Economics 101, the third

One of the many always false assumptions of the pseudo-science called economics, as embraced by libertarians, is the assumption that all of the costs and benefits of a transaction are captured between the transacting parties. Since this is obviously false, economists pretend that it's only false in certain anomalous circumstances they call "market failure," that may require some form of intervention. But in fact it is always false, perhaps with trivial exceptions that one can invent, but it is false in every standard commercial transaction.

I won't go into that in general right now, but in the case of health care it is especially, glaringly obviously and egregiously wrong. One obvious reason why it is false is the case of infectious disease. People who are contagious are a danger to others. If infectious disease can be prevented by vaccination, or cured by antibiotics, then innumerable other people benefit. In the case of HIV, although it cannot be cured and there's no vaccine, people who receive and adhere to appropriate antiretroviral treatment are no longer contagious. These are very good reasons to make sure that contagious diseases are prevented or treated, regardless of whether people want to pay for it, or can afford it.

A second reason is that people's health is strongly determinative of their economic and household productivity. Sick people can't work, can't provide for themselves or their dependents, and can't properly care for children or others who may need caregiving. They may well even become dependent on others. This is why prior to the ACA at least Medicaid was made available to families with dependent children. Better that the children get health care to enhance their future prospects, and that the parents get health care so they are better able to work and provide for their children and themselves -- and indeed, wise guy, most families that receive Medicaid do have at least one working member. The fact is that some jobs don't pay enough to lift people out of poverty. Now, in those states whose governments are sufficiently non-insane to have accepted the Medicaid expansion, all low-income adults can receive it. Again, that makes them better able to work and perhaps not even need Medicaid next year.

In other words, health care isn't just a service that is consumed. It is also an investment that creates both social and economic capital. Making sure that everybody has access to quality, affordable health care isn't a handout, and it isn't stealing from Peter to pay Paul. It's to affluent Peter's benefit to contribute something to make it happen, because it will help Peter's business be more profitable.

There are many other externalities I haven't mentioned because libertarians don't care about them. Most people are distressed to see mentally ill homeless people, or children who live in poverty, and would certainly be distressed to see people dying in hospital parking lots because they didn't have insurance cards. I understand that you might not be. So just read the preceding paragraphs.