A Stitch in Haste

To review: Every scarce good must be rationed. That is not economics but elementary metaphysics.

Under capitalism, the rationing is achieved by the price mechanism, a/k/a "supply and demand."

Under any other system, the rationing is done by the government, a/k/a "the politics of pull."

Armed with that, consider the following:

As the baby boomers age into elderhood in the next few years, it won't be cosmetic surgeons they need and we can't afford to lose more doctors to this unneeded specialty. But the market is there; it is those who cannot bear the thought of growing old and now it is being expanded to include children.

"Unneeded"? To be decided by whom? By what standard? How can someone say with a straight face that something for which "the market is there" is "unneeded"? It boggles the mind.

Yet these are precisely the kind of pronouncements you would see under socialized medicine. Corrective eye surgery? "Unneeded" — just wear glasses! Orthodontics? "Unneeded" — that's cosmetic! Paxil? "Unneeded" — use talk therapy instead! Birth control? "Unneeded" — use condoms! Expensive end-of-life "extraordinary efforts"? You know the answer.

And so on. Someone, somewhere, will be deciding what is "unneeded." And it won't be you, your doctor (whom you can fire if he doesn't satisfy you), or for that matter your "greedy" insurance company (which you also have at least some choice about). It will be a bureaucrat — whom you will never meet and whose decisions you can never appeal.

Note also the "zero sum" fraud underlying the argument — the presumption that physicians (and nurses and all sorts of other medical professionals) are a fixed resource, like a coal bed. "Lose more doctors"? As if the doctors were your property to begin with? Such is always the presumption of socialized medicine — the doctor as indentured servant, the nurse as chattel.

What is it about medicine that makes IQs drop so sharply? Almost everyone understands and accepts that "wishful thinking" has no place in the practice of medicine. Yet it is the principal component of almost everything written about the finance of medicine. Go figure.

(Via Kevin, M.D.)

I've blogged previously about proposals to tax cosmetic surgery for no other reason than because some self-appointed arbiters of what are "proper" and "improper" uses of one's money or one's professional skill would prefer that you not get breast implants or a round of liposuction. (Recall that cosmetic surgery is almost never covered by health insurance.)

But there's more to taxing cosmetic surgery than just arrogant majoritarian standards of propriety. As law professor Frank Pasquale demonstrates, what separates one boob tax (cosmetic surgery) from another boob tax (strip clubs) is the preposterous redefinition of "externalities" to try to legitimize a cosmetic surgery tax:

I've proposed taxing cosmetic surgery before, and some cities (like Beverly Hills) are starting to target taxation in this way. Beverly Hills merely argues that "the centers become a drain on resources relative to the taxes they pay"[.] But if these interventions also "constitute the kind of annuity medicine that will entail regular surgical tuneups," their externalities are larger than once thought.

I've debunked this preposterous redefinition of "externality" previously:

If I lock my apartment door on my way to work, then perhaps, technically, yes I have imposed "negative externalities" on my neighbors, who are now prevented from, for example, coming in and watching my television. But if we start defining down externalities to the point where private people and private businesses not engaging in altruistic deviation from profit maximization is an "externality," then the word no longer has any real meaning, and any or every policy proposal, no matter how anti-capitalist and anti-libertarian, is functionally and morally equivalent.

Applied to Pasquale: A physician who -- has she no shame? -- chooses to become a cosmetic surgeon consequently does not become a cardiologist or a pediatrician. That is, we are told, somehow an "externality" warranting a corrective (i.e., a punitive) tax. Cosmetic surgery requires anesthesiologists. Greater demand for anesthesiologists drives up the price of anesthesiologists. This is, we are told, somehow an "externality." And now we have Pasquale's jump-the-shark redux: breast augmentation requires maintenance (i.e., "tune-ups") -- more (private-to-private) "externalities." Somehow.

Since there are no bona fide externalities from plastic surgery (no third-party reimbursement, no taxpayer subsidies, etc.), malcontents such as Pasquale have no choice but to redefine "externality" to become more -- forgive the pun -- "plastic." When reality contradicts you, redefine reality to suit your needs. How convenient.

Note also the lack of any outer bound for this faux-externality theory of tax-to-control policymaking. If every private transaction, by its impact (however minuscule) on supply and demand constitutes an "externality," then what isn't deserving of punitive taxes?*

As I noted in a comment at Pasquale's post:

Do you support taxing braces? Surely all that "unnecessary cosmetic dentistry" is imposing "externalities" upon "legitimate" dental practices.

Or how about infant male circumcision, which is also an unnecessary vanity procedure that "crowds out" other medical procedures?

Some more examples: Only the vain get contact lenses rather than eyeglasses. They should be punished via a contact lens tax. Indeed, those who wear anything but the cheapest eyeglass frames are generating "externalities" -- slap a tax on designer frames too. Add your own examples in the comments.

One last, modest proposal: Someone who chooses -- has he no shame? -- to become a law professor generates an "externality" by not becoming a pediatrician. Shall we be seeing a "law professor tax" any time soon?

Kip's Law: Every advocate of central planning always -- always -- envisions himself as the central planner.

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*Or, for that matter, command-and-control socialist regulation generally -- see Wickard v. Filburn, 317 U.S. 111 (1942).