To begin, Moore and Friedman agree on one thing: the U.S healthcare system is inefficient and is in dire need of reform. Despite significant advances in technology, which in markets are generally indicative of a decrease in cost, U.S healthcare spending has risen to extremely high levels as a percentage of GDP. Friedman demonstrates this by citing that the percentage of national income spent on healthcare was 3% in 1919, 4.5% in 1946 and by 1997 17% of the national income was spent on healthcare, measured as a percentage of national income the U.S spends more on healthcare than any other country in the world.

    I must interject here to describe Moore’s position, as far as I can understand it. Moore’s proposal has three points, as follows, 1) Every resident of the United States must have free, universal health care for life 2) All health insurance companies should be abolished 3) Pharmaceutical companies must be strictly regulated like a public utility. It is evident that Moore’s proposal is far from comprehensive and not fully explained, therefore in order to analyze his argument I am forced in some instances to fill in the gaps of Moore’s proposal, as I believe he would. A difficult task but I will try to do it fairly.

    With the above qualification another point of commonality between Friedman and Moore is that they both find third-parties as the culprit for the huge increase in cost of healthcare. Moore’s position however is aimed at employer insurance benefits while he does not understand the government to account for a third party. Friedman on the other hand attributes third party status to both the employee insurance programs as well as the government, under Medicare and Medicaid. In essence for Friedman any organization that separates the consumer from the merchant constitutes a third party and increases the costs by usurping the choices of the consumer and giving the consumer good cause to spend more on health insurance (that is provided by the employer and subsidized by the government) than they would if the money spent on health insurance was done directly from the after-tax income of the consumer. Friedman also explains how Medicare and Medicaid have increased the costs. Once the costs are set to zero the demand will always go up to an infinite level which in turn forces a rationing system to conserve the supply. Friedman sees the healthcare market, not as evidence of capitalism run amuck like Moore but rather as heading “toward complete socialized medicine-and if we take indirect tax subsidies into account we’re already halfway there.”

    Moore does pay lip service to “the need to eliminate the middleman” but his understanding of whom the middleman is, is questionable. As Friedman demonstrates the government is fully capable of acting as a middleman, in fact it very much is in the circumstances of Medicare and Medicaid. In effect a middleman is an insulator of competition, giving all control over to the government would effectively create a monopoly, and reduce the insulated competition as the system is now to a level of no competition. This system in place does not necessarily reduce healthcare costs. This would put us in a system like the one described above in which the demand is infinite and the cost of healthcare is as low as the administrative rationing system chooses it to be. Another downside of this policy would be to retard or freeze altogether the ability of technological advancements in the healthcare industry. Instead of companies reinvesting their profits to maintain an advantage in their respective markets there would be no profits to speak of. Therefore all medical advances would come only as legislator’s allocated funds to research. As this system offers no real model for reducing healthcare costs the likelihood is that legislative attention would be paid to keeping costs down at the expense of technological advancement.

    It would be a matter of course that under Moore’s proposal there would be no health insurance companies. If healthcare costs zero of consumers after tax income why would consumers spend after tax income to insure themselves of something that was already free in terms of after tax income? Obviously insurance is a critical part of any free market health care proposal. Friedman explains the oddity that is health insurance by comparing it to other insurance markets. Friedman states that the large subsidies found in employee insurance programs have created a situation where insurance claims or co-pays are enacted over rather trivial expenses. He says that we do not make automobile insurance claims when we purchase gas or homeowner’s insurance claims when we cut the grass. Rather we insure the “catastrophic” and unforeseen expenditures. Friedman notes that complete privatization of healthcare is not a likely political strategy (which would require abolishing Medicare, Medicaid and government subsidies of employer benefits) but as a step forward Friedman recommends employers and/or the government to purchase “catastrophic” insurance policies as a way of reducing the monthly premium, while increasing the deductible and then starting medical savings accounts on the behalf of employees/constituents that would allow them to choose their medical provider for minor expenses incurred for healthcare visits.

    More could be said on both of the positions but I think a general description of both advocated systems has been achieved. There is no question that I would prefer to follow the general guidelines of Friedman’s proposal, but the reader can choose which system he prefers based on the above discussion. I would now like to address the debate itself. Moore would have us believe the debate over healthcare is exclusively an ethical debate, and in his formulations he places a universal right to healthcare over all other considerations. This is both dishonest and unfair to the debate. Moore makes it sound as if there would be no deleterious effects from his proposed plan but the reader should know better than that. It has been shown by economic principles that Moore’s proposal would perpetuate relatively highly levels of GDP spending on healthcare and limit the advancement of medical technology, which could in turn reduce healthcare prices in the future. If economic principles are not enough proof we can turn to the comparative examples of Great Britain and Canada which have single-payer universal systems and have experienced the predicted negative effects of their systems, also include high dissatisfaction and long waiting lists to receive healthcare (one may also take note of the U.S governments aptitude in running the entire public school system). Furthermore, I wonder what Moore has to say about the ethics of this situation. As we watch countries with politically stable situations and efficient markets decapitate their ability to advance and grow technologically in the healthcare market what country will show the way forward? It is evident that technological advances (which even our current system is conducive to) in the future will fall heavily on the shoulders of countries that have not frozen their ability to advance technologically.

    As Moore likes to frame this debate in terms of ethics as opposed to economics (also with a heavy propensity for passion and emotion) he is responsible for taking unintended consequences for granted. What is likely to happen during the course and after a proposal is implemented is a question of economics in the case of the healthcare market, whether or not the likely consequences are ethical, is the ethical debate. Moore is likely to be as unqualified to participate in an ethical debate as he was in the economic one, but that would be unlikely to stop him.