David R. Henderson  

Ron Paul and Austin Frakt Agree

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Background: There's been a lot of discussion on the blogosphere about Ron Paul's answer to a question about health care from Wolf Blitzer: was it a softball, how should Ron Paul have answered, etc. (For a post that links to virtually all of the prominent answers, see John Goodman's "Answering Wolf Blitzer.") Some of the suggested answers have been very good, although I would add that none of the answerers is a 76-year-old responding in real time under bright lights. I think that context-adjusted, Ron Paul did a great job.

But here's what I found most interesting. In a post that purports to be a criticism of the libertarian approach to health care--the post is provocatively titled "Your life is not your own"--Austin Frakt ends up pretty much agreeing with what Ron Paul said, except that Ron Paul advocated that people be charitable and Austin Frakt did not.

To review, here was the Q&A between Blitzer and Paul:

BLITZER: Thank you, Governor. Before I get to Michele Bachmann, I want to just -- you're a physician, Ron Paul, so you're a doctor. You know something about this subject. Let me ask you this hypothetical question.

A healthy 30-year-old young man has a good job, makes a good living, but decides, you know what? I'm not going to spend $200 or $300 a month for health insurance because I'm healthy, I don't need it. But something terrible happens, all of a sudden he needs it.

Who's going to pay if he goes into a coma, for example? Who pays for that?

PAUL: Well, in a society that you accept welfarism and socialism, he expects the government to take care of him.

BLITZER: Well, what do you want?

PAUL: But what he should do is whatever he wants to do, and assume responsibility for himself. My advice to him would have a major medical policy, but not be forced --

BLITZER: But he doesn't have that. He doesn't have it, and he needs intensive care for six months. Who pays?

PAUL: That's what freedom is all about, taking your own risks. This whole idea that you have to prepare and take care of everybody --

BLITZER: But Congressman, are you saying that society should just let him die?

PAUL: No. I practiced medicine before we had Medicaid, in the early 1960s, when I got out of medical school. I practiced at Santa Rosa Hospital in San Antonio, and the churches took care of them. We never turned anybody away from the hospitals.

And we've given up on this whole concept that we might take care of ourselves and 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.

The cost is so high because they dump it on the government, it becomes a bureaucracy. It becomes special interests. It kowtows to the insurance companies and the drug companies, and then on top of that, you have the inflation. The inflation devalues the dollar, we have lack of competition.

There's no competition in medicine. Everybody is protected by licensing. And we should actually legalize alternative health care, allow people to practice what they want.


So Ron Paul's answer is that the person is responsible for himself, that charitable behavior by others, including Ron Paul's former employer, has handled the problem, and that government intervention makes the cost of medical care higher than otherwise.

Now here's what Austin Frakt writes:

I will send the ambulance for you. Welcome to a society that does at least that. Yes, somebody has to pay for it. If you (we) reject a socialized payment mechanism in favor of a private or libertarian one, it may be you who gets the bill. Consider it the price of being human, social, and surrounded by people who care. You can't have it both ways.

It sounds as if there's no daylight between Austin Frakt's, Ron Paul's, and my view of the issue. Like Austin, I would send for the ambulance too. I'm sure Ron Paul would too and he might bend over and try to help--he is a doctor, after all. I also, like Austin, would expect that you, the beneficiary of the ambulance, would pay for it. I bet Ron Paul would too.

In response to another commenter, Austin Frakt elaborates:

Either way, I would get you some help. That's my choice. Now, who will pay for it? If you say that I should, do you like the incentives? If you say you should, you'd better plan accordingly.

Plan accordingly? There's nothing inconsistent with libertarianism here.

Why do I say that Ron Paul advocated charity and Austin Frakt didn't? Because all Austin Frakt committed to was calling an ambulance. Ron Paul actually worked for a private-sector employer that gave medical care for free.


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COMMENTS (9 to date)
frankcross writes:

We know charity won't do it. Before COBRA, hospitals turned away people with insurance. There was litigation, which the hospitals won, and the act was passed.

Charity seems so weak as a justification. It's like saying you don't really believe in personal responsibility. Charity is fine but it won't do anywhere near what government does. That's what history shows. You have to bite the bullet and say that freedom has some negative consequences.

David R. Henderson writes:

@frankcross,
You mean EMTALA, not COBRA, don't you?

StephenShorland writes:

Unless you believe that doctors should be slaves,somebody has to pay for their services.I would rather live in a prosperous country where I am not robbed at gunpoint (taxed - because if you resist this theft long and hard enough,paid enforcers will kidnap you or shoot you) and where the benefit of hard money and capitalism allows me to earn a living and to save in a currency that can not have its purchasing power printed away and where the benefits of ever increasing production means my savings grow in purchasing power over time.It is a good feeling to be charitable but it is human nature to take care of ones self and ones family first.'When all's safe at home,good willed money will roam.'

Austin Frakt writes:

Naturally, I could also give money to charity. The decisions are separable. But, to David's point, I meant to strongly imply that finding charitable sources of financing one's care is one choice one might make if one has rejected other arrangements. I'm glad someone noticed!

If you're uninsured and worry about the possibility of high bills should you have a medical emergency, you should think about how you'll pay for it.

kyle8 writes:

Frank, If it were not for the constant meddling by governments at all levels, the cost of health insurance would be very low.

Floccina writes:

@frankcross
IMO most charity would come from family and friends not from charitable organizations like the united way. Also given time we might see the return of something like the mutual aid societies.

Floccina writes:

Oh and BTW most american amortize a $500K bill. The hard cases are poor people with no assets and no skills or talents who would not be able to amortize a large bill. So charity could provide for them.

Interestingly the Amish sometimes send their sick people to Mexico for care, charities could do the same. Perhaps the US Government could do some of that though it is obviously politically impossible until the USA absolutely cannot pay their debt.

Hasdrubal writes:

I can't help but think of Shaffi Maher's recent TED talk where he mentions starting up a for profit ambulance service in India that serves everyone regardless of ability to pay. Their billing model is monopolistic: A sliding scale where wealthy people pay a lot and poor people pay nothing. They seem both profitable and effective at serving the community's medical needs.

Centralized government wedded to big business isn't the only way to do health care.

http://www.ted.com/talks/shaffi_mather_a_new_way_to_fight_corruption.html

Arthur_500 writes:

Austin, you have never found a government program that you could disagree with. Instead of personal responsibility I should seek out charitable sources of funding my problem?

You state that we must have personal responsibility and then you promote government responsibility. Of course it is always easier when someone else is footing the bill.

In fact there is no need for charity because the government provides charity.
There is no need for personal responsibility because someone else takes care of me.
There is no reason for caring because it the government's problem.

Throughout our society we find that when people are invested then they really care. This might be in a project, a home or even my child's school. If we can learn from the recent housing debacle many people aren't invesged in their homes and really don't care. The same can be said for healthcare - I don't care unless I get sick then it is someone else's problem. We will never be able to legislate good behavior from our citizens but we can encourage it. Understanding how people act in the face of scarcity (my money for example) is the basis of economics. Unfortunately Healthcare Economists (whatever that is)ignore the basics of economics.

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