Milton Friedman on U.S. medical care
“Free to Choose: A Conversation with Milton Friedman”
Hillsdale College
Imprimis
July 2006
Question: Is there an area here in the United States in which we have not been as aggressive as we should in promoting property rights and free markets?
Milton Friedman: Yes, in the field of medical care. We have a socialist-communist system of distributing medical care. Instead of letting people hire their own physicians and pay them, no one pays his or her own medical bills. Instead, there’s a third party payment system. It is a communist system and it has a communist result.
http://www.hillsdale.edu/imprimis/2006/07/
Comment:
Don McCanne, M.D.
So, outrageous health care cost escalation, impaired access, and impaired health outcomes (including tens of thousands of deaths) are a “communist result” of a “socialist-communist system.”
The way you frame the problem is very important since logical conclusions derive from that framing. Based on Professor Friedman’s observation, we should ferret out and expel all of the communists that have permeated our private insurance industry and our government agencies.
Of course that’s nonsense, but there is a point here. Using an ideological abstraction to frame the problems of our health care system not only defeats consensus, it can never lead to rational reform. A political, social and moral Utopia will always be a fiction.
However the dialogue on reform is framed, it is absolutely essential that every effort be made to objectively define the problems. Then every effort must be made to describe the potential options for reform along with the anticipated outcomes of each option and its variations.
Much of that important work has already been done. We know what the problems are, the options for reform, and the likely results of the various options. If the goals are affordable, high quality, comprehensive health care for everyone, then it is clear that either a national health service model or a single payer national health insurance model would be the most effective means of achieving those goals. The American preference is for the insurance model.
It is difficult to understand why so many are opposed to reform. But many of those who are opposed dump the framing of the problems in objective terms, and substitute the framing as an ideological abstraction of personal
freedom: I’ll take care of my needs and everyone else can take care of theirs. As mentioned, that type of framing prevents consensus and automatically achieves the opponents’ goal of obstructing reform efforts.
But does this ideology of personal freedom or self-interest mean that we should not join together for the common good (something which governments do very well)? Let’s see what Milton Friedman has to say about self-interest:
Question: Do you define self-interest as what the individual wants?
Milton Friedman: Yes, self-interest is what the individual wants. Mother Teresa, to take one example, operated on a completely self-interested basis. Self-interest does not mean narrow self-interest. Self-interest does not mean monetary self-interest. Self-interest means pursuing those things that are valuable to you but which you can also persuade others to value. Such things very often go beyond immediate material interest.
Question: Does that mean self-interest is a synonym for self-sacrifice?
Milton Freidman: If you want to see how pervasive this sort of self-interest is that I’m describing, look at the enormous amount of money contributed after Hurricane Katrina. That was a tremendous display ofself-interest: The self-interest of people in that case was to help others. Self-interest, rightly understood, works for the benefit of society as a whole.
(Professor Friedman seems to prefer Utopia, even if it is a fiction. Charity, as health policy, has been studied extensively. Unfortunately, it is the least effective method of addressing our health care financing problems, having almost no impact at all. 300 million people, each acting as an independent agent, would never contribute the $7000 apiece required to fund our health care system. On the other hand, as reluctant taxpayers, they would collectively fund the $2 trillion health care system, secure in the knowledge that everyone else is paying their equitable portion. Framing this objectively, only government policies can ensure an equitably funded system for everyone.)