Health care: privilege or right?

When John Locke and Thomas Jefferson wrote that human beings possess God-given rights, including the right to life, and when they said that governments exist to protect those rights, they were not suggesting that governments ought to provide every citizen with food, clothing, shelter, health care, and all the other things needed to sustain and prolong their lives. Instead, they were saying that governments should deprive no one of life without due process; furthermore, that governments are obliged to protect the lives of citizens from dangers posed by foreign attackers and domestic criminals.

Locke and Jefferson envisioned a world in which people provided food, clothing, shelter, and other necessities of life for themselves and their dependents through their individual wealth and through wages for their labor. Individuals facing extreme need found help from extended family, neighbors, worship communities, and charitable organizations. Ebenezer Scrooge might sneer that workhouses and prisons sufficed to meet the needs of the poor, but in many cases compassion and charity filled the gaps where hard work and diligence did not suffice. Had God’s Law been obeyed by all the Israelites, there would have been no poverty in Israel. In his Judgment Day parable, Jesus commended those who have the hungry something to eat and gave the thirsty something to drink; he said nothing about lobbying the government to provide resources for those who are hungry, thirsty, naked, homeless, and ill.

In the “good old days,” doctors made house calls. Sometimes they accepted vegetables or baked goods as payment for their services; sometimes they waived payment out of the kindness of their hearts. But in those “good old days,” doctors did not remove cataracts, provide knee and hip replacements, or use CAT scans to diagnose problems. Health care and medicine have come a long way since the “good old days,” which is why they are so expensive. People expect more from their doctors, hospitals, pharmacies, and therapy centers than ever before. Every year, research and development provide new benefits to conquer disease and to prolong life and health. Some research and development is funded by government grants, and some raises money through donations, but much is done by for-profit companies. They have the combined goals of making life better for all people and offering a return on the investment of their sponsors.

Health insurance was invented as a way to spread the cost of health care move evenly over time and throughout the population. Buyers of insurance gamble that they are going to get sick and need expensive care; providers of insurance gamble that most people are not going to get sick and need expensive care. Insurance is necessarily inflationary—an insurance company must pay workers, maintain offices, and return a profit to their investors, while still keeping their promises to pay the medical expenses of their customers. A complicated system of fees, deductibles, negotiated settlements, and other financial arrangements has developed out of these needs. Otto von Bismarck of Germany was one of the first government leaders to ask employers to contribute to the health insurance of their workers. Today a person struggling to pay medical bills may also be benefiting from the health care industry through investments that are adding to that same person’s retirement fund. Life is complicated that way.

In the free market, health care and health insurance may not always be fair. People with more money can afford more helpful health insurance, while those with less money have insurance that does less for them. Wealthy people can afford care that is unavailable to others. Within the free market, governments intervene to make sure that essential care is available to all. Doctors, hospitals, and clinics cannot deny certain kinds of care to people in need, even when those people cannot afford to pay. Defining “essential care” is a challenge faced by members of the government, who must negotiate with each other to write a law that meets that need.

Under pure socialism, the government would gain control of all hospitals, clinics, pharmacies, medical offices, rehabilitation centers, and therapy providers. The government would pay the salaries of all health care workers as well as all other costs of maintaining these facilities. Citizens could receive health care at no cost; although, to reduce the burden on taxpayers, the government might require fees for certain services that are not defined as “essential care.”

The Affordable Health Care Act of 2010 (known as Obamacare) stopped far short of socializing all health care in the United States. Much of the legislation in that package focused its attention on health insurance rather than on reducing the cost of health care. More innovation in the latter regard might solve some of the current problems in American health care without threatening greater government control or a trend toward socialism.

Education of health care workers is expensive. Many professional health care workers begin their careers with enormous debts. Government loans that are part of that debt could be reduced or forgiven when these professionals participate in health care benefits to the poor and deprived—providing health care through urban centers for the poor, homeless shelters, and the like. Medical facilities and equipment are also expensive. Government grants could make them available in low-income communities at less cost than it takes to promise free health care to all the poor in those communities. Research and development need to continue in the health care industry. Government grants and charitable organizations contribute to the costs of research and development, but private funding with a hope for a profitable return should never be excluded from the equation.

The world contains sufficient food that no one should be hungry. Food is not distributed fairly. Inviting the government to collect all the food and distribute it evenly would be wasteful and unfair. Charitable giving, with some government participation, solves the problem far better than would total government control.

Sufficient housing exists in the United States for all the people who live here. Problems of homelessness are complicated by mental illness, addictions, personal choice (in a few cases), and other factors. Forcing every American to live in government-provided housing would be wasteful and unfair. The free market—with some charitable help and some government participation—solves the problem far better than would total government control.

Health care can be provided for all Americans. Putting the government in control of all health care—or even in control of all health insurance—would be wasteful and unfair. People need to be allowed to choose among various options regarding both health care and health insurance. Charitable help, with some government participation (such as Medicare) solves the problem far better than would total government control.

Protecting each citizen’s right to life is not the same as meeting each citizen’s needs in every way. The free market always innovates and creates better answers than would total government control. Through further study, negotiation, and compromise, more help can be found for the needy. Socialism does not offer answer that would improve upon the current system. J.

Regulation

In a free market economy, governments regulate certain aspects of the economy for the good of consumers, of workers, and even of business owners. Although the motto of pure capitalism is laissez-faire—“leave it alone!”—even Adam Smith (the foremost proponent of capitalism) recognized that government regulation was needed for capitalism to succeed among imperfect people.

How do governments acquire the authority to regulate the economy—or, for that matter, to make any laws telling people how to live their lives? The many theories about government and the source of its authority can be sorted into three general categories: strong people seize authority and use their strength to tell others what to do, people give authority to the government to ensure safe and productive lives, or governmental authority comes from God and is given by God to those who rule.

These three theories can be combined. For example, some might believe that strong people seize authority and become rulers (“caudillos”) but that people allow that to happen and have the power to prevent a strong leader from arising or to transfer power from one strong leader to another. Likewise, some people (this author included) agree that government authority comes from God (as described in Romans 13:1-7) but that it is bestowed through the people; therefore, the people have a God-given right to overthrow one government and replace it with another when the first government is no longer using divine authority in a God-pleasing manner.

Under some theories, government must be strong so it can accomplish its purposes. Under other theories, government should be limited by the people so it does not rob them of their rights. One approach says that some problems are too big to be handled by anyone other than the government; another approach says that too much government is the biggest problem. Thomas Hobbes described government as a necessary evil, a monster that must be fed and maintained, but that also must be watched constantly and controlled to keep the monster from causing too much trouble and destruction.

So, governments make rules on behalf of their citizens. They inspect food and other products to be sure that they are safe and uncontaminated. They ensure that workplaces are safe and that workers are being treated fairly. They prohibit monopolies, trusts, and cartels, breaking apart businesses that otherwise could take advantage of customers and workers. They protect the air and land and water from pollution. They zone some areas for industry, some for sales, some for homes and neighborhoods, and some for parks and natural preserves.

All these regulations are part of the social contract, an agreement between the people and the government. The government claims strips of land from landowners, develops them as roads, demands that travelers move from place to place only on those roads, restricts the speed and other behavior of travelers (fining lawbreakers when they are caught), and charges for the use of the roads with taxes, licenses, and tolls. Most citizens accept the government’s right to do these things because we need roads; many kinds of trouble would follow if each citizen traveled from place to place as he or she wished, without government roads and without traffic laws.

Within that social contract, disagreements arise and compromises much be reached about the level of government regulation and the details of that regulation. Which pollution standards are beneficial, and which are excessive? Excessive regulations are costly to businesses and consumers. They can rob the economy of jobs and businesses. Yet insufficient regulation leaves people in danger of being poisoned by pollution. Likewise, minimum wage laws are controversial. Some people insist they are needed to reduce or prevent poverty; others say they increase poverty by raising prices and by persuading businesses to hire fewer workers, replacing them with affordable machines. Lawmakers must consider all sides of such a debate. They must decide for themselves which regulations help the people and which are excessive. They must vote according to those decisions, and they must explain their votes to the voters who will decide if those lawmakers keep their jobs or will be replaced.

Some regulation is needed. Some regulation is beneficial. When the government assumes the job of controlling the economy, the people suffer. When the government uses its power to make decisions that are better made by the business owners, the people suffer. A free market, regulated but not controlled by governmental laws, historically works better than a socialist system in which the government manages the economy. J.

Freedom, government encroachment, and compromise

The range of options between pure socialism and pure capitalism is a spectrum which includes free market capitalism and the welfare state. Sometimes advocates of capitalism accuse their opponents of promoting socialism when those opponents only want more restrictions for the benefit of workers and consumers without desiring socialism. Sometimes people even call for socialism without realizing that what they truly want is not socialism but merely a more comprehensive welfare state. Labels can be slippery tools in our hands, especially when we exist on a spectrum of options.

One of the clearest guides to distinguishing capitalism and socialism is intent. Those who want a few more regulations to protect workers and consumers are still working within the free market system. Those who want to spread the wealth—to take money away from the rich and give it to the working classes, or to give away for free what was formerly bought or earned—by taxing and penalizing wealth are clearly working for socialism and against capitalism.

Here is one example I have seen online: imagine a society where the wealthiest people are earning $50,000 a year and the poor are earning only $25,000 a year. Imagine a change that brings the wealthiest people up to $100,000 a year and lifts the poor to $50,000 a year. Someone inclined to support capitalism will rejoice that all the people in the society have seen improvement. Someone inclined to socialism will complain that the disparity—the difference between the wealthy and the poor—has doubled because of the change, and that disparity is not fair.

Kurt Vonnegut, in one of his novels, imagined a society that tried, by law, to make life fair for everyone. People stronger than average were forced to carry weights. People smarter than average were forced to wear earpieces that distracted them with random noises. People more attractive than average were forced to wear clothes and makeup that made them ugly. Such efforts to make us more equal in every way clearly cause more harm than good. Bringing the higher-level people down to average does not necessarily help lift the lower-level people up to average. In fact, every attempt to reduce the wealth of the richest people through taxes and other legislation only causes them to move their wealth away from the places where it is vulnerable. It discourages them from making more wealth by selling improved products, hiring more workers, and performing other tasks that increase the wealth of the rich and also add benefits to the working classes and the poor.

Government’s job is to protect the rights of all people and to defend citizens from those who would harm them. A right to life includes protection from invasion and from crime; reasonable people still differ and debate whether that right to life also includes guaranteed food, clothing, and shelter for all citizens. In a democracy, the government is chosen by the people to do the will of the people; however, doing the will of the people means more than following and obeying the latest opinion polls. Those elected to govern are expected to learn and understand what is best for the people. Elected officials and their appointed staffs consider proposals, research them, and ultimately vote whether to enact them. Opinion polls might show that more than half the population wants college to be free for all students. Elected officials must still study and learn whether free college would be a benefit to most citizens or whether the cost of free college, assumed by the government, would become a burden to most citizens. Those who govern balance benefits and burdens. They speak to each other about these benefits and burdens. Their votes represent, not only the opinions of the people they represent, but also the best interests of those they represent. As a result, their votes often disagree with the opinions of the majority of the population.

Moreover, a representative government cannot condone injustice, even if the majority wants to be unfair to the minority. In protecting human rights, the government considers all the people, not most of the people. Even though the government has fallen short of it duty in the past, permitting oppression and abuse of some of its citizens, the solution is not to be unfair to a different group. (Two wrongs do not make a right.) We cannot change the past; we can only start with the current situation and move forward, seeking to make things better for all people.

Every person running for office states positions to attract like-minded voters. Different candidates have different priorities among the number of issues that matter. Elected officials work together for the common good. Each official holds some positions that cannot be compromised and others that can be compromised. Negotiation and compromise are part of the art of politics; they are necessary skills for anyone who seeks and gains elective office.

When a government gives each benefit that some citizens wants and then forces all the citizens to pay for all the benefits, that government cannot last long. The value and cost of various benefits must be considered; agreements and compromises must be reached. The more a government encroaches upon the freedom of its citizens—even with the encouragement of many or most of those citizens—the more that government fails to govern wisely and successfully. Sooner or later, the government that offers too much and promises too much and charges too much will collapse. The social contract is canceled when government demands too much of its citizens, because they still retain their basic rights to life, to liberty, and to property. Government does not give these rights to people, and it cannot take them away. J.

Ethics, government, and the economy

Should a human government follow the ethical principles described by Jesus in the Sermon on the Mount? The answer, in a word, is, no.

Jesus calls his followers to love their enemies, to turn the other cheek and to go the extra mile, to forgive those who sin against them and do good to those who persecute them. But the government is established by God to protect its citizens, to punish those who do wrong, to uphold the law. Instead of forgiving the sinner, the government must punish the wrongdoer, “eye for eye and tooth for tooth,” rendering justice on behalf of all its people.

During the Baroque Era (or Enlightenment), European philosophers described human rights and said that governments exist to protect those rights. John Locke wrote about rights to life, liberty, and property. (Thomas Jefferson, writing the Declaration of Independence, would fudge the third right to “pursuit of happiness.”) Governments protect the rights of their citizens—they take life only from enemies who attack the country or from the worst of criminals who threaten the lives of others. Governments protect the liberty of their citizens, only depriving criminals of freedom, and then only for a term that fits the crime. Governments protect the property of their citizens. They may claim some property as fines for misdemeanors, other property as fees for services, other property as taxes, and still other property to provide services such as roads. In general, though, governments take no more than they must take from their citizens. When they become overbearing, when they stop respecting the rights of their citizens, the citizens are entitled to change their government, to find new leaders who will respect and protect their rights.

Philosophers spoke of a social contract between citizens and their government. Citizens agree among themselves what they want the government to do, and they use their property and their energy to help the government accomplish these goals. If citizens want public schools, they agree to pay taxes to support those schools, and they agree to send their children to those schools. For protection from foreign enemies and domestic criminals, citizens are willing to limit some of their own freedoms and property. For other services from the government, some citizens are willing to accept further limits. Among any group of citizens, a range of opinions will be found: some want the government to do more, and they are willing to pay more for those government services; others want to cede less to the government, and in return they are happy to receive fewer government services.

To some Americans (including Franklin Roosevelt and Bill Clinton), some problems are so big that only the government can address them. To other Americans (including Ronald Reagan), the government is the biggest problem and life improves when government is reduced and limited. Pure capitalism demands that the government not involve itself in the economy—capitalists say laissez-faire, leave it alone. Even Adam Smith in Wealth of Nations acknowledged that some government regulation is necessary for the good of all citizens. Under socialism, the government controls more aspects of its citizens’ lives; in return, it demands more property and restricts more freedom of those citizens. In a free market economy, the government regulates what must be regulated but leaves more freedom and more property in the hands of its citizens.

The question remains: which economic system is better for all the citizens of a nation: socialism, or a free market economy? J.

Capitalism or socialism–you make the choice

In 1980, a few Cuban citizens sought refuge in embassies, seeking to leave Cuba. After Fidel Castro announced that anyone who wished was welcome to leave, the number of emigrants swelled to more than 125,000. Cubans living in south Florida arranged boats to transport emigrants to the United States. Many of the migrants had to be housed on military bases in the United States until sponsors were found for them all—many of whom were relatives of the migrants, while others were charitable organizations offering help.

One young man from Cuba was taken in by his uncle and aunt in Miami. After a few days, he startled them at the breakfast table by announcing that he was ready to go pick up his Nikes. Further conversation clarified what he expected. The government of Cuba gave one pair of shoes to each Cuban citizen once a year. Now that he was in the United States, a much more prosperous country, this young man thought that he would receive a pair of expensive sports shoes from the government rather than the less luxurious shoes offered by his former government.

His uncle and aunt explained to him that the United States government does not pass out Nikes, or any other shoes. In the United States one works, saves one’s money, and then buys the shoes one wants and can afford. Those who want to save up for a pair of Nikes can do so; those who want to buy more affordable shoes sooner may do so. People in the United States can buy as many shoes as often as they want, provided they have the income to pay for their shoes. This is part of the difference between capitalism and socialism.

Discussion question: Which do you prefer: one free pair of shoes a year, provided by the government, or the opportunity to buy the shoes you want when you want them, provided you have the money? Explain your answer.

In the movie Moscow on the Hudson (1984), Robin Williams plays a Russian musician who defects to the United States. Shortly after his defection, the musician offers to stand in line to buy coffee for his American host family. He finds himself instead in a grocery store aisle surrounded by dozens of different brands and styles of coffee, which results in an emotional breakdown.

Discussion question: Which do you prefer: one style of coffee, chosen and distributed by the government, or the opportunity to buy the kind of coffee you want when you want it, provided you have the money? Explain your answer.

These two examples are not cherry-picked from an array of comparisons between free market capitalism and socialism. Both of them portray the real differences between life in the American free market economy and life under a socialist government. Once again, which do you prefer? J.

Why socialism?

Given its abysmal track record, why would anyone advocate socialism today?

The reasons for suggesting socialism today are much like the reasons for proposing socialism in the nineteenth century, before it had been tried and had failed. Life is unfair. Poverty and oppression are wrong. All people deserve a fair chance to rise above their situation, to have a happy life, and to perform to the best of their abilities. Because that does not happen as often as it should, socialism was once suggested as a correction for the world’s problems. Even though socialism has failed, some people today are willing to overlook those failures and give socialism another chance, because in theory socialism addresses some of the injustices that exist in the world today.

It’s not fair that a back-up infielder can earn more money in one baseball season than a third grade teacher earns spending forty-five years in the classroom teaching children.

It’s not fair that a thousand people work in a factory forty hours a week, then go home to squalor and hunger, while the owner of the factory lives in luxury without ever having worked a day in his life (because he inherited the factory from his father).

It’s not fair that these inequalities are reinforced, to a measurable extent, by gender, ancestry, language, appearance, and zip code, not to mention physical and emotional disabilities.

Socialism promises to address these injustices, to make people equal, to eradicate poverty and its accompanying problems. Socialism promises to care for the poor and needy and oppressed, to rescue them from the clutches of greedy rich and powerful capitalists, to end their oppression and to allow them to live up to the potential of their lives as human beings.

But socialism has never kept these promises.

If wealth is to be redistributed, the first question is how it is to be divided. Should each person receive an equal amount of wealth? Should those with greater needs be given more and those with fewer needs be given less? Should those who work hard and produce more benefit for others be paid more than those who contribute less? All of these answers have been proposed, but none of them ever has been accomplished.

Compare North Korea to South Korea, and judge for yourself whether socialism reduces or increases poverty and injustice. Compare Mao’s China of 1970 to Xi’s China of 2020 and judge for yourself whether socialism heightens or lowers a nation’s wealth and the average wealth of that nation’s citizens. Consider again why people fled East Germany, North Vietnam, and Cuba—was it because they wanted to live where life is less fair, or was it because they believed that life would be better (and more fair) in a free market economy?

When Jesus said, “The poor you always have with you,” he was being realistic and not defeatist. Jesus still wants his followers to care for the poor and oppressed, for widows and orphans and foreigners among us. But Jesus was quoting Deuteronomy 15:11, which says, “There will never cease to be poor in the land.” But that verse follows closely after Deuteronomy 15:4-5, which says, “But there will be no poor among you; for the Lord will bless you in the land that the Lord your God is giving you for an inheritance to possess—if only you will strictly obey the voice of the Lord your God, being careful to do all this commandment that I command you today.” Poverty exists because people—even God’s people—have not lived the lives that God wants to see people living.

The world contains more than enough food to satisfy its population; but the food is not distributed evenly. The world contains more than enough room for everyone to live comfortably; but some people are crowded into cities and living on the streets. The world contains enough resources to meet the needs of people everywhere. Thanks to science, the food supply has grown even faster than the human population. But the world is not fair. Socialism tries to force justice upon all people, redistributing the wealth for the benefit of all. Instead, socialism supports a bureaucracy of managers while increasing rather than diminishing the misery of the workers.

Socialism claims to be a better way. Free market economies have shown themselves to be the better way. History demonstrates repeatedly that free market economies benefit more people than socialism. But some people listen only to the promises of socialism and do not consider the historic record. J.

Against socialism

I know better than to check social media at bedtime. But, for some reason, I decided to look at Facebook late Saturday evening. When I saw that my sister had shared a poster favoring socialism, my ability to sleep was entirely lost. My first impulse was to reply to her that someone must have hacked her Facebook account, that she could not possibly have intended to share that post. But instead I shut off the computer, went to bed, and tossed and turned for hours, framing the response I wanted to make to her post.

Of course, what I arranged in my head during those hours far exceeded the proper length for a Facebook comment, or even for a single WordPress post. In fact, before I fell asleep, I probably had the makings of a book arranged in my mind. I have taught college history classes. I have addressed socialism as an economic theory: its origins, its beliefs, its strategies, and its results. I have read much about socialism—in fact, this month, I have been reading the philosophical writings of John Stuart Mill, a nineteenth century philosopher who favored liberalism and who addressed the idea of socialism. I am well prepared to discuss the topic, or to write a book on the topic.

But I know how my sister operates on Facebook. She sees a poster that appeals to her, and she shares it. She has not built a consistent philosophy of history or economics or any other field; she does not try to remain consistent with her posts. At one time she will share a poster calling all people to care about each other, respect differences of opinion, and try to get along. An hour later, she will share a post describing how horrible people are who do not wear masks during this virus crisis. She is not seeking to discuss or debate positions. She would not take kindly to a corrective comment.

I wish, though, that I could persuade her to consider the history of socialism. The first time socialism was attempted on a national level was during and after the Russian Revolution, when they formed a country that they called the Union of Soviet Socialist Republics (USSR). After World War II, the Soviets exported their brand of socialism to other countries. For example, Germany was divided between the Federal Republic of Germany (aka West Germany) and the German Democratic Republic (aka East Germany). The western government adopted a free market economy, like that of the United States, the United Kingdom, France, and other western nations. The eastern government adopted a socialist economy like that of the USSR. After a few years, the eastern government had to surround western Berlin with a wall to keep the German people from fleeing socialist East Germany in preference for free-market West Germany. The wall remained until the socialist government of East Germany collapsed in 1989. Two years later, the socialist government of the USSR also collapsed, ending a seventy-year experiment in socialism—an experiment that found socialism lacking in value.

The experiment was even more decisive in east Asia. Korea was (and remains) divided between North Korea (socialist) and South Korea (free market). Presently, the South Korean economy ranks roughly tenth in the world (depending upon which measurement is chosen), while North Korea comes in at 117th. In 1949, a revolution swept through China, capturing twenty-one of its twenty-two provinces. The government of the Republic of China retreated to Taiwan and maintained a free-market economy, while the Peoples’ Republic of China fostered a socialist economy. During the twentieth century, Japan, Hong Kong, and Singapore also maintained free market economies. The results were so clear that in the 1980s, the Peoples’ Republic of China turned its back on socialism and adopted free market practices. China now has the second largest economy in the world.

Vietnam was divided as Korea and Japan were divided. Because the division happened later, Vietnamese people were permitted to relocate before the border was closed in 1954. Ninety thousand Vietnamese citizens moved from south to north, into socialist North Vietnam. One million Vietnamese citizens moved from north to south, into free market South Vietnam.

In 1959, a new, socialist government was established in Cuba. Since then, a few American citizens have tried to get into Cuba. Hundreds of thousands of Cubans have tried to leave. In 1980 alone, 125,000 fled Cuba in the Mariel boatlift. At other times, Cuban citizens have risked their lives trying to get out of socialist Cuba and into the free market United States.

Numbers do not lie. Historically, socialism is a failure. Any attempt to swing the United States from a free market economy to a socialist economy is choosing failure for the United States. I have much more to say about this. In the coming days, I will. J.