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Do fat people deserve medical treatment?

by David Veksler David Veksler 3 Comments

Faced with an “obesity epidemic“, that has dramatic consequences for medical costs, pundits have proposed different solutions, ranging from excluding obesity from health insurance, government-run prevention campaigns, higher taxes on junk food, or higher premiums for fat people.

The possibility of greater government involvement in medicine with the passing of ObamaCare puts this debate in a new light. If the government decides who gets money for medical treatment, the question of whether fat people deserve medical treatment will become a political issue.

The question of who “deserves” treatment is only conceivable in a welfare state. In a free, capitalist society, people are able to allocate their wealth according to their judgment of the merit of their own and other’s health, including the degree to which they are culpable for their condition. However, there is no rational way to allocate property taken by force.

Does Jake, who became paralyzed because he liked extreme sports, or Kate, who has lung cancer because she is a smoker, or Mary, who has problems because has a tendency towards obesity which she does not try to control with diet or exercise, or Sue, who is dying from old age, and whose life might be slightly extended at tremendous cost deserve my money?

Once the idea that theft is justified because others need something is accepted, there is no objective way to decide which group is more “deserving” or which values are most “needed.” There is no way to make moral evaluations when “need” trumps justice and morality.

Justice and merit are moral concepts. To “deserve” someone’s property, is to have a moral claim to it. We create a claim to someone’s property when we engage in voluntary transactions – such as labor for wages, or goods for services, child care by choosing to bear children, or paying for injury if it is due to our neglect. But to claim that someone “deserves” our wealth merely by the fact of them being alive implies that some human beings have a moral claim on the life and values of others. That is a form of slavery. A modern, democratic and egalitarian form of slavery, but still slavery.

For someone to receive medical treatment, someone else must first create the wealth to pay for it. In a free society, people produce values voluntarily, and exchange them to mutual benefit. But the premise that someone has “a right to healthcare” means “a right to” seize values by force from those who produce them and give them to those who didn’t earn them. In such a slave society, people exist and produce values by permission, to the degree that those in power find them useful. Whether their values are seized directly, such as in socialism, or nominally theirs, but controlled by the state, such as in the fascist state our healthcare system is in, is irrelevant.

Some “moderates” argue that sick people “deserve” medical care when their misfortune is not their fault. But why should it matter whether they are responsible for their condition? People desire all kinds of values, whether cars, iPhones, shoes, friends, plastic surgery, or a long life. Sometimes they succeed in gaining those values, and sometimes they fail – whether it is due to a character flaw, ignorance, or just bad luck. But whatever the reason for their trouble, why does their misfortune give them a right to steal those values from an innocent third party?

If it is impossible to allocate socialized medicine objectively, how is it allocated? It’s simple – the group that ends up getting the loot is the one which has the most guns. In a democracy, where ballots are the bullets, the biggest, most corrupt, and politically-connected group wins. The implied message of their “awareness” campaigns is “my gang has more guns than yours.” The monstrosity of the welfare state is that the more virtuous and productive a person is, the more of his life and values he is forced to sacrifice, and the more unproductive and needy he is, the more he is rewarded for it. Like all forms of statism, medical socialism punishes virtue and rewards vice.

No such thing as a free lunch

by David Veksler David Veksler 1 Comment

When arguing against the Genetic Information Nondiscrimination Act last year, I wrote

If discrimination based on comprehensive genetic screening is legal, we can expect health providers to tailor plans according to our individual risk factors. That might be to the disadvantage of a minority of high-risk individuals, but greater information about risk factors will lower uncertainty, and thus lower rates overall. Furthermore, insurers will offer incentives to people who take proactive steps to discover health risks and take steps to alleviate them. Expensive procedures such as frequent biopsies or preemptive removal of organs might be fully covered for individuals whose genetic profiles uncover a high cancer risk.

Unfortunately, Congress did not heed my arguments, and banned genetic discrimination anyway.  It is now illegal for health insurers to take genetic factors into consideration when setting premiums.  What effect do you think the law had on the incentive of insurance companies to pay for their customer’s genetic screening?

If the goal of the law was to encourage genetic screening, it clearly had the opposite effect.  In response, celebrities are now “fighting for women to have access to MRIs and genetic testing.”  Having forced insurance companies to ignore the results of genetic testing, people now want to force them to pay for it.

Do you think that people who find out that they have a higher probability of having an illness with genetic factors would be more likely to purchase more health insurance than individuals with a low probability of genetic illness?  As I wrote last year,

It does not take an economist to predict that rates would immediately rise, as healthy people, refusing to pay for their neighbor’s health risks, stopped using insurance altogether. As the young and healthy jump ship, insurance companies would have to increase rates, accelerating the trend. Without further government interference, the health insurance business would disappear completely, shortly after millionaires on their deathbeds became the only people able to afford policies.

Are you still wondering why healthcare is so expensive in the U.S.?