Last month, the Boston Globe published an op-ed written by two medical doctors which attempted to establish a dichotomy between two possible policy options: the individual mandate and the single-payer national health insurance program.¹

The first approach, which was made law in Massachusetts and will be instituted in July of 2007, forces uninsured and underinsured residents to purchase additional coverage. This coverage is highly subsidized by the state (i.e. by taxpayers), despite being marketed as a solution encouraging individual responsibility. The other approach is the system that has been instituted in Australia and Canada, in which the federal government finances universal health insurance. This approach is championed by the authors of the op-ed. The authors, in spite of making dubious inferences and statistical references, make no attempt to hide the ultimate source of the financing. Brazenly, they write: "The program would be funded by an increase in taxes," and "It would be an improved and expanded version of Medicare."

Although the second proposal is drastically worse than the first, the differences are, in a sense, superficial. Both options use force, and both involve redistributions of income. In a different era, both would have been publicly exposed as futile and statist by the great identification of French enlightenment economist Frederic Bastiat: "The state is a great fiction by which everybody tries to live at the expense of everybody else."

Philosophically, what allows such utopian proposals as single-payer national health insurance to gain a following in the profession is the unfortunate fact that today's doctors are unequipped to defend themselves against calls for self-sacrifice. As medical students, these doctors are told, and many believe, that the only proper motive for entering medicine is to help other people—not intellectual challenge, love of the field, or to earn a good living. In other words, doctors are told they must be altruistic, self-sacrificial, and prideless. The guilt that this false theory of morality inculcates is a powerful psychological tool. It is exactly what advocates of state-run medicine need in order to attract the new breed of doctor necessary for their grand vision: the 9-to-5 bureaucrat physician who would rather practice medicine out of a government manual and treat "the public" than think for himself and treat individuals.

Government-funded medicine means government-controlled medicine; it is an inescapable truth of political economy.² To see doctors march into these programs not reluctantly or hesitatingly, but willingly, is chilling.

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¹ Hochman and Woolhandler, "Healthy Skepticism," Boston Globe, October 28 2006

² Feldstein, P.J. Health Policy Issues: An Economic Perspective Health Administration Press. Chicago IL. Third Edition, 2003.

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