“Medically-Assisted Death” Makes the Case for Free Market Healthcare
A Complicated Case
Last fall, I wrote a draft of an op-ed responding to an article by John Gustavsson in National Review. I was planning to update it and release it, but I decided to release the (dated) original draft. It touches on a complicated topic: assisted suicide. I find this issue difficult, because it pits my libertarian sensibilities against my conservative ones. In principle, I’m not sure I believe the government should have laws preventing people from taking their own lives. It strikes me that this is beyond the remit of the state. The right to life includes the right to end one’s own life. I don’t believe suicide is morally right, but also don’t believe it’s my business to force that belief on others.
But in practice, assisted suicide calls into question whether or not the state has an interest in preventing other people from helping a person take his or her life. I think it does, if only because too many of the cases we hear about strike me as perhaps not entirely voluntary, and if suicide isn’t voluntary, it’s… something much darker. I worry that while assisted suicide in principle work perfectly fine, in the real world it falls into a gray area where compulsion and coercion rear their ugly heads.
Finally, I think there is a dramatic moral difference between a government turning a blind eye to people who choose to take their own life, and a government using the power of the state to facilitate that choice. Especially when we are talking about real-world cases which fall into a gray area implicating coercion. I also believe that this issue begins to shed light on one of the deep and fatal flaws in the case for nationalized healthcare. Which brings me to my draft from last year:
By now, the travails of Canada’s trial with assisted suicide (medical assistance in dying, or MAID) are well known. If John Gustavsson is correct, it may soon be available in the United Kingdom too. While it is often pitched in moral terms – society shouldn’t gainsay an individual’s choice of a painless and dignified death – Gustavsson points out that there is another consideration driving the Labour Party’s proposed MAID legislation. Prime Minister Starmer is desperate to cut costs and wait times at strapped NHS hospitals, and allowing terminally-ill patients to choose death may achieve that. As Gustavsson says:
“There is no denying that the Canadian [MAID] system is a money-saver. A substantial share of lifetime expenditures on health care takes place in the last six to twelve months of life. In countries with universal health care, this cost is borne by the public. In most of those countries, that is also true for the cost of nursing homes and other social care for the elderly and disabled.”
In America, where rising healthcare costs drive public debt and create financial pain for millions, this point may resonate with some folks. The elderly use a disproportionate share of healthcare. A young woman once told me that the vast sums spent to keep infirm individuals alive and comfortable were actively destroying the planet and taking scarce resources away from the rest of the population. Moreover, she added, their quality of life is poor anyway.
Russ Roberts, of EconTalk, offers a different perspective. He sometimes remarks that a society willing to spend vast sums of money to keep individuals alive and comfortable is a decent society which values human life and dignity so much that it puts its resources into medical treatments for increasing lifespan and improving quality of life in old age.
My friend offered the more common view on the part of young Americans today – that human life is a drain on the planet’s resources. Roberts offers a more hopeful view – that human life is a positive good. The discussion around MAID hinges on the disagreement between these two. The central question is whether the world is zero sum. If so – if prolonging life exhausts precious resources and giving medical care to the dying inevitably requires rationing medical care for children – then my friend is correct in her view, if perhaps not in her formulation. It is important for societies to take into consideration quality of life and years left when rationing medical care, and the disproportionate share of healthcare taken up by the terminally ill reflects a basic unfairness.
But if, on the other hand, the world is not zero sum – if demand for medical care by the elderly drives medical innovation which ends up benefiting our children and grandchildren – then Roberts’ view is correct. A society in which people spend money to keep their loved ones alive is a society marked by love of life.
Discerning readers will have picked up on the subtext contained in Gustavsson’s line, “In countries with universal health care, this cost is borne by the public.” Nationalized healthcare systems, despite their high-minded ideals, are necessarily zero sum. They depend on contributions made by the working public through taxes. They face hard limits defined not by the laws of nature but by the laws of nations. They are zero sum because no system of economic planning ever derived by man has escaped the trap of being zero sum. There is only one system in the tragic history of the human race on this finite planet which has ever been positive sum. There is only one system which has ever taken limited resources and created more than enough to meet people’s needs.
This is the system which Adam Smith called “the system of natural liberty,” and which you and I know as capitalism, or free enterprise. It isn’t really a system at all, but rather an unplanned, spontaneous order which arises when human beings are left free in peace to pursue their own lives as they see fit.
The environmentalists today who see humans as a burden hearken back to Thomas Malthus, who foresaw untold famine should the human population be allowed to increase. Malthus was right in the context of his time, in which life was governed by scarcity and poverty, but he failed to foresee the market revolution which would transform human life, lift billions into abundance, and solve the problem of famine.
If we are plagued by shortages in medical care today, how much more were our ancestors plagued by food shortages? Indeed, the chief fact of human life until the nineteenth century might have been the scarcity of food. And yet, when the proper conditions were laid (property rights, the rule of law) and human beings were left alone to innovate in the pursuit of profit, they created abundance where once was scarcity.
Throughout history, when kings and governments have tried to plan and control food production, scarcity and famine have followed. In a command economy, food is zero sum. In a capitalistic economy, food is so abundant that more people die from eating too much than too little.
All of which leads to the conclusion that in a planned economy, my friend is right about the world and about human life, but in a free market Russ Roberts is right. And more specifically, in a nationalized healthcare system, medical care is zero sum. But in a free market system, medical care is not zero sum. The demand for medical treatments drives inquiry and discovery, it drives demand for doctors which leads to higher salaries, which leads to more medical students. Healthcare dollars are an investment in the future. And terminally-ill patients are not a burden on a rationed system, but valuable human lives.
This is why free market medical care is morally superior to nationalized healthcare. Only in a capitalist economy are human beings not burdens but valuable contributors to a positive sum system. Only in a free market can healthcare supply meet healthcare demand.
Of course, when I say, “free-market healthcare,” I am not talking about the healthcare system we have now. I am talking about one in which supply is not constrained and demand is not subsidized, in which a cartel doesn’t artificially cap the number of doctors by limiting entrants into medical schools, in which doctors and patients are free to transact as they choose, in which the government makes no attempt to centrally control prices. This is a far cry from our system, but at least our current system has enough freedom left in it that we aren’t where Canada finds itself.
The debate around MAID is a fraught one, with proponents talking about the fundamental right of voluntary choice, and detractors worrying that perhaps that choice isn’t entirely voluntary in some cases. And while its ethicality is outside the scope of this essay, the debate around it sheds light on a different question, the question of the best healthcare system for human flourishing. That would be the system in which human life is valuable and in which medical care is positive sum: free-market capitalism.