Will the Real Conservatives Please Stand Up?

In his column a few weeks ago, Paul Krugman lists what he sees as the three categories of people who are opposed to health care reform: (1) the "crazy right," i.e. "the tea party and death panel people," (2) the "fiscal scolds" whose greatest concern is the deficit and national debt, and (3) the progressive left, whose dreams of a single-payer system, or at least a public option, have been killed. His response to each of the three groups is effectively (1) it isn't worth responding to lunatics, (2) the bill if anything will reduce the deficit, and (3) yes the progressive left didn't achieve all its goals, but it got something, and that's at least a step in the right direction.

But Professor Krugman is leaving out an important group—an group that has real objections to health care reform that deserve to be taken seriously and whose views merit a serious response. The people to whom I refer are the true libertarians who view all government programs with suspicion, and who believe that we should return to a pre-1937 state of affairs.



After all, there are (as I see it) three main aspects to the health care bill: (1) an effective mandate for individuals to buy insurance, (2) expansion of Medicaid, and (3) strict regulation of insurance companies. All three do involve a substantial government interference with private affairs. The first imposes a coercive tax, the second expands publicly funded social welfare, and the third ties the hands of a private profit-seeking industry. It is certainly not incoherent to believe that such measures are inappropriate for government, and that market-based and private solutions could provide solutions to our health care problems that would be more efficient than government and less intrusive than government, and that such solutions would ultimately result in both greater prosperity and greater liberty for all Americans.

The standard argument against this political position is that private and market solutions to these problems have not yet surfaced and therefore we'd be foolishly optimistic to believe that they will surface if we simply leave health insurance and care as it is. The rejoinder to this argument is that private institutions in this country are simply atrophied—they've never had a chance to show their full potential, because since the 1930s, every time this country has faced a social problem it has turned to the federal government for a centralized solution. As the federal government has in most cases obliged, private institutions have never had a chance to really flex their muscles and do the heavy lifting.

I think that to defend the health care legislation against these critics, one has the burden of presenting a real counterargument that is less dismissive than Krugman's.

(1) First, one might argue that the genie is simply out of the bottle. At this point, our governmental structure has too much inertia for us to return to a pre-1937 state of affairs. However, this is not so much an argument as an observation. A return to the pre–New Deal country would require a huge upheaval in our social structure and would cause severe problems for many people—particularly the most disadvantaged in society—but it is not entirely inconceivable.

(2) Second, I would argue that health care is not a "market" sort of problem. The market works well for most commodities. The market finds a price above supply outstrips demand, and below which demand outstrips supply. This market system entails that above some price, consumers will stop buying. Insurance companies are profit-seeking private entities. They are required by law to maximize the returns for their shareholders. Thus, the price of insurance is set where it is most profitable for the company—at an equilibrium where the ideally efficient number poor people cannot afford it. Thus, for the people who need health care the most to have access to it, we need a non-market solution.

(3) Finally, what is the libertarian proposal? One in six Americans have no health insurance. Should we ignore these people? If not, how shall we account for their needs? What sort of private entities can fill the gap where libertarians do not want government? I'd be interested to hear the proposal.