Public versus private, lighthouses, libaries, and medicine

by John MacBeath Watkins

One of the more peculiar things about the current state of American politics is that an entire political party devalues all things public (except police and the military) and valorizes all things private.

    Like many Netizens, I spend too much time arguing with idiots on the internet. One exchange involved me and an Australian librarian discussing the need for libraries with a business consultant, who argued that libraries are not needed.

    "Where's the market failure?" he asked, as if no form of human organization was legitimate unless it could not be provided by the market. Markets Über Alles has long been the cry of business conservatives, but other than assuming that markets are superior, they don't seem to spend much time justifying this choice.

    The truth is, we have centuries of experience and thought that help us understand the difference between public and private institutions, but few people seem to avail themselves of this knowledge.

    Markets work very well when used for goods from which people can be excluded, both physically and morally. The example usually cited is lighthouses. Everyone can see a lighthouse and use it in navigation, but because no one can be excluded, it is difficult to collect a fee for the services provided by the lighthouse. In England, private companies built lighthouses, then found they could not collect money from those who used their service, so they got the ports to collect port fees to support lighthouses. Then, the profit incentive was to spend as little as possible on maintaining the lighthouse while still using the power of the state to collect the fees. Eventually it was discovered that only government had the means to collect the fees and the incentive to provide decent service. This is the essence of a public good.

    At one time, excluding people from health care services was considered morally tenable. Physicians served the rich, barber-surgeons served the rest, and neither had an enviable record of curing people, so home remedies were often as effective as medical care in any case. John Locke argued that natural law shows we all have a right to life, liberty, health and property, and he first gained a powerful patron by acting as a physician to Anthony Ashley Cooper, Lord Ashley, not long after getting a medical degree at Oxford (Locke got the medical degree in 1665 and treated Ashley in 1667.)

    As medical care improved, it became increasingly evident that to exclude someone from medical care could result in them losing their health or even their life. If we are all born owning ourselves, depriving us of such things interferes with our fundamental right to exist and our property right to ourselves.

    In 1986, Ronald Reagan signed the Emergency Medical Treatment and Active Labor Act, which said hospitals could not refuse treatment at their emergency rooms for people because of citizenship, legal status, or the ability to pay, in order to end the practice of "patient dumping," that is, discharging patients because they might cost the hospital too much money. It was possible to physically exclude people from treatment, but was in morally acceptable?

    Theodore Roosevelt in 1912 campaigned on a promise of social welfare insurance, including a national health service (he founded the Progressive Party, better known as the Bull Moose Party, for the purpose of running.) Medicare, Medicaid, and the Reagan-era emergency room mandate were all patchwork attempts to deal with the failure of American politics to provide a path to universal access to healthcare when it had ceased to be morally acceptable to exclude people from healthcare. The Affordable Care Act (AKA Obamacare) attempted to solve the same problem more comprehensively while not eliminating the private-sector actors in the insurance and health care industries.

    We have, at this point, spent more than 100 years trying to solve the problem of medicine becoming good enough to be worth having, while private enterprise could not provide the service in a morally acceptable way. Medical care has made a transition from private good to public good.

    Oh, and returning to the business consultant's question, where's the market failure that justifies the existence of libraries?

    First, no market failure is required to justify people's desire to have a public amenity. We are free to organize our society however we want, provided we don't infringe on the rights of our citizens. If we elect a government to build public institutions and keep electing those who found and fund libraries, we are free to spend our money though taxes just as we are free to spend our money in markets.

    Second, libraries provide goods from which it is immoral to exclude people. They provide knowledge, both in the form of non-fiction and in the form of literature, that people ought to have access to in order to realize their potential and to have sufficient knowledge to exercise their freedom of conscience.