Timed with the current national release of Michael Moore’s Sicko, I have a (fairly) honest question: why do political libertarians reject the idea of state-financed universal health care? Now I know why they say they do: it would interfere with our individual liberty to do what we like with the products of our labor. Taxing me to provide health benefits for other citizens simply forces me to work X amount of hours for a distribution of those goods I didn’t (or wouldn’t) choose, in the same way federal arts funding forces me to work for other people’s enjoyment of art and opera that I myself might never want to indulge in. Nevertheless, there seems a simple bootstrapping argument available to the fans of universal health care, and I don’t quite see why libertarians would resist it. Perhaps you can help.
The argument simply expands on a foundational tenet of libertarianism: the state’s only function is to protect its citizens from external or internal threats to their life and liberty. What this is taken to mean is that there should be state-run military and police forces (and perhaps state-run fire departments and court systems), but nothing else. Taxation for such services is (justified by a complicated argument, usually) to be universal, so that everyone gets equal protection for their (mandatory) equal payments. But of course some threats to my life and liberty aren’t susceptible to protection by the military or the police. Instead, some of these threats are truly internal, coming from diseases and other bodily breakdowns. So the question is this: why wouldn’t libertarians also want to insist on a state-run system of universal health care to protect against, correct, or assuage the pain of, these threats to life and liberty?
One immediate thought is that the threats dealt with by the military and police are due to agency, so the government needs to be there to protect me from the nasty aims of other people, either from within or without the country. But why should the source of the threat matter? Surely I need protection equally from that missile heading our way if it was caused by a push from Putin’s finger or by Putin’s dog’s wagging tail whacking the button or if it simply shorted out and fired on its own. What matters is that my life and liberty be protected, not that it be protected only from certain sorts of (agential) threats.
On the other hand, not all non-agential threats are created equal. For surely there is something to the libertarian complaint about my having to pay for someone’s else’s lung cancer if it were caused by that person’s free choice to smoke, or having to pay for someone’s bacon-related heart attack to be treated. But there remain a great many kinds of diseases and ailments that are incurred through no choice of the subject at all. And while it could be very difficult to distinguish between those diseases that are incurred through choice versus those that aren’t, that epistemic difficulty wouldn’t undermine the general principle established placing the (theoretical) obligation for certain forms of health care squarely in the hands of the state. And at the very least, this would justify state-run preventive care, involving education about healthy lifestyles and free check-ups and screenings (which, when taken advantage of, significantly reduce later long-term hospital stays and costs). (Notice, though, that there’s no similar libertarian distinction, when it comes to military and police protection, between those threats that are primarily one’s fault and those that aren’t – the cops still have to come when the guy at the bar slugs me, even though I’d been taunting him mercilessly about his mother all evening long.)
As I said, this is an honest question. This isn’t my field of research, so there may be a lot written on this topic already of which I’m ignorant, or there may be a breathtakingly simple answer, in which case I’ll quietly retreat in shame. But I thought I’d throw open the PEA portals on this one on a curious whim.