Oaks on Religious Freedom

Elder Dallin Oaks speaks out on religious freedom.

Religious Freedom at Risk

Right to Health Care: When Freedom is Slavery by Another Name

Health Care a Right?
"Health care should be a right", says Representative John Dingle. I've heard this same impassioned comment from dozens of others. The language of rights is powerful in American history, so the assertion has a compelling feel to it. Isn't the right to "life, liberty and the pursuit of happiness" our most sacred principle of freedom? Without good medicine your life and happiness are in great jeopardy. So obviously,the logic goes, health care should be guaranteed to all freedom loving citizens. In fact, we should also be free from want and...and from fear itself! But not so fast...

Let me show you the sleight of hand. It's quite simple. The triumvirate of rights (life, liberty, and the pursuit of happiness) refers to what in Natural Law is known as inalienable rights. These are rights that, in the rawest state of nature (say if you were alone on a tropical island) you would be guaranteed to have. These are God-given innate qualities of the human condition. They exist without a social contract. We are designed to assert these rights even as Nature challenges them with hunger, disease, and the elements.

Then comes society. With society comes the ability to exchange rights with others. These are "vested" rights. Vested rights occur as the result of exercising inalienable rights. You can use your free will to voluntarily trade your right to property for a right to someone else's property. The key word is voluntary. Successful societies have learned how to create law which promotes the inalienable rights of everyone. Because everyone has different talents, true protections of inalienable rights will always lead to unequal outcomes.

The concept of a right to health care descends directly from the notion of "freedom from want". Franklin Roosevelt first articulated this progressive ideal in his "Four Freedom's Speech". This "freedom" refers to the guarantee of receiving goods and services. In the rawest state of nature, goods and services don't exist. They are created through the application of labor. Nature bestows no absolute right to the fruit of of someone else's labor except through brute force. It is one thing for you to say "I have a right to pick that apple" and quite another to say "I have the right to force you to pick that apple for me". Having the "freedom" to take the produce of another used to be called plunder and slavery.

Photo of Benkos Bioho by who is that with rachel

The guy who says that health care should be a right is saying "I have a right to force people to serve me". 16% of U.S. GDP is devoted to creating the good s and services of medical care. It represents millions of people working hard each day. Should we have a right to their labor (or the labor of the tax payers funding them) for little or no cost? The real kicker is this: that mentality is equivalent to the thinking of southern slave owners two hundred years ago. The slave had no rights to the fruit of his own labor. They belonged to somebody else. He was compelled to provide goods and services to somebody else at no cost. In addition, the slave could not live his life freely. His owners told him how to live his life (being healthy was definitely a requirement). Current health care proposals in Washington contain both these aspects of slavery.

Elements of coercion, to some extent are necessary evils of any society. We have had a military draft. We have had eminent domain seizures. We have had quarantines. But aren't these the exceptions to the rule? The principles of freedom require that we always try to minimize such coercion.

A note about taxes. Taxation is an example of a necessary evil. You can never get unanimous consent from all citizens about whether to be taxed and by how much and for what purpose. Since this subject deserved a full exploration, I wrote about it at length here: Freedom Based Taxation. In short, we can balance the freedom of collective action with that of individual action. The evils of taxation can be minimized by observing the locality principle and by ensuring that the benefits are shared equally by all.

Partial Slavery
I probably won't have many people argue with my view that outright human bondage is a bad idea. I think most would agree that we'd rather suffer a reduced quality of life than live directly on slave labor. Examine the condition of a slave. Would it make it better if we gave the slave Saturday off? On Saturday he can keep all his earnings and do as he pleases. Does that make it better? Okay, let's give him 3 days off. Now he's 42% free. Probably not good enough, so how about he only has to work for his master one day of the week and we'll let him pick which day. Now he's a fractional slave only 14% of the time. Lastly, let's let the slave be free to leave the plantation entirely but he must remit 14% off his earnings back to his master. Are we good now? I think it is obvious that nothing short of 100% free will do, don't you agree? But today, some taxpayers are fractional slaves to others. 4 in 10 tax filers pay no federal income tax at all and the top 50% pay 97% of the taxes. Clearly, an unduly large class of Americans receive benefits paid for by others without their consent.

"Freedom from want" entails large scale widespread coercion. No people in history has ever enjoyed freedom from want. It is part of Nature's Law. "Want" is what drives people to action. The current drive to nationalize health care is just one more attempt so solve social problems at the expense of individual freedom. It cannot but increase the level of fractional slavery we already have.

Take a look at some of the popular arguments for slavery and compare them to arguments for nationalized health care. In each case the speaker illustrates a supposed tangible benefit. Does material comfort trump principle?

Argument Type	Slavery	Nationalized Health Care
Because others do it	John Calhoun: "There has never yet existed a wealthy and civilized society in which one portion of the community did not live on the labor of the other"	Paul Krugman: "...every other advanced country offers universal coverage, while spending much less on health care than we do. "
Paternalism	Calhoun: "look at the sick, and the old and infirm slave, on one hand, in the midst of his family and friends, under the kind superintending care of his master and mistress, and compare it with the forlorn and wretched condition of the pauper in the poor house."	Barrack Obama: "I will make sure that no government bureaucrat or insurance company bureaucrat gets between you and the care that you need"
Stability	Calhoun: "I venture nothing in predicting that the experience of the next generation will fully test how vastly more favorable our condition of society is to that of other sections for free and stable institutions"	Obama: "Now, that's what Americans who have health insurance can expect from this plan -- more security and more stability."
Economic	Chancellor Harper: "And what would be the effect of putting an end to the cultivation of these staples [cotton and rice], and thus annihilating, at a blow, two-thirds or three-fourths of our foreign commerce? Can any sane mind contemplate such a result without terror?"	Max Baucus: "We need to pass very strong, comprehensive healthcare reform this year...Otherwise American families are gonna pay half of their family income on health care premiums"

It is ironic that the practice of partial slavery is more advanced today in what are known as "the blue states". These states were once the liberators who sacrificed life and limb to enforce the Emancipation Proclamation. Progressives in these states still see themselves as liberators. These political cartoons were published during the 2004 election in an attempt to link southern conservatives with slavery. Oh the irony:

(Click on image)

Also see this one

Freedom Based Taxation

Taxes are 100% constitutional and fully consistent with the principles of a freedom loving people. However, taxes become a form of slavery when they systematically and purposefully redistribute wealth. Wealth is simply the product of someone's labor. Whether the laborer is Bill Gates, or a cotton picker in the 1800's, when the fruit of the laborer is given to another without consent it is coerced servitude. The principle of freedom in taxation is that the benefits of the taxes must be general and fall evenly upon all citizens. This implies that taxes should be as local as possible. It also means that private alternatives should always take precedence over public programs. The fire department is a good example of the locality principle. Research at the National Institute of Health Sciences is a good example of the general utility principle as it produces knowledge that is available to everyone. I'd even say NASA is of general benefit even if you aren't a space buff. Federal highways are OK too.

However, here is where we depart from the principles of freedom in taxation: 1. overly progressive taxes, especially "negative" taxation, and 2. general fund expenditures on individuals and special interests. When the government reduces the level of tax to zero (or below zero) for a class of people, they are reaping the rewards paid for by another class of people. I'm not arguing for a capitation tax, nor even necessarily a flat tax. I'm just saying that the lowest income tax level should not be zero! And the highest should not be confiscatory! Today, because of so many tax deductions and credits, 4 in 10 Americans pay no federal income tax! How well does that bode for freedom when 40% of Americans have no incentive as voters to control federal spending?

Second, whenever the government writes a check to an individual so they can receive a benefit that is unique to them, unfair wealth redistribution occurs. Welfare payments out of the general fund to select groups of people based on things such as health status or income level are unequal expenditures which benefit a few at the expense of others.

In the U.S. we have at least tried to pay lip service to freedom principles in our welfare state. Social Security was envisioned as a separate fund dedicated to one purpose. It was to be self-funded and it would theoretically (except for the lucky first cohort) pay out about as much as you paid in. Thus, it wasn't supposed to be redistributive. It was a mandatory savings program. Medicare was to be the same. Of course they are both ponzi schemes and we all know it. Today, both of these programs simply represent a massive generational transfer of wealth. Current workers are slaves to current retirees and will not receive back what they paid in.

But what if taxpayers voluntarily vote to extend benefits to select groups? Well, up until the early 1900's, it was understood that payoffs to special interests, even if charitable were unconstitutional. See these examples. We are now flouting the constitution with programs like Medicaid and CHIP. But still, if taxpayers approve of it, isn't that their freedom based prerogative? No, inalienable rights* should not be voted away and the Supreme Court should not allow it. The fact that it has been allowed shows how far we've strayed from the principles of freedom. Additionally, you will never get unanimity among tax payers, so somebody is going to be forced to pay for something that they don't benefit from.

^{*The right to property is an inalienable right. Before Jefferson, the three liberties were "life, liberty, and property".}

I agree that there is a gray area. The welfare state proponent will no doubt say things like:

1. The benefit is general because program X reduces crime, for example, and lowers costs to you in other ways.
   
2. You might need government charity someday too. Consider it insurance of which you are a beneficiary.
3. What about that fire department you mentioned? Not everyone will have a fire. So it's like insurance. Why can't we have health insurance for all too?
   

These arguments have a valid point, but one that has a built-in answer in the American system of government. The answer is local rule. The smaller the unit of collective action, the more likely it is that the beneficiaries of the activity will be have the same needs and interests. Taxation will always be an imperfect vehicle for equitably representing the desires of the the tax payer. The best we can do is to ensure that the taxpayer's contributions travel the shortest distance away from her as possible so that she can see it's effects and have a greater say in remediation of any improprieties.

The fire department, again, is a great example. Different places in the country have different approaches to fire fighting. Some areas rely only on volunteers. There is no one-size-fits-all approach. Ever since charity went Federal, we've noticed many more abuses of it. Who is a greater steward of charitable benefits, the man who receives a check from 2,000 miles away or the man who sees his benefactors as neighbors? Keep it local! And when possible, keep it private!

"The government of the United States is a definite government, confined to specified objects. It is not like the state governments, whose powers are more general. Charity is no part of the legislative duty of the government. "
--James Madison

Taxation will always be messy and imperfect. But this does not give us license to view the "rich" as an ATM and for the "poor" not to contribute. And on the spending side, if there is a risk that a program will only benefit a select group, it needs to be rethought or pushed down to a more local group (state, county, or city) or to the private sector.

My Freedom Based Vision for Health Care Reform

My Freedom Based Vision of Health Care
I would like to offer my vision for American health care for the 21st century. This vision statement is not a specific policy recommendation. It is a vision of what the world could be like after a series of incremental changes. I present my vision first because it is essential, in the current health care debate, that we have a common vision before we argue about specifics. I occasionally make mention of specific policy changes in order to persuade you that the vision is realistic. But keep your eyes on the big picture and see if you don't agree that this is a world that you'd want to live in.

My vision of health care is guided by some core principles: I believe in charity and sacrifice by those blessed with more, but I also think people should lie in the bed they make for themselves. I believe in free choice. I believe that the United States has been the beacon of freedom to the world, and that it needs to remain so.


My Vision
I envision a health care system where people choose their doctor and pay their doctor much in the same way that we choose our barber or our mechanic. People would save for health care the same way they save for home or car repairs. They would budget for it and it would be their choice where to go and how much to spend. Prices would be just as transparent as they are at the local department store. And the less fortunate would have no need of insurance because society would provide free care the same way we provide Section 8 or food stamps (no mansion, and no fillet mignon but you do get what you need)

Health care would be often be delivered at home. I'd have phone and email access to my doctor. Nurses would be allowed to do more. The licensing system for medical professionals would allow for much greater latitude in the use of physicians assistants (PA). These PA's would roam the cities to deliver in-home care at hours that are convenient for their customers. People would rarely visit the hospital. Broken leg? A PA would drop by (much like a plumber drops by for emergencies). They would be licensed to perform all manner of outpatient care. Self-blood draws and self-measurement would be the commonplace. Nobody would trudge into the doctor's office just to have their throat cultured. Everyone would have health appliances that can send vitals electronically to their doctor. An additional tier of prescription drugs would be created that would allow some drugs to be prescribed by a pharmacist (Electronic medical records would be an enabler for this.) More drugs would be available over-the-counter.

My medical records would be available instantly from a medical record provider of my choice. Standards bodies (much like the ones that govern the Internet) would ensure portability of records to any service provider. Privacy laws would be enforced to ensure my data remains private.

An aside on a new personal health paradigm: The CEO of Intel, Paul Otellini recently wrote of an entirely new paradigm in health care. Please read his views on a paradigm of personal health at Politico. You see, instead of copying France or Canada, the United States should lead.

Employers
Just as people are free to choose their doctors, they would be free to choose the funding model. No longer would employers be selecting insurance providers. In fact, the tax incentives that force employers to provide insurance would have been abolished. In lieu of health insurance, employers would have increased the salaries of the employees and gotten out of the health business. If the health of employees was important, they could require yearly physicals much like they do in the Armed Services. But they wouldn't be choosing how health care is delivered to their employees. No more worrying about losing health care because you lost or changed your job! (To get there, we need to tax employer health benefits and move the tax relief directly to individuals).

My Vision on Insurance
People would carry only catastrophic health insurance. This is much like how we use home insurance to cover unforeseen events. Home insurance premiums would sky rocket if we expected insurance companies to clean our bathrooms and replace our worn carpets.

The health of society would be measured by whether people receive care or not (the number of insured wouldn't matter). Most people would buy insurance. Some people would choose not to have insurance. In my vision of health care, these people would still receive the health care they desire and can afford. Most health care will be so affordable, it will be paid for out-of-pocket (and with tax credits) If they really can't afford it, they can receive charitable care, which I talk about below.

A word about genetics. In my vision, genetic information would be strictly guarded as a private information. Insurance companies would be prohibited from requiring genetic tests. But, as now, they would be able to ask about lifestyles, habits, and past health history.

A word about pre-existing conditions. If someone waits until their house burns down to get home insurance, it is too late. It would be down right nonsense to require an insurance company to take on a customer that will be a guaranteed liability from day one. Insurance wasn't invented to take care of people. It was invented to enable people to have peace of mind while they buy homes and have children during their prime working years. If you didn't buy this peace of mind, you will need to rely on charity, as I describe below.

My Vision of Charity:
Local and state governments would provide free access to student hospitals and clinics. The care in these hospitals would be rationed the same way it is in Canada. The difference being that, had they chosen to insure themselves, they would not be receiving rationed care. (In Canada you have no choice but to receive rationed care). And unlike Canada, the indigent care would be funded to a high degree by philanthropists, organizations like the United Way, and by state and local taxes. It is a fallacy that only the federal government is rich enough to help the poor. Several states refused New Deal handouts during the Great Depression and took care of their poor quite well. The funding of these clinics, in principle, would not come from the federal government. However, because the Supreme Court has already broadened the General Welfare clause, I would be swimming against the current to deny any role for the federal government. We would continue to provide Medicare-like services for the elderly. The federal government would be allowed to fund student and research hospitals which provide free care as long as it can be shown that the expenditures fell evenly across the states in proportion to their populations. Such federal expenditures would be modest in comparison to the size of the health care economy. In my ideal world, a constitutional amendment would have restricted all "General Welfare" expenditures of the federal government to be 10% of GDP or less.

Under my vision, every American would receive basic health care. Those who choose to provide for themselves will receive the best and most timely health care. We cannot turn our backs on the principle of the harvest. People must reap what they sow. If you didn't plan ahead, you will be cared for, but it will be Canadian style, and prompt delivery cannot be guaranteed. And your doctor will probably be less experienced. But look at it this way, those who receive free care are providing a service to society by helping doctors gain experience.

Cheap Health Care
In my vision of health care, we would honor contract law. Contracts that cap liability would be enforced. People would be free to undergo experimental treatments. The FDA would provide an experimental tier of drug availability. Doctors would guarantee their work, much like a roof contractor guarantees a new roof. Now, obviously, they can't insure every procedure will be successful. But they can guarantee specific treatments by providing free follow-ups and/or money-back if the customer is not satisfied. And because everyone is paying for their care in much the same way they pay their mechanic, costs will be driven way down for any treatments that enjoy economy of scale. (Think Brakes Plus, Midas Muffler, or Pep Boys.) And don't under estimate how cheap care would be if we allowed more in-home care as I mentioned above.

My Vision of Honoring the Constitution
In my ideal world, all law would have to be accompanied by a statement of constitutionality. People would honor the spirit, not just the letter of the the Constitution. The distribution of government from federal, to state, to county, to city would look more like a uniform rectangle rather than an inverted triangle.

The Constitution does not enumerate the power to manage health care. (Please read the 10th amendment in the Bill or Rights.) It does allow taxation and court precedent does allow spending on the "General Welfare". But the spirit of the law is that the federal government does not micromanage the affairs of the people.

Health care services arise from the fruits of someone's labor. Health care is no more a right than dental care, automotive service, or housing. That the government might decide to bestow services to the needy does not make it a fundamental right. Constitution guarantees equal rights, not equal things. Rights have to do with free agency, not with the receipt of goods and services.

A word about Social Security:
In my opinion, Social Security violates the spirit of the Constitution. However, it was found to be constitutional by the 1937 Supreme Court. The old-age portion of SS won assent by 7/2 vote and the unemployment portion squeaked through on a 5/4 vote. Some historians speculate that Justice Owens, the swing voter, was influenced by FDR's court packing scheme. So we now have a legacy in which the "General Welfare" clause of the Constitution can allow the federal government to justify almost any spending. But this does not nullify the spirit of the law.

And what if it can be shown that spending detracts from the General Welfare? If so, it is unconstitutional by any standard. Today, we have unfunded liabilities that if not fixed will eventually bankrupt social security. The 1937 supreme court approved a system that was self-funded. Today it is pay-as-you-go and is producing a huge generational transfer of wealth. The program has led to an unquenchable appetite for pork barrel spending. With 70 years of hindsight, we can definitely see that the program has exceeded James Madison's worst nightmares. What they needed in 1937 was a stimulus program with a sunset. That would have promoted the general welfare in a time of need and then returned the country back to the normal balance of power.

In my vision, two amendments to the Constitution would be enacted. The first, (as mentioned above) would keep "general welfare" spending to less than 10% of GDP unless temporarily overridden by a 3/4 vote. The second would be a balanced budget amendment (again with a 3/4 vote override provision).

Summary
In short, in my vision, freedom of choice is preserved while still guaranteeing help to those in need. I have no illusions about my vision being a panacea. It is just a vision. If only 80% of it were realized, we'd be the envy of the world. It would take a lot of work. As affluent as we are, we'd probably still pay 16% of GDP on health care but it would be by choice. And the rewards would be spread evenly across all people in a way that balances choice, accountability, and charity. Above all, this vision honors the spirit of the Constitution and preserves the principles of freedom which have blessed all of humanity.

Our Best Hope
The best legislation that I have seen to-date is The Patient's Choice Act. I don't understand why this Act isn't being discussed more actively. I know the President would be reluctant to give credit to two Republicans, but this bill addresses the insurance problem while providing a universal solution! He could claim victory at getting everyone covered and receive the bipartisan support which he claimed he would strive for.

Liberals, Conservatives, and the Political Spectrum

I remember being taught about stereotypes in middle school. A stereotype is an overly simplified description of a class of people. When used as a verb, it means to force people into little boxes into which they really don't fit. It creates a tendency to prejudice and false assumptions.

Such is the case with labeling people as conservative or liberal. Not only are these terms stereotypical, but they are not really that accurate. Today's conservatives can be described as classical liberals. Today's liberals can be described as neo-conservatives.

Furthermore, we have created a one-dimensional notion of Left versus Right. If you take the world's smallest political quiz you'll immediately realize how silly the Left/Right spectrum really is. The Quiz presents an improvement by adding another dimension.

But I think the Quiz authors (Libertarians I believe) miss the mark too. The opposite end of Statism should be Anarchy, not Liberty. This concept was well known to the founders of our republic. The political spectrum as they knew it was one in which being a moderate was a virtue (on the Left/Right spectrum, being a moderate has about as much clarity as the muddled conservative/liberal labels).

And so now I present you with the most concise description of political spectrum which informed the creation of the American standard of liberty: