Publicly provided healthcare is wrong

If it is really the duty of the state to take care of the public health, it is surely bound to adopt the most efficient means of fulfilling that duty. Why not then act upon the old adage, that “prevention is better than cure,” endeavour to keep the people always well? Enact a national diet—prescribe so many meals a day for each individual—fix the quantities and qualities of food, both for men and women, how much animal and how much vegetable—state the proportion of fluids; when to be taken, and of what kind—specify the amount of exercise, and define its character—describe the clothing to be employed—determine the hours of sleep, allowing for the difference of age and sex, and so on with all other particulars, for the daily guidance of the nation. Surely this would be much more efficient than any of these half measures, and, in principle, much about as reasonable.

—Herbert Spencer. The Proper Sphere of Government, 1842–1843.

Individuals should pay for their own medical expenses from their own personal contingency funds. They should pay for large unexpected expenses with their own insurance. The presence of a ‘safety net’ simply encourages people to squander all the money that enters their bank account, instead of saving some for a rainy day and investing in insurance premiums.

Healthcare decisions are personal

People are morally entitled to spend as much or as little on their own healthcare as they desire. If an old man prefers to spend money on a fishing trip than on cholesterol-lowering drugs, that is his decision. Some people live lavishly in their early age and die young. Others lead temperate lives preparing for lengthy old age. These decisions belong with the individual. Personal choices which do not hurt others are no concern of government. Government should not consider that it knows better than individuals how to spend their money.

The amount which can be spent on health care is infinite. Accordingly, there is a balance to be struck; for example, should the old man with advanced dementia be given a procedure to allow him to live another six months, or should the money be used to raise a child? The government has no right to make such personal decisions. This principle extends to the choice of insurance policies: some may opt for comprehensive cover and some for basic cover, but the decision belongs with the individual concerned.

Compulsory healthcare insurance for children

Health care for children raises different issues. Parents have a duty to their children which overrides, where necessary, the parents’ right to choose how they dispose of their own income. Parents are properly held to minimum objective standards set by society. Thus parents can decide what sort of food their children eat, but they have no right to starve them.

When an individual decides what health insurance to choose, he is gambling with his own life. However, when parents buy insurance for their children, they are gambling with other people’s lives. Therefore, it is only reasonable that a more conservative approach be taken. Just as trustees must invest conservatively because they are dealing with someone else’s money, so too must parents be required to gamble conservatively with their children’s health.

The items covered by compulsory children’s insurance should be defined in schedules. Determining the minutiae of those schedules is a question for each jurisdiction to decide. For example, whether parents have to pay for their children’s teeth to be straightened will depend upon advances that might be made in teeth-straightening technology (reducing its costs), and the level of the lowest incomes.

Regulation of insurers

Government regulation of insurance premiums is immoral as it interferes with the freedom to contract. Thus when the law prevents an insurer from charging a higher premium for pre-existing conditions, the effect is to convert private insurance into a socialist welfare scheme. It is no longer insurance because it is no longer based on risk; instead it is a deceitful tool for wealth transfer.

Insurance premiums and behavior modification

Insurance premiums should be set by the market, which means that ultimately they will be based on risk. As the premiums increase, behavior alters to avoid the increased premiums. This is generally a good thing—many people are unintelligent or lack the data to perceive the risks they take. Insurance premiums help them see the light. Thus, through higher insurance premiums the bungee jumper pays for his own retina to be reattached, the promiscuous homosexual pays for his own AIDS drugs, the obese person pays for his own diabetes treatment, the snowboarder pays for his own knee reconstruction, the smoker pays for his own chemotherapy, and so on. If by chance they cannot afford their premiums, it means that they are living beyond their means. Thus, the bungee jumper will have to get his highs from computer games, the homosexual will have to practice abstinence, the obese person will have to stop his gluttony, the snowboarder will have to take up train spotting, and the smoker will have to quit. The unmolested functioning of the market is essential to encourage people to behave rationally.

The chronically ill

Those who are chronically ill find themselves in a lamentable position. However, so do those who are:

  • Suicidal;
  • Alcoholic;
  • Retrenched from their job;
  • Obese;
  • Afraid of flying;
  • Cheated on by their spouse;
  • Attracted to abusive partners;
  • Dying of old age;
  • Depressed;
  • Uninspired;
  • Dumped by their childhood sweetheart and never got over it;
  • Intellectually challenged;
  • Self destructive;
  • Self defeating;
  • Bitter;
  • Hedonistic;
  • Unattractive.

The list goes on. There are countless afflictions in life, and the government’s role is not to try to fix them, it is merely to maintain a legal framework in which people can go about their own lives pursuing their own concept of happiness and redressing their own misfortunes (and those of others if they wish to be charitable).

The only role government has in relation to unfortunate people is to ensure they do not use coercion to inflict their misfortune on others. Thus, the chronically ill should be cared for by charitable foundations and trusts, fellowships, fraternal organizations, relatives, and the like. Those who doubt charity can cope lack faith in the inherent goodness of human nature. Good people will always be willing to make donations and volunteer their time to good causes—so long as they are not being bled dry by taxes.

A government ‘safety net’ may sound like a good idea; however, when people are given money by the government they soon regard it as their due. They demand more and more, and then send lobby groups to influence politicians—it becomes a graft-driven corruption of democracy. Moreover, when the government spends money, it is always spent inefficiently. By contrast, charities have limited funds so they make every penny count. Because they want to help as many people as possible, they tend to direct their efforts toward making invalids independent. Government welfare works the other way around; it debilitates the able-bodied by encouraging dependence.


The funding of research and development

The research and development of new pharmaceuticals should not be funded by government. Market forces should determine where money for research and development is spent. Charitable organizations and research trusts should be relied upon to delve into areas where market forces supposedly do not allow. It could be argued that the government has a role in funding research of drugs to cure diseases such as malaria. However, the government never gets value for money in such forays, so it should concentrate the public money on quarantine measures and proven programs (such as releasing sterile mosquitoes, removing still water ponds, etc.). Humanity will eventually conquer all diseases, but history shows that progress in that direction is quickest made through private endeavor, both profitable and non-profit—not through government. After all, how many diseases were cured by the Soviet Union during the period 1918–1991, compared with those cured in the United States during the same period?


The government is rightly tasked with evaluating the toxicity of drugs, chemicals, materials, and technology for safety and potential harm to the environment. Moreover, it is just to require those who manufacture and use suspect drugs, chemicals, plastics, and technology to pay for long-term studies over years, decades, and generations to determine their safety.

This article is an extract from the book ‘Principles of Good Government’ by Matthew Bransgrove