Those who see government power and corporate power as being in conflict, and those who seem them as being in cahoots, each have a point. The alliance between government and the corporate elite is like the partnership between church and state in the Middle Ages: each one wants to be the dominant partner, so there’s naturally some pushing and shoving from time to time; but on the other hand the two parties have a common interest in holding down the rest of us, and so the conflict rarely goes too far. The main difference between “left-wing” and “right-wing” versions of statism, as I see it, is that the former generally seek to shift the balance a bit farther in favour of the state (i.e., toward state-socialism) while the latter generally seek to shift the balance a bit farther in favour of corporatism and plutocracy. (In the U.S., the reigning versions of liberalism and conservatism are arguably both more corporatist than state-socialist; but the liberals are still a few notches farther toward state-socialism than the conservatives are.)

But whether the special interests who are the primary beneficiaries of state power are mainly within the state apparatus or mainly outside it, the actual application of state power remains much the same. Hence it is a mistake to suppose that the corporatist-plutocratic version of statism is in any interesting sense less statist than the state-socialist version.

But it is an all-too-common mistake – and this tendency to underestimate the chasm between free markets and corporatism is enormously beneficial to the state, enabling a slick bait-and-switch. When free markets and government grants of privilege to business are conflated, those who are attracted to free markets are easily duped into supporting plutocracy, thus swelling the ranks of statism’s right wing – while those who are turned off by plutocracy are likewise easily duped into opposing free markets, thereby swelling the ranks of statism’s left wing. (These are the two tendencies that Kevin Carson calls “vulgar libertarianism” and “vulgar liberalism,” respectively.)

As one of the villains in The Fountainhead explains in a moment of frankness, talking about the choice Europe was then facing between communism and fascism:

“If you’re sick of one version, we push you in the other. We’ve fixed the coin. Heads – collectivism. Tails – collectivism. Give up your soul to a council – or give it up to a leader. But give it up, give it up, give it up. Offer poison as food and poison as antidote. Go fancy on the trimmings, but hang on to the main objective.

The largely (though not completely) illusory conflict between state-oriented Palpatine and corporate-oriented Dooku in the Star Wars prequels is a nice dramatisation of the same principle.

This dynamic applies in particular to the debate over health care policy. The contrast between, say, the Canadian and American approaches is frequently described – by both sides – as a contrast between a “governmental” or “socialised” system on the one hand, and a “market-based” or “free enterprise” system on the other. But the American health care system bears little resemblance to a free market; instead it represents massive government intervention on behalf of private special interests, from insurance companies to the medical establishment. The choice between the American and Canadian models is simply a choice between different two different flavours of statism – each with somewhat different vices, it’s true (e.g., do you prefer higher prices or longer waits?), but ultimately coming down to a matter of the percentage to which control of your healthcare is exercised by people sitting in government offices as opposed to being exercised by people sitting in governmentally-privileged “private” offices – but in either case by ambitious, avaricious apparatchiks who aren’t you.

So what would a libertarian approach to health care policy look like? At a minimum it would have to include:

1. Repealing laws that have the effect of cartelising the medical industry (e.g., the licensure monopoly granted to the A.M.A.), thus artificially boosting the cost of medical care.

2. Repealing laws that have the effect of rendering the labour market oligopsonistic, thus artificially lowering people’s ability to pay for (and collectively negotiate for) medical care.

3. Repealing laws that shift healthcare funds from the [PDF] 25%-devoured-by-overhead voluntary sector to the 75%-devoured-by-overhead coercive sector, thus decreasing the amount of healthcare that gets to needy recipients.

4. Repealing laws that transfer the power to make medical decisions for individuals from those individuals to centralised bodies, thus increasing the impact and scope of fatally bad decisions and suppressing the competitive signals that allow the identification of better and worse policies.

5. Repealing laws that wiped out the old mutual-insurance systems (basically HMOs run by the patients instead of by corporations) and empowered insurance companies at the expense of patients.

6. Repealing laws that suppress innovation and distribution in the pharmaceutical industry in the name of “intellectual property.”

Until the unlikely day when the Republican Party embraces this program, let’s hear no more of their favouring a free-market approach to health care.

This entry was posted August 28th, 2008.

Translations for this article:

• Portuguese, Veneno como alimento, veneno como antídoto.