chris... I think if you finish my quote, you will see that it is not extreme at all. I said it was fanciful to think that "the public had one mind and wished to use the same land or labor, or other resource in exactly the same way." If this were not fanciful, then politics wouldn't exist--we'd all agree on how to resolve public goods.

  11. Your quote can be read a few different ways. In the context of this discussion you seem to posit that no one agrees on any public goods. One of the main reasons why I think this is such an important point to discuss is I would like to hear the absolute lower limit to government involvement beyond national defense for Libertarians. Sanitized water? Plowing of roads? Highways?