An offhand Twitter joke and some pushback I got led me to look up what Hayeks’ The Road to Serfdom says about universal health care. Some interesting stuff on Page 125 of the edition that’s in Google books:

Nor is there any reason why the state should not assist individuals in providing for those common hazards of life against which, because of their uncertainty, few individuals can make adequate provision. Where, as in the case of sickness and accident, neither the desire to avoid such calamities nor the efforts to overcome their consequences are as a rule weakened by the provision of assistance, where, in short, we deal with genuinely insurable risks, the case for the state helping to organise a comprehensive system of social insurance is very strong. There are many points of detail where those wishing to preserve the competitive system and those wishing to supersede it by something different will disagree on the details of such schemes; and it is possible under the name of social insurance to introduce measures which tend to make competition more or less ineffective. But there is no incompatibility in principle between the state providing greater security in this way and the preservation of individual freedom.

I take this as saying that Hayek would support a universal health care system but would prefer it to be financed with a flat or regressive tax base. One interesting issue here regards preventive care. Things like regular checkups, wellness advise, basic screening, etc. don’t meet the definition of “genuinely insurable risks.” At the same time, based on what we actually know about medicine an ounce of prevention really is worth a pound of cure and as long as you’re going to be having the state pick up the tab for illness it seems very practically sound to also have the state invest in prevention. But defining what does and does not count as “prevention” would entail a degree of non-Hayekian planning. My take would be that these medical issues are sufficiently technical to think that Hayek’s general point about the superiority of the market to technocracy in organizing knowledge almost certainly doesn’t hold. But either way, we could have a much more constructive debate about health care if the right-wing took more of a Hayekian view and less of a Randian one.

Brad DeLong says I was right the first time about The Road to Serfdom and that the 1976 preface’s disavowal of the claim that postwar western Europe was on a slippery slope to totalitarianism is a post hoc revision. He observes that the 1956 preface certainly seemed to be arguing that Britain was, yes, on the road to serfdom. Which would, of course, be a logical thing for a book titled The Road to Serfdom to argue:

Of course, six years of socialist governmnet in England have not produced anything resembling a totalitarian state. But those who argue that this has disproved the thesis of The Road to Serfdom have really missed one of its main points; that the most important change which extensive government control produces is a psychological change, an alteration in the character of the people. This is necessarily a slow affair, a process which extends not over a few years but perhaps over one or two generations. The important point is that the political ideals of a people and its attitude towar authority are as much the effect as the cause of the political institutions under which it lives. This means among other things, that even a strong tradition of political liberty is no safeguard if the danger is precisely that new institutions and policies will gradually undermine and destroy that spirit. The consequences can of course be averted if that spirit reasserts itself in time and the people not only throw out the party which has been leading them further and further in the dangerous direction but also recognize the nature of the danger and resolutely change their course. There is not yet much ground to believe that the latter has happened in England.

Of course I suppose Hayek would say that Britain was on the road to serfdom from the mid-1940s through to the end of the 1970s and that the election of Margaret Thatcher then represented the resolute change of course necessary to prevent the UK from becoming a totalitarian dictatorship. But even that seems pretty slipshod and absurd. I think it’s fair to say that the UK, like most countries, was experiencing some serious economic problems by the end of the seventies and that Britain’s were perhaps more severe than usual. But the country was pretty clear not on the verge of becoming a Stalinesque totalitarian dictatorship on the eve of Thatcher’s election. Nor has a country like France that never really followed the US and UK down the neoliberal path become a totalitarian dictatorship.

Interpretive issues aside, clearly Hayek’s general critique of central planning as economics was essentially right and has proven extremely influential over the decades. His political views, on the other hand, look to me to have been pretty alarmist and off-base.