Tuesday, March 23, 2010

Restricting Choice

We often appreciate having many options in the things that we do. There are different colors in clothes, different sizes in shoes, different lengths of time for massages, etc. Chances are, if anyone proposed limiting our decision-making in any of the just-listed goods/services, we would be very resentful. What if I don't want to choose between a red sweater or blue sweater, but instead want a black sweater? What if my feet don't fit into a size 5 or 15, but rather a size 10? Or what if I neither like to wear sweaters nor like to wear shoes? Instead, I prefer light jackets and sandals. But no matter how simple and logical all of this is, support for the recent health care reform bill seems to emanate from an alternate realm in which restricted options are actually the preference.

I can only think of one criticism of the above that could be offered as a reason for desiring fewer choices: what if not everyone can make a desirable choice and by limiting others' choices we could give everyone at least something? This is not a novel argument, in general. It has been used to justify various collectivist ventures throughout history, whether that be for a country as a whole or for a particular program within a country. The most important question to ask of such a proposal is how does the non-restrictive status quo in certain industries fare when it comes to concern for those who can't make a desirable choice?

We might as well use some of the examples listed above. With clothing, we don't just choose among colors, we also choose among different types. What do we know about the different types of clothing? For one, there are tons! There is clothing catering to the extremely wealthy (that often looks so fashionable the average person often hopes only a small segment of the population will even wear it), and there is clothing catering to those less well off. With shoes we see the same thing. And that goes for massages too, with both high-end spas in existence and cheaper spa-like operations offering their services too. Nobody's options are restricted in these goods/services, yet we see an abundant variety that could cater to just about everyone. We also have non-monetary transactions that take place like clothing donation and friendly massages, for those who either can't or don't want to pay.

So then why are there so many problems with health care? Well, the market for health care is not remotely close to as freely operating as the markets I just described. Just think about it. There are various medical associations with exclusive memberships that drive up the cost for everyone if medical providers are required to join. There are pharmaceutical companies whose products are patented, preventing competitors from driving down prices. These are the types of things that indirectly restrict choices (indirectly in the sense that nobody is telling you that you can only shop at this medical provider, but rather someone is telling potential medical providers that they can only be medical providers if they do X and Y). The cure for these ills is not a superficial correction of the undesired outcome ("just give this guy what he can't get"); it is a critical examination of the underlying fundamental characteristics of the problem at hand ("what is it about this situation that is making this guy unable to get what he wants?").

What one should begin to realize is that by requiring everyone to purchase health care, in addition to the already choice-restrictive elements of the health care market, we are moving in the exact opposite direction of that which we would move in if we wanted to emulate the clothing, shoe, or massage markets. There is irony in the fear of what might happen if we do so because we already see the bad outcome of restricting choices. There is a painfully consequential misunderstanding of the status quo. We do not currently have many options when it comes to health-related services. So if right now we recognize many problems with health provisions, and right now we recognize that the provision of health care is not full of options, why would we want to further restrict our choices? I thought the current outcome is the problem! There is indeed a serious issue with health care in this country, but the solution is not even more of the failed same, no matter how much it might be marketed as "change."