So, there's a lot of talk about Universal Health Care these days. Unfortunately, while the idealization of everyone having a good doctor or prescription medicine available any time they need one, free of charge, receives a lot of hot-airtime, the reality of exactly how putting the government in charge of managing medicine suddenly makes doctors and medicines cost less doesn't get so much discussion. More importantly, I don't see anyone talking about why "health care" should be universal instead of, say, food staples or tickets to Disneyland, for that matter. Through redistribution, the government can make any subset of goods and services "universal", i.e., provide them free of charge. Roads are one example of a good that the government universalizes, that is, provides largely free of charge to everyone for good or ill.
So, a lot of people feel that roads, doctors and medicines should be universally available. Everyone understands that not everything can be universalized. Communism has been tried seven ways from Sunday and it just doesn't work, for what should be obvious reasons. But on whatbasis do we conclude that roads, but not farmland, should be universally available? On what basis do we conclude that doctors and medicines, but not food, should be universally available? After all, if we're creating a better world, it would make sense to check to see if our programs can be expected to have any chance of improving the world.
Everyone knows that there is no such thing as a free lunch. If the government provides this or that good or service for free, then that good or service is being paid for from somewhere else in the economy. That is, "free" health care is paid for, to at least an equal extent, by other things being more expensive. By lowering the price of one thing to zero, the costs of other things must go up*.
So, if we're going to make all other things in the economy more costly to universalize something, it makes sense that we choose only the most important things to be universalized in terms of cost/benefit so that we ensure that we get the most benefit (in terms of improvement of the human condition) for every dollar spent. This should not be misconstrued as a validation of the state's redistributionist behavior. I am coming from the point of view of damage control, if the state is going to wreak havoc upon us, then we ought to at least ask it to wreak havoc in the least damaging way possible. The Copenhagen Consensus produces a list of global problems that is ranked according to cost versus benefit and the most recent list places vitamin supplements at the top of the list. The question is how many lives (around the world, not just the US ( human life in Zimbabwe is not worth less than human life in the US) can be saved for a dollar spent on vitamin supplements versus a dollar on doctors and prescription drugs? If more lives can be saved from spending the dollar on vitamin supplements, then we ought to desire the state to universalize vitamin supplements more than we desire the state to universalize doctors and prescription drugs.
Granted, the problems facing the US may not be exactly the same as those facing the whole world. Nevertheless, the issue I wanted to highlight is the complete failure of anyone in the Universal Healthcare debate to even address the issue of costs and benefits. It's not enough to say that the healthcare system would be better under UHC than under the current system. Even if you establish that, you have not succeeded in establishing that the same money that goes to UHC wouldn't be better spent on vitamins in Zimbabwe or mosquito nets in Angola. Assuming the goal is to improve, as effectively as possible, the state of humanity, then we have to stop thinking in such narrow confines and try to take in the whole problem. Most importantly, we need to get the debates out of the hyper-emotionalized rhetoric of partisan politics and tackle them in a rational manner.
*Some people object that, as a believer in the free market who touts the positive-sum nature of the free market, I should be able to see that the government's actions could be positive-sum. But the reason the free market is positive-sum is exactly because it is free... all parties to an exchange believe they will be better off (and almost always really are) as a result of exchanging, otherwise, they would not do it. However, state redistribution always entails coercion of at least one party to the redistributive transaction, otherwise, there would be no need to involve the state (force). There are other forms of voluntary zero-sum (in monetary accounting terms) redistribution, for example, life insurance, charity and gambling. But, by virtue of being voluntary, these forms of redistribution are not merely zero-sum (in terms of subjective utility) since each willing participant reveals by his voluntary exchange that he is better off than he would have been had he not made the exchange. The need of involving the state (force) implies that at least one participant is being made worse off and, in money accounting terms, we know that he is made worse off by a significantly greater degree than other participants are made better off.