The current US debate about health-care funding can be understood as concerned with meeting the challenge of doing three things at once: (1) ensuring that everyone can afford to buy ample medical services and (2) lowering the price of care while (3) not interfering with our choices.
If you assume that most or all of the features of our current health care system should be treated as given, the trilemma really does seem irresolvable. Suppose everyone can afford ample medical care. We know what doctors charge. We know what hospitals charge. We know what drug manufacturers charge. We know what medical device manufacturers charge. And we know what insurers charge to, we’re told, make it all possible. And we know the charges are anything but insubstantial. So, given they way things work right now, if everyone can afford ample medical care, then everyone must be able to spend a lot of money.
If the current pricing of medical care really reflects conditions in the current market, and there’s no reason to think it doesn’t, then there’s no way to lower the cost of care without, realistically, making fewer services, fewer drugs, fewer devices available, as long as current market conditions persist. And that means, of course, interfering with our choices, since it’s hard to choose an option that’s not on the table. With fewer services available, options have been reduced, and, assuming the real value to patients of some available procedures that would be less prevalent as a result of cost-control measures, the quality of services would be reduced. So Goal 1 doesn’t look too achievable.
Of course, we could insist that Goal 1 be achieved no matter what, perhaps along with Goal 3. But then it’s hard to see how Goal 2 could be achieved. Or we could dramatically reduce choice, and perhaps, just perhaps, that might enable us to offer an ample supply of, well, some kind of care judged by someone to be of high quality, while controlling costs. Would the quality be adequate? Without choice, it would be hard to tell, and it would be hard to require quality, since that’s what unrestrained markets do, and since we wouldn’t have anything like an unrestrained market.
So it might seem, at first glance, as if there were a real problem achieving all three goals. But there’s not, if you vary one assumption that isn’t being made explicit in most of the discussions being conducted on-line, on TV, and in the print media by Beltway insiders. That’s the assumption that we need to keep a whole range of monopolistic cartels intact, cartels established by the state at least in part precisely to keep costs up.
A natural approach for anarchists to take is to challenge this assumption, while suggesting that, if it’s not endorsed, the three explicitly stated goals can all be achieved at the same time. One way to think about this is as an ongoing contribution to the debate about “socialism.” The Tuckerite claim (I’m not precisely a Tuckerite, but I like to think of myself as a fellow traveler) is, I take it, that “socialism” is best understood as naming a series of goals which can be achieved using the political means or the economic means. For the Tuckerite, the economic means turns out to achieve the desired set of goals more efficiently than the political means—and so without the aggression that’s definitionally part of the use of the political means. But what is achieved is still socialism. The Tuckerite socialist can achieve what the state socialist purports to want, but without many of the human and financial costs created by a state-based approach.
Health Care: An Anarchist Approach
Mark Canney dissects statist health care claims (Podcast)