Why fire and police departments, but not health care?

TALKER asks why, if it makes sense for government to fund and manage the military, police, and fire departments, doesn't it also make sense for the government to fund and manage health care and other favorite liberal causes? As a CATO-supporting libertarian -- with progressive leanings -- let me try and explain.

We libertarians look at the world and notice that the vast majority of innovations that improve people's lives come from individual inventor/entrepreneurs, and the companies (sometimes their own) which sell and market those improvements to the mass public. For hundreds of years now, since the modern corporation was invented, entrepreneurs and private enterprises have improved prosperity by providing a broader range of products and services at lower prices over time.

Back in the 1800s, the free market brought us farming innovations (plow, reaper, etc) that helped us feed more people using less labor, growing our population, and allowing more Americans to move into cities where specialized merchant and blue-collar classes grew and prospered. Cities and labor specialization brought us all of the industrial and information age innovations that drive our economy today. Innovations in transportation (trains, cars, planes) help us move people and goods faster and more cheaply every year. Innovations in communications (telegraph, telephone, TV, Internet) allow us to communicate with one another much more easily than ever before -- at almost no cost. The list goes on and on.

In contrast to all of these market-based industries, which almost every American agrees provide more public benefits (more choices at lower prices) under private/corporate control than they would under government control, the military, police, and fire departments, are unique enterprises whose chief purpose is to "ensure the safety and security of Americans" and "enforce the law". These are two critical areas where even libertarians agree that it is better to have one monopoly enterprise enforcing the law, or protecting public safety, than multiple competing enterprises.

When it comes to the use of force, the belief is that a nation will be more safe and secure if it has one military than if it has five (or one police department as opposed to 5). In other words it is preferable to have less competition, and slower innovation, in military and police "industries", by having just one government-run monopoly "business" than the negative side-effects we would have if there were 5 American militaries running around and competing with each other. The same goes for police forces (which, since they are organized locally, actually number in the hundreds nationwide -- but each has a monopoly over a tightly defined geographic area).

So what about health care? Or what about other favorite liberal causes (ie. Social Security, K-12 education, etc)? Well, these "industries" do have some connection to "ensuring the safety and security of Americans", and that's why I would agree that there is some role for government to play in these industries. Personally, I believe that government is playing far too large a role -- and that we could benefit greatly from more innovation, more competition, and reduced costs in health care, K-12 education, etc, if we allowed the market to play a larger role -- but many liberals seem to think that government monopolies would be better at all of these enterprises.

Why on earth would folks think that? Personally, I am not certain where this confidence comes from. Government monopolies have never been very good at doing anything. Amtrak does have its trains running more on time than they used to, but the system has been losing $1B per year for more than twenty straight years now, and their attempt to implement high-speed Acela trains in the 1990s had numerous problems that are still not fully solved. The US Postal Service does deliver mail better than they did in the 1960s, but all of the innovation in the "letter industry" have come from private enterprises (UPS, FedEx, etc). Even the military buys many of its products and services from private entities (Lockheed Martin, Boeing, Blackwater, etc), because private companies have incentives to drive innovation, make things more cheaply, and increase profits. Innovative military hardware like the Predator aircraft are not very often invented by government employees -- the invention usually occurs at private companies under government contract.

So why would a government run health care system be any better? Most liberals point to Sweden, England, or other countries that have state run health care systems. I will readily agree that these countries health care systems are better than our 50% private, 50% public health care system. However, all of these other countries benefit greatly from the innovative new procedures, drugs, and medical technology that are most often created by private and quasi-private companies that make up the 50% private portion of American medical care.

I have read Maggie Mahar's book, and -- although she does a great job outlining the history of how we ended up with the terrible hybrid Health Care System that we have -- I think the way she leans her book towards recommending a fully-funded government-managed single-payer system would result in Americans having Amtrak-like health care 10-20 years down the road, and therefore isn't the best policy option for our country.

Instead, libertarians like myself believe we should tailor government intervention in the health care market very tightly and carefully at places where the market won't automatically "ensure the safety and security of Americans" or "enforce the law". Outlining those areas will require a completely new post, so please look forward to that in the coming weeks...

No healthcare? Easy answers...

1. The pharmaceutical industry would stand to make very little money.
2. if America's health was truly a concern to the gov't, they would focus intensively on prevention. As it is, they don't. This way the Rx industry makes tons of money, and so does the govt. Doctors, however, can't even pay back school loans.
3. Clearly, then, the bottom line is money. And people spend it on healthcare, are health illiterate, and then die, in which case their money goes to...heirs? NO! Uncle Sam.
4.So if we could find a way to make health productive for the economy, JOE, let's do it!

a random Joe (not verified) | October 26, 2007 - 1:36pm
talker's picture

on the nail

Quake - In a round about - and enjoyable - way, I think you answered my initial question: the government should step in - "tightly and carefully" - where the market doesn't "automatically ensure the safety and security of Americans." I agree entirely.

Looking forward to your next post - when we get to find out where those areas are!

talker | October 14, 2007 - 1:58pm