Is NOT the Essential Value of Freedom
Jay B Gaskill
How far the ideal has strayed from the real world? …Very far, if a recent New York Times piece is at all representative.
My attention was recently drawn to the New York Times’ blog section, where a piece dated June 29, 2012 by Uwe E. Reinhardt, a Princeton economics professor, appeared under the title Health Care: Solidarity vs. Rugged Individualism.
According to the professor –
“In essence, the struggle over the mandate is merely part of this country’s struggle over a fundamental moral question: to what extent must I be my poorer brothers’ and sisters’ keepers in health care? Americans are far from united in their response to this question.”
The author went on with a thought experiment, but the main point was flagged in the tag, “Rugged individualism” vs. “solidarity”.
This slogan or some variation thereof is the Twitteresque distilment of a false dichotomy that has “informed” progressive – liberal discourse for almost a century. The conceit that conservatism and other liberty-friendly movements are all about rugged individualism is at least 30 years out of date.
Think about it.
Are conservatives living on islands inhabited by rugged individualists? Are liberals living in egalitarian solidarity gulags along with the poor and bereft?
No thinking liberal lusts after true solidarity, though he or she might wish it inflicted on someone else. No thinking conservative wants the nasty, brutish and short life of the “free” savage. None of us can survive for long without the blessings of civilization.
Liberty is a precious and intensely valuable condition that is enjoyed by the individual or not at all. But it exists only under modern conditions and only when a given civilization is committed to its protection. When we speak of ordered liberty we are describing the result when liberty is held as a reciprocal value, protected by law on condition that one may forfeit one’s claim to liberty by trampling on the liberty of another. In the most sophisticated, liberty-friendly civilizations, liberty is protected vis-a-vis other citizens and from the depredations of the government itself – accomplished through a robust protective legal mechanism like the US constitution.
Without a liberty-friendly civilization, capable of protecting freedom, no individual is free to be or not to be a liberal, to be or not to be a conservative.
The modern dichotomy is an entirely different animal. It is between authoritarian bureaucracies and the activities of non-conforming creative individuals and communities. I suspect that the dichotomy between “Nanny Bureaucrats” vs. “Civilized Individualists” will prove more descriptive, more relevant and more apt.
The health care debate (to the extent we were allowed to have one) was never about whether to make access to health care more widely available in the USA. It was about how to do so without degrading the quality of care of the 80% of Americans who were happy with their present arrangements. The Affordable Care Act (a three trillion dollar violation of truth in advertising, if there ever was one) supplied a bureaucratic bulldozer approach to every non-bureaucratic, creative solution to the health care delivery problem that was proposed.
As someone who is firmly in the free and creative individual camp, I hope that there is another chance to get this right. In that to-be-hoped-for debate, I strongly recommend the class of solutions that build-in price and quality transparency (instead of the prevalent bureaucratic and accounting obfuscation); provide meaningful individual choice (aided by intelligent consumer advocacy); support robust respect for the doctor-patient relationship (free from political “oversight”); and grant sensible assistance for the poor or high risk patients that does not degrade the quality of care for all the rest.
Above all, we must preserve the tradition of medical innovation that provides most realistic hope over time for more effective, efficient, affordable and patient-friendly health care.
In this, we should be guided by four precepts:
 Incremental reform with results-testing beats comprehensive reform that risks irreversible harm.
 Absolute equality is the enemy of reasonable individuation.
 Trust the marketplace to operate rationally over time. Every really valuable medical innovation was expensive and limited in practice before it became standard practice and inexpensive.
 Bureaucracies are the enemy of creative innovation.
We need to repeal of the Affordable Care Act. Whether the repeal is partial or complete, it will provide an opportunity to make something significantly better…and actually affordable.
There is no crisis.
We have – and should insist on taking – all the necessary time needed for discussion and review. At a minimum we need to honor that duty to which every physician is charged by his or her oath- First, do no harm.
First published on The Policy Think Site
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 Reinhart proposes –“Let us set up two distinct systems for health care within our nation. Call one the Social Solidarity system and the other the Libertarian system. Ask young people — at age 25 or so — to choose one or the other. People joining the Social Solidarity system would know that they will be asked to subsidize their less fortunate fellow citizens in health care through taxes or premiums or both. They would also know, however, that the community will take care of them, and they will not go broke, should serious illness befall them. People choosing the Libertarian system would not have to pay taxes to subsidize other people’s health care, and they would pay actuarially fair health insurance premiums — low for healthy people and high for sicker people. Libertarians, however, would not be allowed to come into the Social Solidarity system, unless they were so pauperized as to qualify for Medicaid. Hospitals would have every right to use tough measures to make them pay their medical bills in full, to prevent freeloading at the expense of others.”
 Described by Thomas Hobbes (1588-1679), the British philosopher – author of the notion of the “social contract.”