The most notorious moment in the Republican presidential debate the other night revealed something about Ron Paul the “liberty” candidate’s idea of what freedom actually means to him. Clearly some vociferous audience members, presumably members of the Tea Party, think they define it similarly, but I don’t think all Americans do or would.

Sam Stein at Huffington Post described the moment (you can watch a clip at the link):

A bit of a startling moment happened near the end of Monday night’s CNN debate when a hypothetical question was posed to Rep. Ron Paul (R-Texas).

“What do you tell a guy who is sick, goes into a coma and doesn’t have health insurance? Who pays for his coverage? Are you saying society should just let him die?” Wolf Blitzer asked.

“Yeah!” several members of the crowd yelled out.

Paul interjected to offer an explanation for how this was, more-or-less, the root choice of a free society. He added that communities and non-government institutions can fill the void that the public sector is currently playing.

Specifically, Paul said, “In a society where you accept welfarism and socialism, he expects the government to take care of him. But what he should do is whatever he wants to do and assume responsibility for himself. My advice to him would be to have a major medical policy, but not before–” and here Blitzer interrupted him, wanting to return to the hypothetical of the dying man after the choice to forgo insurance has been made.

It’s instructive to counterpose the two ideas of freedom that Paul is contrasting here. Is the individual in, say, a society with a single-payer system who not only expects but deserves to have government pay for unforeseen health catastrophes less free than one in a market system who had opted, based on actuarial probabilities, not to be covered and finds he’s made a bad bet? Paul seems to believe so. Never mind that the person in the single-payer system may be able to make choices beyond what the one in the market scenario will be able to make, assuming they survive their respective hospital stays. The former individual will, at least, be free to think about actions other than paying for unpaid health bills.

Maybe Paul believes that the person whose freedom most counts here is not the unwell individual but the taxpayer in each society who may or may not be subsidizing the health care costs of strangers. In single-payer health care systems, you’re certainly not free to buy out of paying into the system, which means that if you’re lucky enough to be well and stay well, your money will, like it or not, go to someone else’s care. Of course the same thing can happen in a free market system if you opt to pay for health insurance and don’t need care, with the only difference being that you pay for strangers’ care via a private insurance company. And in a market system, despite the dangers of being uninsured, one is, at least, free to take that risk (though gods help you if the worst happens); but if one does take that risk, then the tax payer is, yes, freed from having to pay for the uninsured person’s bad decision.

So the liberty candidate’s concept of freedom as far as health care is concerned boils down to a couple of principles:  having the right to gamble badly and having the right not to pay for strangers’ dumb decisions. Is that all freedom is about?

“That’s what freedom’s about,” Paul made explicit during the debate, “taking your own risks.” He later added, “We’ve given up on this whole concept that we might take care of ourselves and assume responsibility for ourselves. Our neighbors, our friends, our churches would do it. This whole idea–that’s the reason the cost is so high.”

It’s debatable about why the cost of health care is so high. It seems more likely to me that American health care is expensive because insurance companies are cheap bastards who like (and are free, of course) to make profits. If all medical care costs were reliably covered by payers, would that really somehow make providers charge more? Or do they charge more to cover the gap between what they believe they’re owed and what the insurance companies want to pay them? Wouldn’t the cost of health care go down if the payer was not so deeply and expensively invested in not paying?

In any event, the cost issue seems to be extraneous to the freedom issue, a crowd-pleasing non sequitur to get Paul out of a debating jam.  Paul has no problem expecting neighbors and friends to foot the bill for an associate who bet unluckily against getting catastrophically ill. Better those acquaintances chip in a lot than strangers pay a little to cover the unlucky in society, right?

Stein added another layer of nuance to the story in a post today:

Paul’s 2008 campaign manager, Kent Snyder, went through a strikingly similar experience to Blitzer’s hypothetical one, dying of complications from viral pneumonia just two weeks after Paul ended his presidential bid. Snyder was uninsured, so family and friends were forced to raise funds to cover his $400,000 in medical bills. Their efforts included setting up a website soliciting contributions from Paul supporters.

The episode reflects what Paul himself argued should be the free-market ideal for health insurance policy.  ….

While the episode provides a window into the type of principled approach that makes Paul both an appealing candidate and a lightning rod, the question of whether Snyder’s story affirms the congressman’s worldview is far more controversial. It shows community support can fill the void that government often plays, but at the same time, not all uninsured individuals can rely on family, friends or campaign email lists to raise $400,000.

Apparently Paul viewed Snyder’s death as a “sacrifice” in the fight for liberty.