Solutions, not just complaints

I am critical of both the current situation in health care, and of the nationalized plans offered to "solve" it. In the spirit of bringing solutions instead of just complaints, I'll offer three things in one post: freedom (and responsibility) to take care of yourself without having to seek permission from a Craft Guild, private action to help the poor, and mutual aid for the working and middle classes to help themselves. I think the correct solution mix requires a truly free market in medical services and goods - not the mixed market we have now - coupled with creative solutions to pool risk and to support the poor through private action.

First, Reason editor Kerry Howley found that he was able to survive in Myanmar's dangerous wilds, where a patient could freely roam the halls of a pharmacy without a prescription, and actually get needed drugs without first genuflecting at the MD altar (and in Myanmar, that's almost the only thing you can do freely). Dangerous? Well, maybe, but not being able to get needed drugs because you can't afford the gatekeeper is dangerous, too (via MarginalRevolution, where Alex discusses risk). As David Friedman points, medical licensing and drug prescription laws may raise the quality of the average doctor, but it lowers the quality of medical care delivered because 0 (the amount received by people who can't afford cartel prices) always lowers the average.

Second, retired teacher Jean Ann Lynch was featured on yesterday's Morning Edition, where they reported on her Baby Basics charity. Baby Basics provides diapers to the working poor, helping to break a cycle of strained budgets, rash-plagued babies, stressed mothers, and (in some cases) abused babies. I guess I'm a little surprised that they aren't promoting cloth diapers, but I am always mindful of a theory of mine that a poor mother's time is relatively more valuable to her and her family than the time of a wealthier mother (why? Possibly because she has so little that she can afford not to rent out and possibly because she cannot afford substitutes ... it's still a work in progress). Despite the billions of dollars spent on these programs at all levels, this is a simply solution that is being addressed privately, perhaps because private solutions and actors are more observant, nimble, and motivated than faceless bureaucrats.

Finally, David Beito's From Mutual Aid to the Welfare State: Fraternal Societies and Social Services, 1890-1967 is one of my new favorite books. I haven't gotten around to reading it a second time, yet, but it describes a feature of American life that is so disregarded that it is almost unknown. At one time, some 50% of the population of many cities, especially immigrants, the working poor, and minorities, belonged to mutual aid societies, where a small fraction of their income (relative to both then and today) was used to purchase life insurance, preventive medical care, hospitalization, sick relief (temporary wage replacement for people too sick to work), old-age support, survivor benefits, and even burial services. The aid they received was not charity, but rather service received for fees paid; the dominant paradigm was self-sufficiency. Frequently, services were rendered to people who were unable to pay after review by the benefits committee, but cheating was effectively thwarted. The societies built strong community ties that government programs do not. Eventually, laws intended to stifle mutual aid societies' competition had their effect, the AMA squashed the "lodge work evil", and "free" government services crowded out the societies, abandoning "self-sufficiency" for "self-actualization". That self-actualization principle spawned the situation described in Alex Kotlowitz' excellent There Are no Children Here, in which he documents the lives of the youngest of three generations of a family living in a public housing project in Chicago with no clear path out.

Bastiat said it best (from The Law, 1850):

Socialism, like the ancient ideas from which it springs, confuses the distinction between government and society. As a result of this, every time we object to a thing being done by government, the socialists conclude that we object to its being done at all.

We disapprove of state education. Then the socialists say that we are opposed to any education. We object to a state religion. Then the socialists say that we want no religion at all. We object to a state-enforced equality. Then they say that we are against equality. And so on, and so on. It is as if the socialists were to accuse us of not wanting persons to eat because we do not want the state to raise grain.

I want people to have better health care. I don't think the government is the only, and certainly not the best, means for achieving that end. People should be able to get the drugs and services they need and consult with doctors if they want or need to, but they shouldn't have to consult with them if they don't want or need to. A safety net is a good thing to have, but universal healthcare in which everyone pays for everyone else regardless of their ability to support themselves is not a safety net. Private solutions offer a number of advantages that government services do not and never will offer; government solutions offer only one "advantage" that private solutions don't: a bigger budget.