Life, Liberty, and the Pursuit of Mandates, Part 1

The debate over health care reform has taken on sense of monumental importance for a number of reasons. The White House has basically put its prestige on the line, and this has created a political need to accomplish something called health care reform. Some have even decided to claim the moral high ground by claiming they are fighting for a human rights issue.

The first thing to understand is that there is no right to health care, although it is not difficult to imagine why one might believe there is.

The US's Declaration of Independence states, "We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness." A reasonable level of health care is certainly a precondition for Life, and arguably for Liberty and Happiness as well.

The UN's Universal Declaration of Human Rights also declares, "Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control." The US has considered the Declaration of Independence as a moral obligation since the time of President Abraham Lincoln, and the US is a signatory of the Universal Declaration of Human Rights. So the whole matter would appear to be settled.

Not so fast. There are other preconditions to Life, and some of these are mentioned in the UN declaration as well. Namely, Life depends on the availability to adequate food and shelter (there are those who argue if clothing is actually necessary). This means there is a human right to food, and this right is more fundamental than the right to health care (food can sustain Life without health care, but health care cannot sustain Life without food). How has this right to food been handled?

Estimates of the number differ, but there is consensus that millions of people in the US do not get enough to eat. The US also has plenty of food, so much so that many US farms receive subsidies to produce less than their full potential. Combine ample supplies of food, individuals' right to that food, and a breakdown somewhere getting the food to the right people; the only logical conclusion is that the government must step in to rectify this market failure. Indeed, the government has.

Did the federal government buy all of the food and distribute it to the people? Of course not. Government agencies and nonprofits have developed to serve specific populations. The market is functioning just fine for the vast majority of Americans, and the gaps are addressed with as little nonmarket allocation as possible so as to preserve that market. The system is imperfect, but no one is advocating a Universal Food Service approach.

The federal government has regulations mandating minimum standards for food, but this has little to do with delivering food to those who need it. Article I Section 8 of the US Constitution gives the government authority to regulate food, but only if it crosses state lines. Community gardens, farmers’ markets, local produce used in restaurants, etc. are all outside of federal jurisdiction (the idea that anything could be outside the federal government’s jurisdiction comes as a shock to many).

Programs to provide food to those in need exist alongside ("compete with") private enterprise, but the programs serve only those not served sufficiently by the regular market. A problem delivering health care to a segment of the population is similar; an underserved segment of the population is cause for targeted intervention, not cause to uproot the system with which the vast majority of Americans are quite happy.

When the government attempts to provide universal service in competition with private providers, a pattern always emerges. The government stacks the deck in the public entity's favor (e.g., the legally mandated minimum fees for couriers and delivery companies are higher than US Postal Service rates, the taxes collected to educate a child always go to a public school rather than follow the child to whatever school he/she actually attends), consumers show near-universal preference for the private version, and market distortions from stacking the deck put the private version economically out of reach of many who otherwise would choose that option.

The proper thing for these public entities to do is to contract in scope and provide only to those who need them, letting an efficient market handle the bulk of the population. Government bureaucracies don't do contraction very well, so the whole market suffers. Enacting an overbroad government health care plan would be extremely difficult to undo, so too little is definitely preferable to too much.