“Political tags — such as royalist, communist, democrat, populist, fascist, liberal, conservative, and so forth — are never basic criteria. The human race divides politically into those who want people to be controlled and those who have no such desire. The former are idealists acting from highest motives for the greatest good of the greatest number. The latter are surly curmudgeons, suspicious and lacking in altruism. But they are more comfortable neighbors than the other sort.”

-- Robert A. Heinlein

My column last week chiding Sen. Catherine Cortez Masto for wanting to give Donald Trump ever greater control over our family health-care decisions resulted in something that I still can’t quite wrap my brain around – folks on the far, far left angry at me and, apparently, at our junior senator, for not going far enough in wanting to give control of our lives over to President Trump.

I don’t get all this Trump trust/love from the left, I really don’t. Although after seeing just a little of the avalanche of truly vile tweets that come from pointing out rather obvious flaws in people’s utopian fantasies if only they had unlimited power, perhaps the kindred spirits who erroneously think “Sick Burn!” = “Intellectual Superiority!” are starting to identify one another…

Stranger still was the rage from some quarters that The Indy would dare to publish an opinion with which they disagreed. Personally, I enjoy reading things I disagree with – I generally learn something, or, at least, if poorly argued or reasoned, I come away with greater confidence in my current position. So I actually appreciated seeing two attempts at more long-form rebuttals of my piece this week, first for the efforts at a debate rather than calls to censor “wrong” opinions, and second, for the support they (unintentionally) provided for my original position:  That what the government pays for, the government will inevitably control.

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First, we have student and socialist activist Ozzy Hayes, who makes this truly amazing statement in defense of his philosophy:

Single-payer health care does not mean that the government “controls” our health care. It means the government provides our health care through socialized means.

I am truly curious what Mr. Hayes means when he says “socialized means.”  Does he not understand that “the government” in this context is a set of bureaucrats, controlled to some degree or another by Donald Trump, who will make decisions on what health services will be provided to him, and what won’t be, and that whatever he is provided for “free” must be taken from someone else (by force, if necessary)? I’m not saying we shouldn’t have taxes or safety nets, but we ought to be honest about what that means. Does Mr. Hayes not understand that, in the absence of private options, major medical decisions under his preferred plan would be made solely by Donald Trump’s bureaucrats? Does he think these bureaucrats (or elected officials who pay them) will always be competent, or always act ethically?

I used to be a public defender, the “socialized” version of criminal defense. I’m proud of that work, and I admire the majority of my friends and colleagues still doing that difficult job, and doing it well. But not every lawyer in the office was the same. Some were downright terrible – some well-meaning but talentless, some struggling with their own mental health or addictions, and still others simply lazy or burned-out folks who knew they’d never be fired and that they’d get paid exactly the same whether that suppression motion got filed or not.

Only a small number of PDs fit those descriptions, but if that’s who was appointed to your case, well, tough luck for you – unless, of course, you had the escape hatch of hiring a lawyer in the private sector, whose pay depends entirely on your continued satisfaction with the services provided. That doesn’t mean I want to get rid of public defenders. It means I’m glad there are other options available.

Mr. Hayes goes on to argue:

The most essential difference between private health care and insurance and a single-payer system is that we, the people, cannot vote out corporate officers.

The implication, of course, is that we can vote out poorly performing cogs in the government health-care monopoly machine, any time we don’t think they’re doing a good job. (If he wants to make all government employees at-will, I’m all for it. But I’m pretty sure his fellow lefties active in the labor movement might have something to say about that.)  

The reality is vastly different. Firing a public employee, even for demonstrated misconduct, is enormously difficult. Take the Veterans Administration, for example, still plagued by scandal, incompetence, and corruption after years of generating embarrassing headlines and the promises of politicians to fix things every single cycle. As a veteran, I’m grateful the VA is there for me, but I am also profoundly relieved that I don’t have to rely exclusively on the VA for my medical care.

On the other hand, private health-care providers, just like any other business, absolutely can be “fired.” People do it all the time, without waiting two or four years for an election. We “hire” and “fire” corporations of every size and description every day by how and where we choose (there’s that word again!) to spend our money. Creating a monopoly on those providers doesn’t make them more accountable, but less.

Mr. Hayes acknowledges that there are problems in single-payer countries like Canada, but argues that’s because there’s still too much choice and not enough government control. A more pure socialism would solve all of those problems – just look at the wonders it’s done for the public health of Venezuela!

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In the other response to my column, Jessica Brown, a recent graduate of our state’s most (and least) prestigious law school, does us the courtesy of not pretending she isn’t interested in absolute control. The problem, she argues, is that we have too much medical care, and, well, there oughtta be a law…

Unnecessary procedures generate revenue for doctors and increase iatrogenic risk—the risk that comes from every medical intervention. […]  This is what happens when you have no system.

Those darn doctors, twirling their mustaches and cutting open the tummies of pregnant women just to line their own pockets! If only we had a “system!” But if we can’t trust the doctors, then who’s in charge of this “system?” Once again, a set of government bureaucrats, not patients or families in consultation with their treating physician, will decide what medical care is “necessary” for you or not. And if the doctors are truly that awful, what happens when they all work for the government and can’t be fired? What happens when you’re stuck with whatever awful doctor (or midwife) the “system” assigns to you?

Ms. Brown’s stats may be accurate but are nonetheless misleading – for example, while it’s true that maternal mortality rates in the US are high, the primary cause seems to be our national obesity problem, not money-grubbing obstetricians or a lack of socialism. But this, too, is a helpful illustration of the problem with those who would shoehorn us all into a single “system.”  The causes of our medical issues, both biological and economic, are as diverse and as complex as the issues themselves – no set of bureaucrats or ideological grad students can ever hope to effectively centrally plan and manage such a complex situation.

Americans may be “over-treated,” but whether my health care is “necessary” in a given situation is a decision I want made by me and my doctor, thank you very much.

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I am not a libertarian who thinks government has no role in providing assistance to those who cannot afford basic health services (or housing, or food, or education, or legal aid). I am clear-eyed about the many flaws in the way health care has come to be commonly delivered in our country, which has far too many middle-men (both public and private) standing between doctors and patients.

But unlike Mr. Hayes and Ms. Brown and their fellow utopians, I recognize that no “system” will ever do what they want a system to do – provide “free” (no such thing), unlimited (no such thing) health services to anyone walking in the door, and any system (or lack of one) will necessarily come with its own costs as well as benefits. I further believe that protecting and enhancing individual liberty, including the right to make health-care choices for you and your children, (a) is the proper and primary role of government, and b) “works,” in that it’s the most efficient way to promote wealth and prosperity (which also means better health outcomes).

Government action can and should soften the free market’s sharp corners, but must never grow so cumbersome or so large that it takes away the free market’s efficiency, responsiveness, or respect for our fellow citizens’ competency to manage their own lives. We can, will, and should endlessly debate how to “correctly” balance these concerns. But when lawmakers or activists on any level reject such balancing efforts and seek total control instead, as in a single-payer health care system, we all will lose in the end.

Orrin Johnson has been writing and commenting on Nevada and national politics since 2007. He started with an independent blog, First Principles, and was a regular columnist for the Reno Gazette-Journal from 2015-2016. By day, he is a deputy district attorney for Carson City. His opinions here are his own. Follow him on Twitter @orrinjohnson, or contact him at [email protected].