As the health care debate rages, many conservatives have correctly argued that government-run “universal care” will lead to medical rationing. To control costs, the socialized health systems of Canada and Great Britain routinely restrict patients’ access to expensive services. A Canadian with a possible brain tumor might wait months for his government-approved MRI scan, whereas an American can receive one within days.
Liberals will typically counter that a free market is just “another form of rationing” — but by price rather than government decree. It is unjust, they say, that patients with money (or good insurance) can receive MRI scans whereas those without money cannot. Hence, they contend, the government must intervene to guarantee a supposedly fair distribution of medical services.
Too often, conservatives then concede this moral high ground to the liberals and defend the free market on purely economic grounds — e.g., a free market would lower costs for everyone. This is a serious mistake. Supporters of the free market should not allow opponents to characterize the marketplace as a form of rationing, let alone an unjust one. Instead, supporters should defend the free market as morally just because it respects individual rights.
To do so, one must properly define “rationing.” As the writer Ayn Rand noted:
“Rationing” has a specific meaning of its own. It means: to distribute in a certain particular manner — by the decision of an absolute authority, with the recipients having no choice whatever about what they receive; it also means that all the recipients involved have an equal claim to that which is being rationed, and are entitled to an equal share.
Examples include sugar rationing during World War II and gasoline rationing during the 1973 oil crisis, when the government dictated the terms and conditions of sugar or gasoline sales.
But in a free society, the government should not be regulating such sales at all. Producers — not the government — created the sugar (or gasoline) in the first place. Hence, they have the moral right to sell it to willing consumers on any mutually acceptable terms. There is no “just” distribution of sugar or gasoline apart from the voluntary exchanges between producers and consumers in a free market.
The same principle applies to health care. Health care does not magically grow on trees. Instead, it is a service that must be created by hard work and rational thought. The producers thus have the moral right to sell it to willing consumers on any mutually acceptable terms. There is no “just” distribution of medical services apart from the voluntary exchanges between producers and consumers in a free market.
Hence, if Bill makes more money than Joe and can purchase a $500 MRI scan that Joe can’t, then Bill deserves it. That’s not rationing, that’s justice — just as it’s not rationing if Bill can afford a house while Joe must live in an apartment, or if Bill can afford steak whereas Joe eats hamburgers.
In contrast, government programs that attempt to guarantee “universal health care” are unjust. There is no automatic “right” to goods or services that must be produced by another — that would be state-sanctioned theft or slavery.
Individuals are entitled to health care that they purchase themselves, is owed to them by contract (e.g., insurance), or is given to them as voluntary charity.
Whenever government attempts to guarantee an alleged “right” to health care, it must also control it. Bureaucrats and politicians must ultimately decide who gets what health care and when, not doctors and patients — if only to control costs. This is true rationing, and it necessarily violates the actual rights of the practitioners forced to provide care on the government’s terms (rather than their own) and the taxpayers forced to pay for it.
The free market is therefore the antithesis of rationing. It respects individual rights, whereas rationing unjustly violates individual rights — a crucial moral distinction.
If liberals are genuinely concerned about making health care more affordable, they should support free market reforms. Although the current American system is not a free market (but rather a mixed system), it is the least-regulated sectors of medicine — such as LASIK eye surgery — that follow the typical free-market pattern of falling prices and rising quality that we take for granted with computers and cell phones. This can and should be the norm in all of health care.
So when someone argues that a free market in health care would be just “another form of rationing,” challenge that claim. You won’t merely be debating semantics. You will be defending justice and individual rights. You will be helping to lower costs. And if someday you need an MRI scan in six days rather than six months, you may even be saving your own life.