Note: Please see the opening note there. It applies here too.
The provision of health care requires the services of doctors, pharmacists, nurses, medical researchers, and their various managers. These services are not free for all of these people have alternative uses for their time, labor, and effort—leisure or other work. Many of these people are well-off, and so are willing to pay a high opportunity cost for leisure. Many of them are also quite intelligent and well-educated, and so have the option of other professions with high salaries they must forgo if they work in medicine. Ever since the Phoenicians invented money, the preferred means to induce these people to work in medicine has been remuneration in excess of these high opportunity costs. So health care will not merely cost money, but a lot of money.
This is a fact entirely independent of structure of health-care finance. Single-Payer
, Nationalized Health Insurance
, Free-Market Health Care
, or the present U.S. system trending ever closer to the former alternatives; all of them will cost a lot of money.
The sole alternative which does not involve a large money cost is the institution of a slave state with only a single free man, the master, and with everybody else aspiring to, at most, the status of well-treated house slave.Some objection has been taken to use of the word slave.
But give me a man who must obey my every command on every subject under threat of torture and death. Even he obeys, I may still torture or kill him with impunity. In what sense is such a man anything but my slave? It is a harsher condition even than that of the historical U.S. slave, for there were at least in principle some slight legal constraints on his owner’s actions. And does anybody deny that this is an accurate description of the relation between the current Kim and all others in North Korea? So how is it not a slave state? At present, the Kims’s North Korea is probably the most faithful realization of this ideal. And indeed the Kims can order anybody with sufficient talent to obtain medical training and then provide health care services without requiring the expenditure of large sums of money.In a deeper, non-monetary sense, the Kims too face a budget constraint. They have only so many slaves with the talent and education to become doctors and each of them has only twenty-four hours in a day. When a Kim orders one of them to spend some of these hours on providing health care, he necessarily forgoes what Kim could otherwise have obtained from the slave.
But if that is an ideal—the fondest dream of most rulers today and in history—one perhaps rejects for other reasons, there is no present alternative to very expensive health care. Systems of financing can obscure who pays the cost. That is why regulation of health-care financing is such a favorite pastime of politicians in democracies. They can ensure their power and popularity by focusing benefits on small, sympathetic, and highly visible groups, while hiding who pays the cost in the most elaborate manner—the more brazen of these politicians will deny that these costs even exist or claim that they will be born exclusively by some hated out-group (foreigners, insurance companies, etc.).
In truth, these costs will alwaysAt least until somebody discovers a genuine and cheap panacea. be with us. And if you cannot tell who bears them, it is probably you.That is for the same reason that there is a sucker at every poker table. Look around at the other players and spot him. If you can’t, it’s you.
