As President Obama seeks to resuscitate his takeover of Americans’ access to medical services, his practical arguments are struggling.  The Congressional Budget Office’s cost estimates are a real drag on the proposal, and many remain skeptical that the federal government can save money by running Medicare and other programs more “efficiently.” So advocates are retreating to arguments of principle. 

One is that health care is a “public good,” so it should be operated like other public goods, such as fire protection.  In a September 3 column, Nicolas Kristof of the New York Times asserted that “a public role in health care shouldn’t be any scarier or more repugnant than a public fire department.”  An online cartoonist named Andy Lebershane has posted a successfully “viral” YouTube video explaining “why we need government-run, universal, socialized, call it whatever you want, health insurance.” 

His primary example is the fire department, and he describes an absurd scenario of a “private” fire department, which finds loopholes in your policy to deny you service when your house catches on fire, such as a “pre-existing” fire in your backyard grill. Even if this analogy were valid, President Obama’s faction is not proposing a “public option” for health insurance that is remotely similar to a fire department. 

If that were the case, he would reduce the federal role, by eliminating Medicare and federal funding for Medicaid, the jointly state and federal program for low-income Americans.  This is because fire departments are operated and funded locally.  There is no U.S. Department of Fire Protection.  Indeed, according to James M. Shannon, President of the National Fire Protection Association, the federal government did not start directly subsidizing local fire departments until 2000, through the “Assistance to Firefighters Grants.”  After 9/11, the Department of Homeland Security took on an enhanced role, but the National Volunteer Fire Council lists only a smattering of financial assistance from DHS and U.S. Department of Agriculture for local fire departments.

The cartoonist’s fire analogy is completely wrong-headed, because access to most medical services is simply not a “public good,” which economists define as non-rivaled and non-excludable.  “Private goods,” on the other hand, are rivaled and excludable, which means that only one person can consume one unit at a time.  An apple is a private good.  Clean air is a public good.  Most modern health care is comprised of private goods and services: only one patient with a failing heart can be operated on by one cardiac surgeon at a time. Some care, however, is comprised of public goods and services. 

Unsurprisingly, it’s what we call “public health.” If an epidemic threatens, there is no reasonable way for one person to avoid contracting the illness, so few deny the government power to reduce the likelihood of infection by serious communicable diseases.  And there are federal agencies that hold such powers, such as The Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC).

Fire prevention is not really a public good, but it is a “collective good.”  If your neighbor without “private fire insurance” should happen to let his grill’s fire jump to your house, you would wind up with higher premiums because of his recklessness, whatever your level of private coverage. More important, putting out the fire is where the public fire department’s mission stops. If your house burns down, you don’t have federal public homeowner’s insurance to replace the value of your lost property.  Imagine if you did…..

To contain costs and standardize benefits, the government would force you to live in a house that the U.S. Department of Housing and Urban Development (HUD) chose for you, with furniture appropriate to the age and mobility of your family’s members.  You wouldn’t be able to decorate it yourself, even using your own money, because you might use something unaccounted for by the government planners who estimate the liabilities of the national homeowners’ insurance plan – which is a very good analogy for the federal takeover of health care. To adapt Mr. Kristof’s language, that prospect is scarier and more repugnant than any public fire department.

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John R. Graham is Director of Health Care Studies at the Pacific Research Institute.