We’ve talked at length here at QandO about the dangers of the Nanny State to individual autonomy – liberty/freedom. If there is a zero sum game out there, it is the trade off between the power of the Nanny state and the degree of individual autonomy you are able to exercise.
I think why this health care bill bothers, no, outright scares libertarians is the degree of encroachment it represents in terms of individual autonomy. The premise I’m talking about is well stated here:
[I]individual autonomy is the core value of a democratic society; there is an inherent trade-off between individual autonomy and public health under health paternalism; and the abandonment of individual autonomy in health policy poses a threat to our other freedoms.
I’d change one word – individual autonomy is the core value of a free society. I’m not sure how it can be considered any other way. There is a trade-off between the state assumption of responsibilities and the amount of individual autonomy you retain. Call it a liberty index if you wish, but every time the state takes over more responsibility for the lives of the citizens, by whatever means, the liberty and freedom of that citizenry is commensurately reduced.
And, as the state takes more responsibility and attempts to enforce it, there is a less than subtle transition from a Nanny state to a Bully state.
The Institute for Public Affairs lays out that case quite well and uses health care to do it. the IPA focuses on a shift in thinking among our ruling elite who support the welfare state that is driving this transition from Nanny to Bully. The transition is based on the failure of their first assumptions. Their assumption was that if the state (Nanny) provided relevant and important health information to the public, the public would heed it and change its behavior to take advantage of that information to live healthier lives.
The provision of that information hasn’t yielded those results. Instead, people still smoke, drink and are fat. Obviously, at least in the opinion of some, that model isn’t working and something better is necessary – for their own good, of course. Nanny can’t get the results she wants simply by providing the information she thinks should motivate others into living the lifestyle she finds most healthy, so she must look elsewhere and at different methods.
To get the results desired, given the “failure” of the previous assumptions, different assumptions are necessary. See if you recognize any of these or can see them coming:
Most of the health care burden is driven by disease that results from lifestyle decisions.
Most of the health care burden is therefore, in theory, preventable.
The cost of most lifestyle-related disease is not recovered from the individuals with such diseases or from the industries whose products contribute to these diseases.
Individual autonomy cannot be the paramount value in health care.
Individual choice as a basis for health is ‘too simplistic’.
Individual freedoms may have to give way to the coercive power of the State.
Interventions, including coercive actions, to change behaviour may proceed in the absence of evidence of their effectiveness.
Individuals have a clear responsibility to refrain from lifestyle decisions that lead to disease and, consequently, treatment can be denied to those who refuse to change their behaviour.
For those of you who can manage to look at the health care bill objectively and have listened to descriptions of what it requires should have absolutely no problem understanding that the list of new assumptions are clearly evident in that bill. One only has to think “individual mandate” to know that the assumption “individual autonomy cannot be the paramount value in health care” is being acted upon. The hiring of 16,000 new IRS agents to enforce that mandate speaks to the assumption “individual freedoms may have to give way to the coercive power of the State”.
So it certainly isn’t at all a leap to also understand that at some point, to keep this from being another in a long line of centrally planned failures, the attempt to intervene and change behavior and to coercively enforce the “responsibility” to refrain from lifestyle decision which lead to disease and the consequent health care costs, will be acted upon. The Nanny state becomes the Bully state.
And for those of you who would wave this away with a “this can’t happen here”, I’ll simply remind you of what was signed into law yesterday and the fact that some of the assumptioins listed above, as I’ve pointed out, have already been acted upon.