"Let 'em fail"?

At the most recent GOP presidential debate, there was a famous exchange between CNN’s Wolf Blitzer, Rep. Ron Paul, and the partisan crowd. Blitzer asked Paul about a hypothetical 30-year-old man who refused to purchase health insurance, got sick, and needed extensive medical treatment. Blitzer asked “Who pays?”

Paul replied, “That’s what freedom is all about, taking your own risks…”

Blitzer interrupted him by asking “Are you saying the society should just let him die?”

A few people in the crowd shouted “Yeah”. But Paul said no—and then explained that society should and would take care of him.

Paul continued: “We’ve given up on this whole concept that we might take care of ourselves, assume responsibility for ourselves. Our neighbors, our friends, our churches would do it. This whole idea—that’s the reason the cost is so high!...We dump it on the government; it becomes a bureaucracy; it becomes special interests; it kowtows to the insurance companies and the drug companies…”

Paul made a number of interesting and important points. But aside from his astute analysis, it’s clear that his reply runs counter to conventional ethics. In contrast, many (most?) people believe that we should not rely on freedom and markets. Instead, they want the government to take a lot of money from a lot of people—to support others who make bad decisions and/or face circumstances beyond their control.

When I heard the debate over “let ‘em die”, I immediately thought of students in a classroom. If a student decides not to study appropriately, should I “let ‘em fail”? I’ve always thought so, but maybe I should reconsider. Should I lower the grades of the successful and increase the grades of those who don’t study or just aren’t very smart. (I could transfer grade points explicitly—for example, from “wealthy” A-students. Or I could arbitrarily increase the grades of D&F students, devaluing the grades of A-C students.)

It turns out that the analogy is limited in two important ways. First, health care can be much more important than grades. Of course, grades are important too. If you don’t graduate from high school or college—or you graduate with a weaker major or a lower GPA—then this will have a dramatic impact on your standard of living. And much health care is not vitally important. So, the analogy only falls short when referring to catastrophic or highly-significant health considerations.

Second, I don’t do anything to get in the way of my students earning a good grade. In fact, I do a lot to help them learn and succeed. In contrast, the government is quite busy making it much more expensive to obtain health insurance and more difficult to obtain care. The federal government subsidizes the purchase of health insurance through businesses, causing it to move away from the normal role of insurance in covering rare, catastrophic events. Vastly broadening the scope of health “insurance” causes a dramatic increase in the cost of health care and especially, health insurance. (Imagine the cost and accessibility of auto “insurance” if it covered door dings, oil changes, etc.) This makes Wolf Blitzer’s scenario far more likely. As the government vastly inflates the cost of health insurance, it tempts people to take their chances.

In addition, state and federal governments have all sorts of mandates and regulations on health insurance—that increase costs and decrease competition in the market for insurance. In fact, government has all sorts of other regulations—on everything from prescription drugs to labor markets—that cause all sorts of trouble, but this would require a far longer essay! (If you’re interested, check out my paper in the Winter 2011 edition of Cato Journal.)

Rep. Paul’s answer was to rely on markets and freedom to take care of people. The flip side of that coin is to reduce government intervention—not only taking money from A to care for B, but also government policies that dramatically and artificially increase the cost of health insurance. Blitzer’s question will always be with us. But why do we ignore the many government policies that make his question so much more relevant?