Sunday, September 19, 2010

ObamaCare and the government delivery system

Why choose a government delivery system?

Who can forget the above flow chart of the bureaucracy associated with ObamaCare. Tens of thousands of additional government workers will populate a new mega bureaucracy produced by ObamaCare and another 16,000 IRS agents to enforce ObamaCare penalties/fines.

The above flow chart begs a question: why choose a government delivery system? That is, why choose a delivery system that is managed by a monopoly, that is very well known as a highly inefficient system, a system that has been known to breed corruption and waste, that is full of red tape that frustrates the end users of the system?

The government delivery system as the first choice rather than last choice

Robert Nozick in his book Anarchy, State, and Utopia puts forth the following observations:

(a) people tend to forget about the possibilities of acting independently of the state,

(b) presumably what drives people to use the state's system of justice is the issue of ultimate enforcement,

(c) similarly, people that want to be paternalistically regulated forget the possibilities of contracting into particular limitations on their own behavior or appointing a particular paternalistic supervisory board over themselves. (1)

What Nozick is observing the use of the state as the first choice rather than a last choice. That the state is used for enforcement. That those subscribing paternalism have a quest to broaden their paternalism to all individuals rather than focusing upon themselves.

Conflict of Visions

Thomas Sowell has described a conflict of visions. That two broadly defined groups exist: the empirical camp vs. the anointed/intelligentsia camp. The empirical camp is based on the concepts that the vast collection of mundane knowledge possessed by individuals based on experience and empirical evidence, individual and property rights, and individual freedom to choose - is in direct conflict - with vision of the anointed/intelligentsia group who's position is based on "special knowledge" which is a non-empirically proposition based upon "the way things ought to be" delivered through verbal virtuosity resulting in painting the world in one's own self image. (2) (3)

The mega state vs. the small state

Although the two groups described by Sowell are clearly in conflict of visions, both groups subscribe to Nozick's points (a) and (b) described above. To one extent or another both groups choose the state to deliver their vision. The difference being that the empirical group wants a smaller state to deliver and enforce their vision whereas the anointed/intelligentsia adds Nozick's point (c) yet wants everyone to subscribe to paternalism through an all encompassing state to deliver and enforce their vision (rather than self imposed paternalism upon only themselves).

Delivering the vision

ObamaCare is in fact a "vision" of the anointed/intelligentsia. Beyond the laundry list of short comings associated with ObamaCare, beyond an attempt to mold a health-care system based on "the way things ought to be", the chosen delivery system, the state (government), will never deliver the "vision". That is to say, no matter how well a construct or how poorly a construct, the "vision" can not be delivered through a monopoly, that is a well known highly inefficient system, a system that has been know to breed corruption and waste, that is full of red tape that frustrates the end users of the system.


(1) Richard Nozick, Anarchy, State, and Utopia. Page 14.

(2) Conflict of Visions, Thomas Sowell.

(3) Intellectuals and Society, Thomas Sowell.


  1. I'm not clear on this. Is this a gov't DELIVERY system, or gov't insurance system?

  2. How will the additional 30 million be treated if you are not adding doctors , nurses and facilities to diagnose them? It's like adding 10-30% more traffic with no new roads.