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Free Health Care after the Revolution

In my response to the CEA, I suggested that socialism did not have to mean a free health system. With everyone economically secure, there would be no need for the government to pay. There would be no hardship in having user pays for routine primary care, and have health savings accounts and mutual insurance schemes for the more expensive and serious care.

However, after further thought I cannot see any benefit in not going to totally free health care funded out of taxes. This is because health care generally does not need to be left to the individual because people do not have different preferences. We want lots of it and when we have a medical condition, our preference for it is lexicographic. In other words, if we need a triple bypass, any bundle of goods and services that does not include that treatment would be less preferred to one that does. You could say the same about any other catastrophic health event. To put it in less fancy terms, freedom from pain and disability is very much an overriding need. Nothing else comes close to it.

At the same time, people who require little health care would want to help others get what they, out of good luck, do not need. It is just a matter of empathy. This is especially so if others are making healthy lifestyle choices which is what you would expect with the end of capitalist alienation. As for the healthy young subsidizing the less healthy old, I do not think this is a big deal. When they get old they in turn will be subsidized by the young.

Of course, there is a limit to what we would commit to health care funding. Even if health were virtually the sole priority, you still need to devote resources to food, clothing, sanitation, housing and sport which also affect health.

While lots of fancy new equipment and a large research and development bill will push up health spending, it will at the same time be pushed down by healthy living and medical advances such as new drugs and gene therapy that reduce the need for long and expensive treatment.

I have already explained in the CEA piece that under social ownership you do not have the tax worries that appear to be a problem under capitalism. So paying for free universal health care would not be a problem. I said that income tax would not have to be progressive. Wage rates would be much more equal and disparities would be there for a good reason and ought not be undone through the tax system.

My point would have been clearer if I had explained how high tax rates on the lower tax brackets would encourage work rather than deter it. (Work deterrence of income tax is a mantra of most economists.) It would discourage people from working less than others by going part time or taking long breaks while at the same time enjoying tax free goodies with everyone else. A poll tax would also encourage work. You have to work to pay for it. A land tax/rent on high demand residential locations that I also refer to might also have the same effect, as those working shorter hours will have trouble bidding against those working longer hours.

I also mention that tax collection, compliance and avoidance costs would be a fraction of what they are now. There would be no more capitalists hiring an army of people to minimize their tax bill nor would there be a need for a taxation bureaucracy chasing down tax evaders.

We are warned that state provision would not have the benefit of market incentives. Well, the proletarian revolution will transform our relations in production and we will manage much better without such incentives. This is Marxism 101, and is discussed at various places on this web site.

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