I have always thought of myself as fairly open minded and find that I am increasingly interested in what I call “other views.”  This is partly because I am consciously looking for any coercive elements inherent in any views, my own included.  There is no shortage of folks who have “great ideas,” ideas so great that they have to be forced on others. 

This coercive tendency is prevalent among ideologues of all sorts and almost anyone involved in politics.  After all, almost every law ever written ends with a section outlining the penalties for non-compliance, or what I call the “or else” clause.  As individuals, any time we might attempt to get what we want from others using force, we are acting criminally and are liable for damages.  Using force on others to take their property or to make them do that which they are not naturally inclined is, however,  the basis and the business of the “state.”  This is why Murray Rothbard defined the “state” as “a monopoly on violence.”

“Buy health insurance or else.”  This is what we have come to isn’t it?  The obvious beneficiaries of this plunder are those who are receiving this new loot, not those from whom it was stolen.  Sufficient numbers of individuals have fallen prey to the state and crony propaganda, however, and justify this robbery, writing countless editorials and letters to the editor in support of compulsory health insurance.  

Two of my favorite rationalizations are:

“Young people need to do their duty and buy this insurance so my (older or sicker person) premiums won’t cost me so much!”


“Everyone should be forced to buy health insurance so my hospital bills won’t include the charges for all those who don’t have coverage and don’t pay.”

I have previously described TUCA (The Unaffordable Care Act) as a Ponzi scheme, where the “contributions” of the young and newcomers directly benefit their elders, a situation identical to social security and Medicare (and almost any government program, really, if you realize the extent to which the money spent by the “state” is borrowed).  To actually see rationalization number one clearly stated (repeatedly) in a letter to the editor or an editorial shows how effective the propaganda machine has been.  I can’t imagine a beneficiary of one of the more established Ponzi schemes making this case and feeling good about it.  ”We’re all in this together,” or “what’s yours is mine,” are increasingly becoming fighting words, as these phrases have “or else” embedded in them.

The “cost-shifting” myth has also been one of the huge successes of the hospital propaganda machine.  Thomas DiLorenzo in his great book, “Organized Crime:  The Unvarnished Truth About Government,” discusses the economics of utility companies.  Even though these companies have high “fixed costs,” the cost of adding an additional customer is almost negligible.  A hospital emergency room requires a great deal of money to establish, but once open and staff are present and paid hourly, the cost of seeing an additional patient consists of the price of the supplies used.  

From someone who runs a medical facility, I can tell you that the costs of the supplies in the operating room are not as high as you would think or have been led to believe and are certainly more than any supplies you would require in an emergency room.    That other patients’ bills would need to be padded with the costs of those who don’t pay the costs of their supplies in the emergency department is simply fictitious.  This is, rather, the justification for the “what can we get away with” pricing encountered in so many U.S. emergency rooms. 

As more and more people purchase health care rather than health coverage, the price of the care will fall and quality will soar.  This is the unintended consequence of TUCA, the creation of a true consumer market in health care, one consisting of mutually beneficial exchanges without the violence and extortion so prevalent in the current crony system.  Hopefully great numbers of people will wonder why many of these hospitals can stay open when the prices for health care are but a fraction of what they are today.

G. Keith Smith, M.D.