Your health choked by the invisible hand of the market

Sometimes the invisible hand of the markets is all too apparent as it clutches us by the neck and strangles us slowly and painfully. If you are a typical adult American, you are likely to have at least one prescription for a drug indefinitely, either until you die or another drug is developed to replace it.

In the world of libertarian fantasy, pharmaceutical companies would compete to develop drugs we need to cure diseases that plague us. Hoping to sell us their products, they would race to develop effective and inexpensive drugs that consumers would rush to purchase. Unfortunately, those profits would be short-lived. People would buy the drugs, get well, and go about their business drug-free and non-contagious. Companies can make some money that way for sure, but it is much more lucrative to develop drugs that do not cure anyone but simply maintain their health.

This is why we have so many drugs for cholesterol, blood pressure, acid reflux, and other chronic conditions with fewer drugs aimed at eliminating disease, and even fewer aimed at curing (or even treating) diseases that affect those too poor to pay for expensive remedies. The fact that there is any treatment, even in early experimental drug trials, for Ebola is thanks to government funding of research. Left to markets alone, the diseases that kill the most people in the world would be completely ignored by drug companies.

Some diseases, such as Type II Diabetes, affect poor people, but drug companies spend quite a bit of time developing treatments for them. This, of course, is because enough people receive insurance payments from private insurance or Medicare and Medicaid to make treating them worthwhile. Almost 27 percent of Medicare beneficiaries 65 or older have diabetes, accounting for 32 percent of Medicare spending.  in 2002, Medicaid expenditures for people 20 and over with diabetes were estimated at more than $18 billion.

Of course, diabetes also affects people who are relatively affluent by global standards. In fact, it is considered a disease of babymotherdeathoverconsumption notwithstanding the fact that many who suffer from diabetes in the US are less affluent. Thus, it is extremely profitable for companies to develop products and services for diabetics in the US where their profits are underwritten by taxpayers. Diseases that primarily affect impoverished people in poor countries get much less attention.

It would seem likely that donations from individuals could fund research and development into alleviating disease. Indeed, the ALS ice bucket challenge raised more than $100 million as of this writing for research and treatment of ALS. But this again, leaves the allocation of resources to the mercy of marketing campaigns. ALS is a cruel disease, and it will only be a blessing if a cure can be found, but diseases that affect primarily impoverished individuals (e.g., malaria, antimicrobial resistance, trachoma) in the world are still waiting for a viral marketing campaign to draw attention to the millions that die from them. Market-based approaches drive money to those with the most influence.

In order to reduce the burden of diseases that affect the most people, we must provide research funds that are distributed where they will be most effective, rather than where the market funnels them. We need research centers funded by money offered with no conditions with the charge only to reduce mortality and relieve suffering. Such centers could be funded by government money or by individual contributions, but funding must come with no strings attached other than a demand for transparency from researchers as to how the money is used and what diseases are being treated. Some have offered solutions that would rely on industry to conduct research and develop products to alleviate suffering, but industry cannot be trusted with this task. Industry will always develop products to maximize profits, not minimize suffering.

The so-called “rugged individualists” in our society would argue that each person should have the healthcare he or she can afford, as income is a reliable measure of a person’s worth. Unfortunately, disease doesn’t attack people on the basis of merit. Honest and hard-working individuals can and do fall ill or become injured. Some are surprised by their turn of fortune. It is easier for a wealthy person to become poor than it is for a poor person to become wealthy, and disease and injury are great conveyors to the lower classes. Some, of course, are rich enough to be indifferent to the cost of healthcare or even long-term care. Even without working at all, these individuals will be housed, fed and treated.

People who work for their income, though, even in highly paid professions, are vulnerable to losing everything to healthcare costs. The “excellent” health insurance many people rely on is tied to employment and employment is tied to health. The unlucky ones who become ill lose both in a heartbeat. Bad luck isn’t a matter of bad choices or immorality; it is only a matter of chance. Libertarians argue, basically, that people should be responsible for the choices they’ve made in life, but libertarians also feel the government should protect people from events and circumstances out of their control. Thus, libertarians support the use of government funds to provide courts, police, and standing armies to protect the security of citizens.

The risk of disease and injury threatens us all. The question is whether we, as a society, should take responsibility for protecting all our citizens from this threat. If we don’t do this through government action, we must do it through collective action. Single-payer healthcare, such as all other developed nations have, is the most obvious solution to making citizens secure. Other solutions exist, and can be considered, but no one can prepare for catastrophe alone—collaboration is required.

We must provide funding for both medical research and healthcare. I am not asking you to provide healthcare for someone else. I am asking you to share the burden of providing healthcare for yourself. Sure, there is the chance you will never need it, but your chances are no better than anyone else’s. If we are not all secure, we are all insecure, we are at risk of being choked by the invisible hand. If we are insecure, we are not free.






Modern Libertarians Hate Thomas Malthus

Whether they are familiar with his work or not, many modern libertarians echo some of the ideas of Thomas Malthus when they advocate austerity in public policy. Most notably, Malthus claimed that the “poor laws” of England of his time deprived the poor of any liberty and independence. He felt that the poor would have more self-respect and freedom if they could provide for themselves and their families through their own labor.

Thomas Malthus

It was Malthus, not Darwin, who first mentioned a struggle for existence. In his 1798 screed, “An Essay on the Principle of Population,” he

“Restless from present distress, flushed with the hope of fairer prospects, and animated with the spirit of hardy enterprise, these daring adventurers were likely to become formidable adversaries to all who opposed them. The peaceful inhabitants of the countries on which they rushed could not long withstand the energy of men acting under such powerful motives of exertion. And when they fell in with any tribes like their own, the contest was a struggle for existence, and they fought with a desperate courage, inspired by the rejection that death was the punishment of defeat and life the prize of victory.”

In the essay, Malthus basically argued that hardship limits population but abundance leads to population explosions. For this reason, feeding the poor is a bad idea, as it will encourage wanton reproduction and the survival of infants into adulthood. By helping the poor survive, they would then multiply and deplete the planet of all its resources. It is the wealthy, of course, who consume the most resources, but even at that, Malthus did not have quite the same view of some austerity minded people of the 21st century.

For one, Mathus wanted to protect the value of farm labor. He said,

“Every endeavour should be used to weaken and destroy all those institutions relating to corporations, apprenticeships, etc., which cause the labours of agriculture to be worse paid than the labours of trade and manufactures. For a country can never produce its proper quantity of food while these distinctions remain in favour of artisans. Such encouragements to agriculture would tend to furnish the market with an increasing quantity of healthy work, and at the same time, by augmenting the produce of the country, would raise the comparative price of labour and ameliorate the condition of the labourer.”

Efforts to drive down the wages of farm labor are, then, anti-Malthusian. He also did not believe in leaving the poor with no help for work and redemption. While he objected to the “poor laws” of his day, he did believe in a tax-supported programs to provide employment for the poor. Thus,

“County workhouses might be established, supported by rates upon the whole kingdom, and free for persons of all counties, and indeed of all nations. The fare should be hard, and those that were able obliged to work. It would be desirable that they should not be considered as comfortable asylums in all difficulties, but merely as places where severe distress might find some alleviation. A part of these houses might be separated, or others built for a most beneficial purpose, which has not been infrequently taken notice of, that of providing a place where any person, whether native or foreigner, might do a day’s work at all times and receive the market price for it.”

Public works projects, such as those put in place by FDR, can alleviate much suffering while also benefitting the public good through improved infrastructure and public service. Note that Malthus did not advocate putting poor people in prison and forcing them to work for free.  Malthus did believe in treating the poor with respect and providing opportunities for honest employment for the betterment of society. Modern libertarians would do well to recognize the basic human desire for dignity and self-respect. When we help one another, we are free.

Ron Paul, Murray Rothbard, and the loss of freedom

Libertarian and conservative critics of progressives seem to endlessly repeat the same refrain that progressives are opposed to freedom and liberty. This generally baffles progressives as they see themselves as the defenders of civil liberties such as free speech, marriage equality, and religious liberty. Listing examples of the liberties they defend does nothing to quell criticism from libertarians, however, as the concepts of liberty that libertarians hold is quite different from the concepts of liberty progressives hold.

For libertarians, all liberty stems from property.  In short, if you have little property, you are not entitled to liberty. Murray Rothbard, who wrote the introduction to Ron Paul’s book, puts this idea quite succinctly in The Ethics of Liberty, saying, “Human rights, when not put in terms of property rights, turn out to be vague and contradictory, causing liberals to weaken those rights on behalf of ‘public policy’ or the ‘public good.’” In other words, when progressives seek to ensure that all people enjoy the same rights, Rothbard and other libertarians claim this actually denies human rights as it causes some individuals to lose some of their property.

So, your right to free speech, for example, depends on your owning enough property to exercise your speech. Otherwise, it depends on the goodwill of some property owner to permit you to speak. As Rothbard puts it, “There is no such thing as a separate ‘right to free speech’; there is only a man’s property right: the right to do as he wills with his own or to make voluntary agreements with other property owners.” And, of course, libertarians feel that all property should be privately held.

So, when Occupy Wall Street protesters are chanting “Whose streets? Our Streets!”, they are going directly against the beliefs of libertarians. Protesters have been evicted around the country on the basis that they are on “privately held” public spaces. You can try protesting conditions in Foxconn plants outside an Apple store to test how much freedom you have on privately held property. Progressives seek to establish publicly held property to ensure that everyone (or as many as possible) has an opportunity to exercise the right to free speech. The same applies to public airwaves and Internet bandwidth.

If you want to be able to speak publicly, you must be a property owner. To have a significant voice, you must own a great deal of property. When the Supreme Court ruled that unlimited political contributions were a matter of free speech, this is really the underlying theme to their proclamation. When George Carlin declared that the owners of this country were the only ones with any freedom, some regarded him as a crazy conspiracy theorist.

Philosopher Isaiah Berlin famously helped distinguish between two kinds of liberty. Negative liberty is the freedom from interference from others. Positive liberty is the ability to act in the way one chooses. Progressives hold that liberty is meaningless to a person who has no means to act or make choices. Libertarians hold that all liberty is negative (freedom from coercion) and all rights are negative (no one is obligated to ensure that you have positive liberty).

When libertarians and progressives talk to one another, they should at least try to understand how the other is using basic terms such as rights and liberty. As for me, I completely understand why wealthy people would be libertarian. I find it much harder to understand why people who have little property (and that is most of us) would embrace these libertarian ideas.