So Wonks Anonymous Libertarian interlocutor has taken a break from talking about the flat tax, or fair tax or whatever they call it now, and come up with proposal for health policy.

Which would be to put everything on a free market basis. Everyone pays at point of service and all that, except that we have government funding of emergency care. If hospitals cannot collect on bills incurred under the Emergency Medical Treatment and Active Labor Act the government reimburses them.

Now Wonks Anonymous must conclude that this is a highly moral proposal since he cannot say that it makes any economic sense whatsoever.

There are many chronic medical conditions, Asthma, Type II Diabetes and High Blood Pressure to name three, which can be treated in two ways: Cheap and unglamorous health maintenance involving regular doctor visits, medication and monitoring or expensive, dramatic lifesaving interventions during the inevitable emergent incidents that are caused by the diseases.

High blood pressure can be treated with medication and medical supervision or it can be allowed to go unchecked eventually causing strokes, heart failure and kidney failure. Under the Libertarian option the government would pay for ambulance calls, emergency room treatment to stabilize the patient and, one imagines, the subsequent hospitalization. Of course at this point the damage to the heart, cerebral circulation and kidneys would already have begun.

No aid would be given for ordinary medical treatment that might have prevented the crisis. Upon discharge one presumes that the patient would again be on his or here own until the next crisis.

Wonks Anonymous speculates that this would continue until the disease rendered the patient entirely unfit to work. At this point the patient would go on disability and everything, including regular renal dialysis, would be paid for by the government.

Clearly this plan specifies the most expensive possible medical treatment. Bound as an economist to believe that there is some rationality in human choices, Wonks Anonymous will speculate on the moral principles that drive this particular choice. These he believes are twofold:

Property is sacred and no one should be forced to use his property to the benefit of others. If A is rich, if A has low medical expenses because he was born with good health, if A is fortunate in any way, A should not be required to share any of his good fortune with B who might not be rich, might suffer from ill health or might have just experienced some other disaster. Hence any regular program to aid the less fortunate at the expense of the better off is an abomination.

It is desirable that the society which we live in keep up the appearance of a civilized society because we might otherwise fell shame and guilt about our good fortune. Dying beggars on the streets are sure to blow our cover. Hence they should be disposed of on a case by case basis in facilities that are not extremely offensive to our senses and sensibilities.

India had Mother Teresa, we have the Emergency Department.

It is all a far cry from Adam Smith who argued for free market policies based the material good that they could do for human beings.