Saturday, December 27, 2008

Unintended consequences

Writing about the problems that arise when the government intertwines itself with an area of the private economy, in this case medicine, Roderick Long writes:

When so much of the health care system has been unnaturally sucked into the federal embrace, such selective de-funding unfairly limits people’s choices in a way that they would not be limited in a free market. If I and my gang use the violence of the state to gain a near-monopoly of some good or service, our decision to refuse to provide that good or service to people we don’t like begins to look not so innocent…

…it’s a great example of how the Rawlsian/Dworkinian [Ronald, not Andrea or poor Gerald] dream of a state apparatus that is neutral among its citizens’ competing conceptions of the good is ultimately incoherent. Federal funding for contraception and abortion violates the rights of taxpayers who oppose those practices on moral grounds; selectively de-funding those practices in the context of a heavily statised health care industry threatens people’s reproductive freedom.

Quite right. There's an important consequence to this: Because neutrality is impossible, state involvement in any area of society encourages additional conflict between citizens, as formerly private activities become public business.

For this reason, it’s somewhat ironic that pro-choicers are generally much more likely than pro-lifers to support more government in health care. As things stand now in the United States, abortion is fairly difficult to assail successfully- totally outlawing it on either the national or state level would require an amendment to the national constitution. But suppose we had universal health care, with everything paid for by the government. Now it’s simpler- you don’t have to outlaw a medical procedure to stop it, you just have to deny it funding.

Getting support for such a de facto outlawing of abortion would be much easier to pull off if universal healthcare existed, as well. As it is now, some people want abortion outlawed, but there are a lot of people who don’t want any part of it themselves but don’t think it should be illegal. However, if all abortions are paid for by the taxpayer, the “disapproving but tolerant” portion of the population is faced with a problem- if you don’t want your own money paying for abortions, or just for particular types (late-term abortions, for instance), your only means of self-defense is to eliminate access to it. (History strongly suggests that once universal healthcare is instituted, conservatives will quickly come to accommodate it and adapted into their own ideology, so any sustained attempt by pro-lifers to fix the problem by returning health care to the private sector is unlikely.) You could try to avoid the problem by making abortions an exception to otherwise universal government funding of health care, but liberal pro-choicers would be the first to condemn such a thing.

There are other possible outcomes to conservative-controlled government medicine that many liberals would find uncongenial- things like sex reassignment surgery or in vitro fertilization could also be made inaccessible through de-funding, and such a thing would be easier to accomplish than making them officially illegal when they’re being directly paid for by those who want them. Making health care a purely government responsibility could also strengthen the hand of conservatives when they argue in favor of government control in people’s personal lives. Sex is the obvious example, since it can be a vector for disease and thus a source of health care expenses. If smoking restrictions, helmet laws, “fat taxes,” and the like are permissible because bad health habits can increase government health care expenses-and liberals have become quite insistent that they are- than such restrictions would only become more desirable when the government is footing the entire bill, and many conservatives have their own list of private activities they would like to interfere with.

As usual, virtually no one ever anticipates the possibility that all the powers they want to give the government will sometimes be in the hands of their opponents.

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