When Ron Paul suggested in a Republican debate that the charitable efforts of a free people were the answer to those who needed medical care and were genuinely unable to pay, critics scoffed.  Why, doesn’t he know we’re too wicked to do that?  We need people with badges and guns to expropriate us.  Only then will the needy be cared for.

There are two responses to this. One involves the extent of charity medicine on the eve of the creation of Medicare and Medicaid. Here I cite historian Allen J. Matusow, who is no libertarian or conservative. Just honest:

The poor had not fared all that badly prior to Medicaid, thanks to the willingness of doctors and hospitals to dispense charity medicine. In the last year before Medicaid the hospital admission rate for families with incomes below $3000 was 107 per 1,000 families; for families with incomes $10,000 and above, it was only 89 per 1,000 families. Before Medicaid, the average low-income person visited a doctor 4.3 times a year — not dramatically less than the 5.1 visits made by high-income persons. Granted that the poor are more frequently ill, these figures do not sustain a thesis of gross inequality….

Most of the government’s medical payments on behalf of the poor compensated doctors and hospitals for services once rendered free of charge or at reduced prices…. Medicare-Medicaid, then, primarily transferred income from middle-class taxpayers to middle-class health-care professionals.

The second point involves why medical costs are so high in the first place.  On this, it’s important to read the article by Vijay Boyapati.  Costs rose twice as fast in the decade following the creation of Medicare as they had in the years leading up to it; Matusow reports that “medical price inflation fueled by Medicare itself helped erode much of Medicare’s benefits.”

Matusow’s book is The Unraveling of America: A History of Liberalism in the 1960s.