I don’t know how, during the long months of this health insurance debate, this quote from Road To Serfdom slipped my mind, but it certainly bears re-emphasis:
“Nor is there any reason why the state should not assist the individuals in providing for those common hazards of life against which, because of their uncertainty, few individuals can make adequate provision. Where, as in the case of sickness and accident, neither the desire to avoid such calamities nor the efforts to overcome their consequences are as a rule weakened by the provision of assistance – where, in short, we deal with genuinely insurable risks – the case for the state’s helping to organize a comprehensive system of social insurance is very strong… Wherever communal action can mitigate disasters against which the individual can neither attempt to guard himself nor make the provision for the consequences, such communal action should undoubtedly be taken,” – The Road To Serfdom (Chapter 9).
This is why, for all the bluster about “death panels,” and health care reform being an irreversible step on the road to socialism, it is the Randian vision of the world that animating the Right’s position on reform at the expense of the far more rigorous, thoughtful, and classically liberal vision of Hayek. Were the influence of these visions reversed, we would have a situation where the Right would actually make a good-faith negotiating partner on the issue of health care reform rather than leaving it up to liberals to negotiate reform with spineless and philosophically unmoored centrists.
The above-referenced quote does not in the least imply that any system of social insurance is acceptable or will work. An individual-based system supported by tax credits or vouchers? Sure. A system of nationalized re-insurance? Quite possibly. Single-payer insurance? Maybe. But a byzantine system of employer and individual mandates, public options, increased regulation, etc.? Absolutely not.
Yet because the Right is so much more infatuated with the Randian vision rather than the Hayekian vision (even as it so often claims devotion to Hayek), leaving unmoored centrists as the gatekeepers, the reform we will get will be the latter. This, I would submit, is the worst of all worlds from the supposedly free market perspective held by the movement Right – the reinforcement of existing flaws and regulatory regimes; increased opportunities for regulatory capture; large increases in overall government expenditures and an ever-larger national debt; and only marginal improvements in the delivery of health care to the currently uninsured (at a cost that many of them may be unable to afford).