Defending The Indefensible: Letting “The Poor Die In The Street”

How often have we libertarians heard the line: “You don’t want state healthcare? Then you must want poor people to die in the street?” Thankfully most people that we debate with have now passed this childish stage; however based on a recent experience this is not consistent, so maybe we require a brief explanation of why this isn’t true.

Logical Fallacy Or Misrepresentation?

Let’s start with a fact: no, I don’t want the poor to die in the street. But, more importantly, this does not follow from wanting state healthcare. The logic behind the assertion that ‘if A then B’ is false: this is known as a non-sequitur. Another argument also used is that “if you don’t want the NHS then you must want the US system” where it is therefore assumed that the poor die in the street. This uses the same false logic in an attempt to portray the libertarian as a heartless capitalist, which is then used as an ad hominem to ‘poison the well’ against further debate. As I questioned in my previous post ‘Is The State Needed?‘ how many of 200+ countries in the world have adopted the NHS model? As far as I’m aware there are none, so there are still 200+ other countries with various healthcare systems to choose from – why always compare to the US?

Comparison To US Healthcare

Incidentally, I’m not a fan of the US system, though not because of often-false propaganda about perceived outcomes peddled by NHS-idolisers, but because the system is heavily skewed by government and is run more for the benefit of the insurance companies and healthcare providers. These vested interests lobby government and their costs increase year-on-year. Even US conservatives recognise that their system can learn from other countries, as per this excellent abridged speech given by Avik Roy on Health Care As A Right.

In a recent study of healthcare quality the US system came last in a list of seven major industrialised countries, despite having the highest cost. It is interesting that this report ranked the UK’s system second out of seven, with many high scores for care: it would be interesting to see this report reanalysed with new data following the Mid-Staffordshire scandal.

Comparison of seven countries' healthcare by Commonwealth Fund

Comparison of seven countries’ healthcare systems. © Commonwealth Fund 2010

What is noticeable from this analysis is that the UK is sixth out of seven for providing ‘long, healthy, productive lives’; I would have thought this was the fundamental outcome required of a healthcare system. Having personally experienced potentially life-threatening ‘healthcare’ only 9 months ago I am unsurprised at this finding; if I hadn’t been so adamant that a consultant’s conclusion was wrong then I would have taken the medication that he prescribed, which probably would have killed or maimed me. However, as I always say, you cannot extrapolate from one data point. Sadly in the last year there were over 16,000 clinical negligence claims registered with the Compensation Recovery Unit, which one assumes were mostly against the NHS, so negligence is not that uncommon.

What’s So Special About Healthcare?

For the vast majority of us we do not need attention from a formal healthcare system from day-to-day, but for all of us we do need food every day. We all manage to choose a suitable food supplier each and every day and feed ourselves, yet few but the most dogmatic and terminally stupid call for a nationalised food system. Food suppliers have to arrange for raw ingredients to be grown, then prepared and shipped to stores for sale to customers. Although the supply chains for these products are often long and complex, and despite the occasional scandal, few people die from food purchased from private-sector shops or restaurants.

So why do so many believe that healthcare is more important to life than food, for instance, even though it patently isn’t? And why do the same people believe that only the state can safely provide this healthcare? The first point is obviously fallacious when the simple facts are considered: how long can you survive without food compared to how long can you survive without the state-provided healthcare system? Obviously you may rely on medication every day, but in reality once you are prescribed that by a GP that medication is (mainly) provided by the private sector – dispensing chemists and pharmaceutical companies – so this does not support the case that it’s important for the state to run healthcare.

My own view is that healthcare need not be provided by the state: there are plenty of partially or wholly funded privately provided healthcare systems globally that work better than ours. In fact in both of the two comparative surveys referenced in this article the Dutch healthcare system, most of which is privately provided, is regarded as better than the UK’s and US’s systems. As in most countries the Dutch government does interfere with the market somewhat, but this is mainly beneficial with minimal negative impact: it requires health insurance to be mandatory but it also pools risk requiring one fixed-price insurance for all.

Also, as I’ve argued before, if we must have a socialised healthcare system then the French model (often regarded as providing the best outcomes globally) is better than the UK’s, but even their system has significantly higher private funding and provision than the NHS. Why do doctors, nurses and other medical practitioners need to work for the state; for instance most are private in France? Although the French system provides universal healthcare, it is not a single-payer system and the French themselves do not regard it as socialised healthcare.

So simply comparing the UK to other countries dispenses with the myth that only a fully socialised healthcare model, with all health providers working for the state, can work. that’s simply untrue. So what’s the next reason that we simply must have socialised healthcare in the UK to prevent the poor from dying on the street?

It’s The Cost, Stupid!

As the World Health Organisation (WHO) states in its 2000 reportHealth care expenditures have risen from 3% of world GDP in 1948 to 7.9% in 1997. This dramatic increase in spending worldwide has prompted societies everywhere to look for health financing arrangements which ensure that people are not denied access to care because they cannot afford it.

Advocates of socialised healthcare, such as the NHS model, often argue that we individuals couldn’t afford the high cost of healthcare without the state providing it for free at the point of demand. This is patently wrong, as the Netherlands and many other countries demonstrate. The simple exposure of this ad ignorantiam fallacy is to ask the question “so where does the money currently come from?” From us all, of course! The NHS currently costs the UK economy just over £102Bn per annum, or around £1,600 per capita; whilst this is lower than most other countries it is still affordable when you consider that a full-time employee on National Minimum Wage incurs £1,641 in National Insurances and Income Tax in a year. The average working UK taxpayer pays over £4,000 per year in income tax alone (without employees’ and employers’ national insurances or other consumption-based taxes).

Conclusion

No libertarian that I know wants “the poor to die in the street” through lack of healthcare, but we do believe that there are better systems for healthcare provision for us all. We believe that if the state wasn’t taxing us all more than 44% of our income then the vast majority of us would be able to afford better healthcare than we currently receive. The genuinely poorest in society (as opposed to the majority who are unintentionally poor due to the state’s distortion of the economy) could be provided for by voluntary contributions or a significantly smaller tax burden.

I realise that this article will almost certainly be taken out of context by those with political motive to do so, especially with the provocative title I’ve given it. However, we libertarians must never be afraid to fight for what we believe in. The liars who deliberately obfuscate our position must not be allowed to do so, they must be challenged with facts. These facts are:

  • The NHS is not the best healthcare system in the world, it’s not even close;
  • The US is not the only system to compare it to, there are 200+ countries in the world to choose from;
  • If you want a socialised healthcare system there are much better than the UK’s NHS;
  • Funding of healthcare does not need to come solely from the government’s tax take, there are better models;
  • Libertarians want better healthcare for everyone, especially the poor who suffer disproportionately under our system.

So the next time you are challenged that you “want the poor to die in the street” as you do not support socialised healthcare, point out the facts above, correcting your accuser that it must be what they want, not you.

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No Longer The Land Of The Free

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“We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.–That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed, –That whenever any Form of Government becomes destructive of these ends, it is the Right of the People to alter or to abolish it, and to institute new Government, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their Safety and Happiness.”

– The Declaration of Independence, dated 4th July 1776, signed 2nd August 1776.

Today, July the 4th, is (wrongly) recognised as the anniversary of the Declaration of Independence. This is a momentous day for many Americans as it signals the beginning of their ancestors’ fight to free themselves from the tyranny of British rule: it led to the US Constitution and the Bill of Rights, both important for many admirers of the limited state. I think after 237th years it’s worth reviewing just how well this legal governance framework this has worked out for Americans.

Following my recent defence of the European Convention on Human Rights several libertarians rightly criticised the framework as it only forces the signatory state to grant rights to the individual, whereas the US Constitution declares rights that the government cannot abrogate. For a libertarian this is a significant difference: it declares that the individual is fundamental and the state only has limited powers seceded to it, selected powers that the people allow, and no more. I’m no constitutional lawyer but this instinctively sounds like a good approach. In theory this should limit the power and scope of government to the ‘night-watchman’ state that minarchists prefer. But how does that work in practice?

In reality the US Constitution doesn’t protect any individual as it only defines how the government should work, it is the Amendments to the Constitution that provide individual rights. The first ten amendments, proposed together in 1789 and ratified in 1791, are collectively known as The Bill Of Rights. This is the decateuch for US Constitutionalists and many libertarians, these amendments defining the fundamental limits of the state. However they’re not the only amendments, the list below illustrates some that may be of interest to libertarians:

  • The 11th Amendment protects states from being sued by ‘foreigners’. Ratified 1795.
  • The 13th amendment abolishes slavery – so the concept of ‘life, liberty original Constitution and Bill Of Rights did not extend to all people. Ratified 1865.
  • The 15th amendment stops states from denying suffrage due to race, colour or previous inservitude. But not for gender. Ratified 1870.
  • The 16th amendment allows the federal government to collect income tax. Ratified 1913.
  • The 18th amendment prohibits manufacture, distribution or sale of alcohol. Ratified 1919.
  • The 19th amendment extends suffrage to women, finally. Ratified 1920.
  • The 26th amendment extends suffrage to 18-year olds. Ratified 1971.

In 1870 Lysander Spooner wrote a pamphlet The Constitution of no Authority in which he disputed the social contract view of the constitution and argued that it was unable to stop many abuses against liberty or to prevent tyranny. After 237 years it is interesting to see the outcome of this experiment in limiting government.

First, an appropriate anecdote. In 2001 I was in Colorado on business and had been invited to a colleague’s house for dinner with his family. I dropped by the local supermarket, Safeway, to pick up a bottle of wine as a gift to my colleague for his kindness. I searched the aisle that had beer and wine coolers but couldn’t find any wine. I eventually asked the only member of staff in sight, at the pharmacy desk, where the wine was stacked. I was shocked when she said that in their state they cannot sell ‘liquor’ in a supermarket. I asked where I could buy wine, she responded: “the liquor store, next door”. this is just one example of the many weird infringements that Americans accept whilst still believing they live in the ‘land of the free’.

Some other examples of stupidity include:

While these are examples of stupid laws that may concern few people, there are greater evils enacted by the US Government that should worry everyone. Three such examples are Ruby Ridge, Waco and the Kent State shootings.

If you are not aware of these events then here’s a synopsis:

There were many student protests from 1968 onwards, mostly over the Vietnam war. In May 1970 at Kent State University in Ohio the National Guard opened fire on peaceful, unarmed protesters. The guardsmen fired 67 rounds over a period of 13 seconds, killing four students and wounding nine others. Other protests in that period that resulted in fatalities at the hands of police include the Orangeburg massacre and the Jackson State killings. At another University protesting students were bayoneted.

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John Filo’s iconic Pulitzer Prize-winning photograph of 14-year-old Mary Ann Vecchio kneeling in anguish over the body of Jeffrey Miller

In 1992 at Ruby Ridge in Idaho the United States Marshall Service (USMS) attacked a family on their property killing the 14-year son and starting a siege. The next day Randy Weaver attempted to visit his son’s body kept in an outhouse and a sniper attempted to execute him on sight, shooting him in his back. Randy ran back to his house, badly injured, and the sniper shot again, firing through the front door blowing Vicki Weaver’s face off and killing her while she stood holding her 10-month old baby. Although the sniper was charged with manslaughter (!) the case was dismissed.

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Vicki Weaver as seen from a USMS surveillance position on 21 August 1992, the day before her assassination

In 1993 at Waco in Texas the Bureau of Alcohol, Tobacco and Firearms attacked the property of a religious sect and were met with armed resistance; four ATF agents were killed. Following a very public 51-day siege the FBI attacked the compound using military type vehicles (including two Abrams tanks) resulting in 76 deaths including 21 children (24 of the Branch Davidians were British).

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Mount Carmel Center, home of the Branch Davidians, in flames on April 19th 1993 following FBI assault with military weaponry. 76 civilians died in the assault including 21 children.

These are just a few examples of what a Government that has no limits will do to its citizens: sadly the Constitution has failed. While each event described above drew criticism and enquiries, no state official was successfully prosecuted for their actions, though in both Waco and Ruby Ridge some of the citizens targeted were subsequently imprisoned. This is the state in action – protecting its own employees, even when clear wrong-doing has happened, and prosecuting its critics (we see this frequently in the UK with the deaths of Ian Tomlinson and Jean Charles de Menezes as recent examples). One only has to review the list of the White House Horrors during Nixon’s tenure, especially the Huston Plan (including illegal surveillance of, and detention camps for, student protestors), to realise what contempt the state apparatus has for its citizenry.

So on this anniversary let us rightly celebrate the Declaration of Independence, regarded as a great step forward for the people of North America, but let’s not forget it led to the well-intentioned Constitution which has in every measurable way failed to protect the rights of its citizens. The US Government is a ‘democratic’ dictatorship run by authoritarians from one of two ruling parties, who bleat about freedom at the ballot box, but shred individual rights when elected by the feeble-minded and hoodwinked. The US citizen should remember there is “the Right of the People to alter or to abolish” a despotic government; they alone amongst the people of the world have a legal and defined precedent to do this in their Declaration of Independence: it enables them to legally overthrow their shackles. They should peacefully and legally invoke the Declaration’s intent and petition for the winding up of the existing government structure.

I’ll leave you with a thought from Lysander Spooner:

“As long as mankind continue to pay “National Debts,” so-called,—that is, so long as they are such dupes and cowards as to pay for being cheated, plundered, enslaved, and murdered,—so long there will be enough to lend the money for those purposes; and with that money a plenty of tools, called soldiers, can be hired to keep them in subjection.”