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Health Care Reform and the Libertarian Impulse

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""freedom for the moderns 'is but' the peaceful enjoyment of private independence." Benjamin Constant (1819)

President Obama's supporters have failed to address the theme of health reform protests, namely, that the country's strong libertarian preference rejects the federal government serving as a provider of health services, including health insurance.

These protestors maintain that government bureaucracy stifles personal freedom, is unsympathetic to patients, and, ultimately, will ration patient health care (or, worse, morph into perverse, so-called 'death-panels'). Government bureaucracy is neither personal nor corporately-owned, and, unlike private health institutions, does not concern itself with patients' welfare. Most patients, the argument continues, would prefer to be treated by their privately-retained doctor, than one provided for by a federally-administered insurance agency. That is, patients do not want health services administered like the post office, which is characterized by long queues and unaccountable or rationed service.

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However, such claims seem rather partial. Health reform opponents fail to acknowledge the federal government's substantial public health accomplishments. For example, Medicare for the elderly and the US Veterans Administration programs have both successfully achieved their goals -- so much so, indeed, that their beneficiaries are increasingly concerned that health reform might damage these programs. It is also unclear how many of the current town-hall protests have, in fact, been sponsored by the health insurance industry itself, which, according to the Insurance Industry Institute in 2006, was worth $73 billion.

Unfortunately, health care, by definition, does not fit neatly into a business-market model. Medical care is a pre-condition of personal freedom, because an individual has no freedom if he or she cannot obtain the treatment necessary to survive illness. Medical treatment, like food and shelter, is a necessity of life, which an individual cannot simply choose to do without. Libertarians on the left for example, maintain that society must be structured to guarantee basic resources so that an individual may do what he or she wants with life, and thereby attain the personal freedom that libertarians require.

As another example, many left libertarians are less concerned with the structure than with the actual provision of medical care itself. Thus, if an individual is denied privately-owned health insurance because of a prior illness, or a job change, this threatens his or her personal freedom as much as a does a public bureaucracy that rations the amount of medical care (e.g. by 'pulling-the-plug on grandma', as it were).

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The US Census Bureau (2008) has reported that there are now nearly 46 million Americans who lack health insurance. These uninsured patients face severe restrictions on their personal freedom, and indeed on their very chances of survival, because of their inability to purchase expensive medical treatment. The United States stands alone amongst industrialized democracies by virtue of the fact that it permits a major segment of its population to go without even rationed forms of medical treatment.

Most democracies, such as those that comprise the European Union, or Canada with its single-payer system (much derided in the United States), consider medical care as a fundamental human right, irrespective of whether it is provided by a public bureaucracy, or a privately-owned business, or some mixture of these approaches. The Gallup Poll organization reported (2006) that more than half of the residents of Canada (52%) and the United Kingdom (55%) describe their respective healthcare systems as "excellent" or "good".

Additionally, one of the world's leading human rights treaties, the International Covenant on Economic, Social, and Cultural Rights, recognizes medical care as a fundamental human right. Only three countries in the world have signed but refused to ratify this treaty -- these being the United States, Liberia and Cambodia. The US refusal is, however, a story for another article.

Libertarianism as a political philosophy exists in either a socialist or capitalist context; and, as already discussed, libertarians can be either of a left or of a right-wing, anti-statist kind, but will all embrace structures that increases personal freedom. The right-wing libertarian maintains that the only way to preserve quality medical treatment is to maintain a profit-oriented, business-operated, private health care delivery model. However, the current private-business health care model manages to deny health insurance to nearly 46 million Americans. Personal freedom, the first-principle of libertarian philosophy, is denied to these patients.

President Obama has crafted a compromise between these competing versions, proposing a Medicare-like public option, but also maintaining existing private health insurance plans. This accomplishes the twin objectives of maintaining the private character of health insurance and, with it, high quality medical treatment, whilst also guaranteeing personal freedom by making certain that no one goes without medical care.

It has taken nearly a century for Congress to decide whether to provide health insurance coverage for all Americans. We can only hope that libertarians, and people of all other political philosophies, will agree to a solution that permits even the poorest and most ill patient to visit a good doctor.

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Dr. William K. Barth's book is entitled, On Cultural Rights: The Equality of Nations and the Minority Legal Tradition (Boston, Martinus Nijhoff Publishers, 2008). He received his doctorate from the Univeristy of Oxford.

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