You Cannot Free Yourself

Senator Rand Paul made a controversial statement this week, and I feel compelled to defend it. Please watch the following clip, then continue reading:

With regard to the idea of whether you have a right to health care, you have realize what that implies. It’s not an abstraction. I’m a physician. That means you have a right to come to my house and conscript me. It means you believe in slavery. It means that you’re going to enslave not only me, but the janitor at my hospital, the person who cleans my office, the assistants who work in my office, the nurses.

Unfortunately, too many people, including a few who should know better, have elected to oversimplify the implications of Senator Paul's statement.

Matt Welch at Reason, for example:

Could slaves free themselves by changing professions? Do doctors in Switzerland get taken away at gunpoint? To treat the analogy with technical seriousness, even setting aside (as if you could) the colossal weight of America's most lasting shame, is to render it ridiculous, in my opinion.

In my opinion, Matt Welch is working hard to miss the point.

First of all, let's discard the silly idea that slavery is a sacred topic. As noted by one commenter, "Slavery has existed for most of human history. It is not limited to the US. If you are offended by the use of the word, get over it. It is a valid English word, and not limited in scope to the antebellum South."

More importantly, let's disabuse ourselves of the notion that taxpaying physicians, by changing professions, can somehow free themselves from the involuntary servitude imposed by the redistribution schemes of health care entitlement programs.

Income taxes and payroll taxes are converted by government into all sorts of entitlement goodies, including health care. If you exercise the right to work for financial compensation, the state will infringe upon that right by confiscating the product of your time and effort to provide health care services for other citizens. This will happen whether you work as a physician or not. The arms of coercion are sometimes convoluted, but involuntary servitude in the health care industry is compulsory for everyone who is gainfully employed in the United States.

Let's also disabuse ourselves of the notion that hospitals and physicians can simply walk away from their explicit legal obligation to provide free care. Whatever ethical scruples a health care provider might or might not have (and regardless of whether patient is truly indigent) EMTALA laws force hospitals to provide free care to deadbeat patients, and the litigation risks associated with "patient abandonment" force doctors to provide care to those who will not pay.

I challenge Matt Welch to find a physician or hospital administrator who has managed to flout these laws without being "taken away at gunpoint."

If you listen carefully Senator Paul's comments, I think it will be pretty clear that he understands moral problems associated with entitlements are not confined to the health care industry:

Basically, once you imply a belief in a right to someone’s services — do you have a right to plumbing? Do you have a right to water? Do you have right to food? — you’re basically saying you believe in slavery.

I’m a physician in your community and you say you have a right to health care. You have a right to beat down my door with the police, escort me away and force me to take care of you? That’s ultimately what the right to free health care would be.

[emphasis added]

Again, let's not get bogged down by the fact that physicians and hospitals are usually paid for their services. Here's a good response to Welch's post from the comments at Reason:

[Rand Paul] said that the idea that you have a right to health care means you have the right to the work of doctors and nurses and hospital administrators and janitors and pharmaceutical manufacturers in exchange for nothing at all. Whether the government wants to lift the burden and have the middle/upper classes pay for it through taxes is a side issue. The question is "Do you, an individual, have a RIGHT to health care?" If your answer is yes, you are pro-slavery, and like everyone else who has ever been pro-slavery, you want to be the master.

Ultimately, entitlements are a zero sum game. Directly or indirectly, entitlement programs transform tax-paying citizens into bond-servants for the recipients of entitlement freebies. That's true whether the entitlement goodies come from the health care industry, the housing industry, the education industry, or any other industry.

Rand Paul is right. The "right" to free stuff makes slaves of the producers of said stuff.

I wouldn't try to prescribe an overnight solution to the moral hazards that have been created by entitlement programs, but a truly compassionate, fair and free society would be actively seeking remedies.

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