That Entitlement Feeling
I know many people are uninsured and suffering through no fault of their own. It’s certainly not all of them — plenty are uninsured by choice and will now be saddled with a mandate — but it’s many of them. I truly hope they get the relief they’ve been praying for, because that’s the most obvious benefit of this bill. Now that the bill has passed and there’s no turning back, I really do hope that ten years from now there are families who will be able to say that it made their lives better.
And I do believe that will happen. Do I know how many people will be better off? Not a clue. Do I think it will make enough people better off, and to a great enough degree, that it’s worth the costs it will impose on the majority of Americans for decades to come? I have no idea how to answer that question, at least not without some sort of a priori appeal to either egalitarian or individualist virtues, and now we’re in a moral debate.
I suppose I could attempt to weigh the costs and benefits, but it’s an incalculable exercise. Sure, I’ve written several times about direct costs, but that’s an easy lie to expose to anyone willing to listen. The bill won’t save us money over 10 years or 20 years or ever — if you actually believe that, you don’t understand economics or politics, and I’ll debate you any day of the week.
It’s incalculable because of the unseen costs, which few people on either side of the aisle are talking about. A libertarian professor I know once said he believed that libertarianism’s greatest intellectual contribution is a recognition of the unseen. We’ll never see what open competition could have done to health costs in markets for health care left free of government interference. We’ll never see how the voluntarily uninsured would have spent the money they’re now required to spend on plans. We’ll never see how many lives could have been saved or how much healthier we could be in a world with technological innovations that are more costly and burdensome to develop as a result of government. I’m not saying there will be no technology and no innovation, I’m saying when we make these choices “as a society” we sacrifice the unseen what-could-have-been for a “bird in the hand is worth two in the bush” philosophy that defies the most basic tenets of economics.
I know a cautiously optimistic public intellectual who says we’re going to get freer and more prosperous only because the pace of human ingenuity will always outpace government’s ability to stifle it. It’s a sad irony that government’s inefficiency relative to individual entrepreneurship is precisely what allows it to impose huge burdens on society and come back later to say “see, things aren’t nearly as bad as you thought” thus paving the way for further intrusion. There’s a seemingly endless debate between those who say “think what economic growth we’d have with less government” and those who retort “but without government, what makes you think we’d have growth at all?” Except that thanks to politics, the debate is awfully one-sided in favor of a intervene-more approach. Surveys of past presidents bear this out especially well: a few presidents deliberately did very little to get in the way of the people, and even where increased prosperity resulted, you’ll find those presidents sitting comfortably at the bottom of the popularity lists.
Do I think the world’s coming to an end because we have sweeping health care legislation? Absolutely not — certainly not before 2014 (remember, the start date was pushed a few elections back for precisely the reasons you’d suspect) and probably not at all. I simply have to believe that the more dismal predictions won’t bear out. We’re certainly not going to get most of was promised, no question about that. At the end of the day I suspect, as I do with most government legislation, that we’ll be much better off than the worst fears of the naysayers but much much worse off than we could have been in a world without it. But because it’s unseen, no one will ever know.