The Liberal's Problem of Using Force

Coercion Versus Voluntary Means

Underlying debates among political philosophies and political economics is the distinction between coercive and voluntary actions. Daniel Klein defines the distinction between coerced and voluntary.

“You are coerced when someone brings physical aggression or threat thereof to your property. Your property is your stuff, including your person, and ownership implies a claim to your property good against the world. A claim, a benchmark, not an absolute or inviolable right.

Voluntary interaction is our consenting, in the absence of coercion, to alter our property arrangements and to form agreements such as contracts. As for who owns what, there are rather universal norms, beginning with the soul’s ownership of its person, extending to property acquired within the family and in trade, production, and gift relations.[5] Liberty is freedom from others messing with your stuff. Restrictions on voluntary interaction are diminutions of liberty.

Sure, there are holes and gray areas, and forms vary with social norms. But the basic ideas of tangible property, ownership, and consent are cogent and apply so widely that we may think of the exceptions as exceptions.”

Is It Important?

Some writers (for example, George Stigler and Gary Becker) hold the position that the distinction is either not important or not particularly useful given the complexities of our society, our wealth, concerns for efficiency, or utilitarian values of government action. But, of course, these arguments border on ignoring serious implications that arise from using some desirable end to justify a coercive means.

Given a political issue with desirable ends such as health care, the coercive/voluntary distinction operates at a deeper level within an ideology that apparently governs how people view facts, intentions, government actions, and results of various proposals.

The Problem of Force Posed

If modern day pro-government advocates are to justify government action in any political issue, they will have to tackle the implications of the distinction between coercive and voluntary action.

Here is how we might pose the liberal’s problem in making the moral case for coercion:
1. Is it moral to make one person a gainer at the expense of another person?
2. If in some circumstance we think it desirable to make one person a gainer at the expense of another person, is it then morally sound to use force to so do?
3. If rather than individuals, groups are involved—one group made a gainer at another’s expense—does using groups make using force more or less justified?
4. Does using government force make it more or less morally justified?

How Do Human Societies Construct Themselves?

While it may appear to some to be an esoteric, or perhaps useless philosophic point in discussions of “real” problems such as health care, the distinction between coercive and voluntary action goes to the heart of understanding how society constructs itself. How do we explain the development of society? What exactly is the source of social and psychological construction, the free activity of people or the activity of people controlled by some central plan, government, or god that subordinates activity to some higher ideal or common good?

In organizing our society, it would seem that how we explain how human activity can transcend itself to construct the new and better—whether that is social, economic, religious, psychological, technological, or even biological activity—would form a fundamental issue that underlies most of our problems in the world today, and it seems to begin with the distinction between whether some form of external control and therefore force is necessary or whether within human activity there exists some self-organizing and self-transcending factors at work and therefore free activity is necessary.

The Long-Term Consequences

Counter to this problem is the question of whether over the long run it is free activity or whether it is coercive methods that tend to produce destructive consequences and the direction each tends to move a society over the long term. However stated, the problem must not be ignored otherwise we will remain thoughtless in our political ideology and given to what is only intuitive or what merely feels good.

Health Care—What Matters Is the Direction We Push the System

Often public policy issues focus on, well, issues. Issues tend to be the states of affairs we would like to have, and there is nothing wrong with that. But a limited focus on issues is dangerously thoughtless in setting public policy, particularly when we thoughtless assume it should be a political issue reduced on to the question of how to design government to address the problem. Of course we have wants, goals, ends, outcomes for our societal good but in centering our attention exclusively on ends, we hide the more fundamental differences among the means to be used, the design if you will of a system that is implied in a position on an issue.

The means are more important since they are the operating rules of the system and they determine what can be produced; they are the dynamics of the method of production as opposed to the statics, the descriptions of the state of affairs we want as outcomes and goals or that are actually being produced by the current system. To ask how we get to a desired end raises difficult intellectual challenges since it requires us to pull out the structure of the system inherent in a design that we will think we could use to organize the production of the end. It is intellectually much more challenging that a limited focus on ends or states; it requires what psychologists call a “reflective abstraction” in which we pull out of our thinking the relationships that are implied in our thoughts.

Perhaps the lowest level of thoughtless public policy is to simply focus on the appealing aspect of ends and goals since it is done without the conceptually difficult work of figuring out and explaining how the desirable ends could actually be produced. Educated people seem particularly susceptible to expressing good intentions as if they are good political policy. “Everyone should have the right to affordable health care,” one psychology professor wrote in an opinion piece. That goal would be nice of course, but when we ask for details on exactly how such a “right” (more properly he is referring to an entitlement) is not obviously unrealistic.

Think of all the nice sound bites that express goals most of us want: control of rising costs, better access by poor people, affordable drugs for senior citizens, curbs on excess profits by drug companies, better availability of organs, lower infant mortality rate, and so on. More thoughtful people can agree with the desirability of the goals but reject the goals as unrealistic and unwise as a basis for policies because they know the ends cannot justify the means.

This thoughtless focus by a professor on goals happens in other areas of public policy, not just health care. Public education is always an issue and it too is dominated by this kind of thoughtless kind of advocacy and focus on ends. In education the ends focus mostly some form of high test scores with some reference to holding someone accountable but without a corresponding expression of any valid understanding of the means by which human intellectual growth is produced, testing and accountability can’t describe any methods for actually delivering the ends. They remain hopes, good intentions, desirable states of affairs we all can easily agree would be nice to have.

The difficult challenge in shifting the focus in health care discussions to the means is that it involves a new focus on relationships. Relationships shift the focus away from goals and outcomes; they are more complex, more abstract, and less observable as content of thought. To pull out the relationships involves requires an investigation and conceptuation of third party systems of government programs and intervention and compare these to the direct, two-way relationships of free systems of consumers directly pay and benefiting from producers. The content of this kind of thinking is that of the difference in the relationships of these two kinds of health care systems; it is no long about the concrete descriptions, facts, outcomes, goals, desired ends that are easily debated.

Since underlying our policy discussions is the policy choice between whether to move the health care system toward more government planning, control, and funding or toward more direct consumer/provide relationships, we cannot consider the wisdom or morality of such proposals merely by looking at how various government programs would work to produce some desired outcomes. We have to also understand and compare these government methods with methods of free systems of health care that are controlled by the self-regulation inherent in voluntary, mutually beneficial exchanges between consumers and providers. Until we understand both, we cannot thoughtfully reject one or the other.

All thoughtful public policy involves this kind of abstract thinking because at heart, all public policy involves the question of the direction we want to push a system. As to the means of any public policy, do we want to design the means that would put more of the human activities of our society under government control or do we want to design a policy that would promote the free constructive problem solving activities of citizens. It may be true, and it does some evident from survey data, that most citizens cannot think at such a level of abstraction. But if that is so, then that incapacity calls into question the very idea of democracy as the means for organizing our society. It would suggest that rather than democratically getting together to decide what to do about health care, we should instead examine why and how our design of government tends to make so many issues into political ones. If government is prevented from controlling, spending, and intervening in an area then we have no public policy issue since we would have society solving the problem and producing public benefits without government.

Opposite to the authoritarianism of dictators is not democracy, it is a free system. Control of citizens’ activities is as authoritarian when imposed by a majority of the ruling, voting group as it is by a dictator. Both produce oppressive government. The opposite this oppression by government either imposed democratically or by a dictator is a society that protects the free activity of citizens. To pretend the democracy of imposed government control is better than a society that protects the free activity of citizens from government requires an assumption that free activity doesn’t work or is somehow destructive of the public good, not its source.

The scope of history shows conclusively that free societies promote the societal good to an astonishing degree while government controlled societies impoverish citizens. Much of the public good is produced by society without government planning, controls, and spending. The solution to public policy issues is not more democracy. More democracy implies ‘governmentalzing’ a problem so that we have more government and the imposition of more restrictions on citizens’ activities. More democracy in this sense is a cause of problems since it is the inappropriate expansion and use of government power that creates even more problems and political issues such as it has done in health care.

The inescapable policy question underlying the health care issue is whether we want to increase the use of the force of government to mandate and control citizen activities or do we want to push the system toward solving problems with less centralized control. Already our health care system is fundamentally controlled and distorted by government funding and involvement. It is a matter of which direction to push the current reather dysfunctional and inefficient system—toward more government which caused most of the problem in the first place or towards more direct, voluntary choice and opportunities between consumers and providers. The wisdom of our choice always comes down to the third party problem. The benefits and costs are separated by third party government programs, and there is no known economic solution to the problems that causes. Such systems are inherently unstable and inherently tend to move toward increasing costs, restrictions of supply, and decreasing or fixed levels of quality.

To thoughtfully choose such a system would necessarily mean to have developed and demonstrated some new design. The new design would have to show that it avoids the problems of third party programs that are caused in systems imposed and protected by government force. Since it has never been done and appears economically to be undoable, without this clear demonstration of how a new, workable design solves the third party problems of government control, such systems must be assumed to be defective. If it cannot be shown how it will solve the problems, then it must be considered to be harmful to society. The benefits and justification of free systems need no longer be proven; the imposition of government systems must be. With history, experimental results, and theory clearly established, we no longer have to prove that free markets work. However, if we are to push society toward more government that imposes third party programs by force, we do have to somehow come up with a theory of government that demonstrates these government designs can work. It has not yet been done. Without this clear showing of benefit in promoting the public good, it must be considered immoral to use government force to impose controls on citizens’ activities against their will and their choices.

Universal Health Care—Is It Wise?

All Universal Health Care proposals are variations of a system of third party funding that are centrally planned and imposed by the government. Third party funding is a system of non-reciprocal relationships among a consumer and a producer, two parties, in which the producer is paid by a third party, not the consumer. Removing the connection between the value received and the value paid by one party, the consumer, the reciprocal relationship, destroys the voluntary, mutually beneficial power of human reciprocal exchanges that makes free societies so constructive of the human good.

Design Problems of Government Programs of Third Party Funding

To make the destructive effects of third party funding clear, suppose Arleon buys dinner for all of us on one of our family outings. Now, except for the time and energy involved, the cost for each person, except for Arleon, is zero. Whatever I order from the menu is free to me so I can order whatever I’d like regardless of the price. In contrast, if I was buying my own dinner, I might not order an expensive entrée or order wine or dessert; I might not eat out at all. But in this case of Arleon’s generosity, it is free; there is no value and no benefit to me for considering costs so I participate but in this face-to-face situation I don’t want to appear to be taking advantage of Arleon. So in this intimate, limited, private situation, the arrangement works well for its purpose.

But the situation makes the problems worse if Arleon stays home but told us he would pay for our evening meal. Then he sees the total bill but he doesn’t know who ordered what, who might have wasted food, who ordered more expensive dishes, or even what our level of enjoyment and appreciation was. We have the case of third party funding in which someone, Arleon, is paying for something we receive free from the restaurant but now this set of relationships among three parties doesn’t work quite as well with Arleon absent as it did in face-to-face interactions. The situation deteriorates still more if Arleon repeats the generosity on a regular basis. Now suppose that some members of the group think everyone needs basic food care so we vote to make meals an entitlement. Of course we can’t make Arleon foot the bill but we can make government pay for the entitlement.

Now instead of a person and a private, voluntary arrangement of private good, we have created an impersonal, government program, and we have done so by force, the force of law. Besides removing private good from society, the government meal care requires some central planning with enforced mandates determining how citizens must obtain food, the kind of food they can receive, the costs that will be allowed, how the program will be funded, and who can deliver the food. Food care must in some way be standardized to be fair but because citizens are so diverse, some will be better served than others. To get what they need and want, the vegetarians must fight political battles with the meatatarians. The food providers must do battle to get more funding. Now reform of meal care becomes a perennial business since shortages, poor quality, the “funding crisis,” the standards, the corruption and influence peddling, all kinds of problems require constant attention. Politicians now can easily make grave announcements about problems that they will solve if elected. But with so many people and food providers invested in the system, no one dares suggest that it was the attempt to create a government program to solve the “food care crisis”, that is, third party government funding, that is the fundamental problem.

As to design problems, these conclusions follow:

First of all, that programs of third party government funding can only operate if mandated by force of law;

Second, they destroy the private good by substituting the destructive effects of third party government funding for the constructive power of mutually beneficial exchanges between parties and the generation of private good;

And third, they create permanent problems of increasing costs, the tendency to extend and grow, the reduction of quality and service, the limitation of services, shortages, and constant political conflict.

My personal philosophy is this: Since government programs of third party funding always substitute destructive incentives for constructive incentives, they do not define nor serve the common good, and government programs are a priori immoral. But where government is properly used to prevent force and fraud in any human exchange in society—including its own use of force or fraud—it protects the common good that arises and can only arise from voluntary actions of citizens as they incrementally create more and more cooperative relationships from their constructive activities of creation and exchange. By definition if we use government to take away these constructive powers of free human activity, that government action is immoral.

In the case of having Congress devise a system of Universal Health Care, we cannot escape creating all the fundamental design issues and political problems (and probably corruption) that always arise in any attempt to use government force to impose a system of third party funding on all citizens. And underlying the design problems are issues of equity that we can uncover when we ask, who benefits? But besides these fundamental design problems, the question is also one of fact as to the results of the various designs. The facts are also fraught with difficulty.


Using Research to Determine What Works

Trying to answer the question of the whether Universal Health Care might be wise by using empirical research fails unless we understand the nature of the research problem. We don’t have controlled experiments—a free market health care system in one country which could be compared to a Universal Health Care system in another—so we don’t have clear data that are meaningful in answering the question of free market health care versus government controls. Added to this are the difficult problems of how things in the political arena tend to get distorted by ideologic feeror, and it means we should be humble about our beliefs of fact founded as they mayt be many on misconceptions or misperceptions.

First, and perhaps most important, to pose the political issue as limited to one between our existing system and Universal Health Care is a classic example of a false dichotomy. The design of the U.S. health care system is not one of a free market system since it is already largely under government controls which in fact are causing most of its problems. For example, in the HMO Act of 1973 the government created HMOs (which we all seem to hate); they are not the result of the activities of a free-market. That HMO law required all but the smallest employers to offer their employees HMO coverage.

The government also changed the tax code during the war years to allow businesses but not individuals to deduct the cost of health insurance premiums; it effectively tied insurance to employment. The government also created Medicare, Medicaid, and other programs; now the government accounts for almost two-thirds of health care spending and most of the costs of paperwork and bureaucracy necessary for administering health care services.

Most recently, the Bush administration pushed through the largest single entitlement program in the history of the U.S., the prescription drug entitlement for retirees. Government involvement created the problems due to entitlement programs and coupling employment to health insurance and which have particularly hurt the unemployed. We must blame Congress for the unintended consequences of the government failing to deliver on its promises. Since we don’t have a free market in health care, we cannot blame the free market incentives for causing the health care “crisis.”

Second however, even in comparing the U.S. Health care system to other systems, perhaps most people would accept four generalization that can be derived from the research:

1. As to efficacy, international comparisons of longevity are distorted by things like homicide rates and low-birth-weight infants.

2. As to universality of coverage, the number of uninsured is boosted by illegal immigrants, people eligible for Medicaid who have not signed up, and people earning over $50 K per year.

3. As to costs, the recent rapid increase in health care spending in the U.S. the last 30 years has been in procedures involving specialists and high-tech medical equipment.

4. As to fairness, comparisons among groups receiving different levels of these types of high-techn services surprisingly do not show significant difference in outcomes.
We can use these generalizations to evaluate political positions that advocate Universal Health Care. They should not try to use incomplete or misrepresented facts to create an improper justification nor should they make comparisons between the results of the U.S. system and other nations’ systems as if that is the only choices we face.

For example, these are true but misleading statements about health care that politicians and advocates use in support of Universal Health Care:

1. The United States has lower life expectancy and higher infant mortality than Canada, which has national health insurance. A true statement but none of the difference can be shown to be due to the differences in the designs of health care systems. Other factors—differences in violent deaths, immigration.

2. Some 47 million Americans do not have health insurance. True according to census data but those data do not take account of Medicaid, illegal immigrants, richer people who could but choose not to be insured, or those who decline employer offered insurance. The percentage who need insurance but can’t afford it is only a few percentage point of the total population.

3 and 4. Health costs are eating up an ever increasing share of American incomes. True but not due to differences in health care design. Spending on public and private health care in the U.S. rose from about 5 percent of United States national income in the 1950s to about 16 percent. This increasing cost isn’t due to waste, abuse, or fraud but is due to advances in medical technology and the rising wealth of Americans. Just as Americans have much larger homes, more cars, more technology, more leisure activities and travel, more of everything so also do they buy more health services. That increase in spending is s sign of progress of our wealth producing capacity.

The important conclusions is that the U.S. system is now largely a design of third party funding and as a result, it tends toward over treatment and increasing costs with decreasing benefits. In order to decide between free market and designs for Universal Health Care, and then choose Universal Health Care, we must have clear data that show there are health care systems of third party funding imposed by government do not reproduce the problems always associated with any systems of third party government funding. A more extensive approach would be to compare the results in general of free markets versus centrally planned systems of government involvement. Those comparison can be made and have been done. Their results are unequivocal. Free systems always produce increases in quality, efficiency, choice, and availability whereas government systems at their best present a stasis in a system (perhaps the U.S. Postal Service would be an example) but more often they produce decreases in quality, efficiency, choice, and/or availability (and in the case of government schooling, in equity as well we might add).

Summary—My Position

Politically, health care is now defined to be in a “crisis,” and we must understand that politicians must so define the situation whether it is or not if they are to use health care as a viable political issue for their election. They can define health care as a problem by the improper use of research. There are, of course, problems with our current system but the almost universal approach to the problems of previous government intervention in health care is to advocate more government intervention even to the extent of Universal Health Care imposed on all citizens by government force. But few politicians (I can think of only one presidential candidate) urge the removal of the perverse incentives established by government design. It is government intervention in health care that has created most of the current problems and it is more government intervention that is proposed as a solution. But before accepting that solution, we need to more deeply understand what happens when we turn things over to government. We need to discuss and understand the proper role of government, how constructive human activity advances society’s well-being, and how government helps or hinders the constructive power inherent in humans’ free activities. And rather than a grand plan affecting everyone, for those problems concerning the poor or disenfranchised, we need to consider exactly how they could be precisely targeted and better served.

We don’t necessarily have to turn to Universal Health Care as the only alternative to our current system; we can consider how a free market system would work, how it could better serve to advance society’s health, and how even the poor can be well served in free systems. However, if we are to make a wise and moral choice, we must understand the fundamental differences we face between moving our society toward free markets versus moving it towards more government involvement. The fundamental debate as always comes done freedom versus government.