as we move toward "social" or government-run medicine - and very decisively in the requirement to buy health insurance - we socialize or collectivize the costs of healthcare. now i am not going to deny that there are good features of this, but of course it is also riddled with difficulties. but here is the really problematic bit: it justifies extremely wide-ranging state power over the bodies of each person.

so, the basic principle by which a scope of individual liberties or rights is delineated still in our imagination is the principle of classical liberalism: i should have a right (or i do - naturally, inherently, or as a child of god - have the right) to do whatever i want, compatible with equal liberty for all, or right up to the point where i harm someone else. so the government can step in to prevent you harming someone else, for the sake precisely of equality of freedom.

now "social cost" is a great problem for this point of view, one that john stuart mill, for example, had to deal with very elaborately. so if your bad habits lead you to disease or death, your actions do harm various other people: your family, for example, or your employer, and whoever generated whatever resources you draw on that weren't yours to begin with.

a "collective" health provision scheme very directly makes everyone's contributions seem to depend on individual decisions. what i actually pay in healthcare, for example, might (in a simpler or more rational system than we'll ever see) vary to some extent with the rate of obesity or seatbelt use in the population. the scope of your decision stops at me: my body and my resources and my rights. you are harming me by being obese. so together we can require you to observe a certain dietary regimen, etc. there is virtually no dimension of your behavior that does not potentially or statistically impose costs on others. so there is virtually no dimension of behavior that the state cannot regulate.

mill argued that we absolutely had to distinguish between direct and indirect harms, between cases where i harm you intentionally and cases where i harm myself, and in doing so harm you, as it were, accidentally. otherwise, he says, we face tyranny. but that sort of distinction - hard enough to make stick at any time - is compromised more and more by programs such as collective healthcare.

really though this is a pretty idealized sketch, and on the other side the costs to me of the obesity of one woman in arkansas, even in the worst result, is infinitesimal, and i'd do better to think about the costs of medical technologies, drug monopolies, administrative costs, and so on. but the move then is to demographics, statistics: we weigh your actions not as your actions but in terms of the statistical frequency and effects of many people making similar decisions. we're imagining 300 million people as though they were five people who have decided to share a house or something; the actual mutual dependency has ascended into the realm of pure abstraction: any one person's relation to any other one person is, we might say, notional.

but the point is that "public" healthcare will actually be the lever for many specific abrogations of the autonomy of many actual people, because the argument in terms of social costs can be squared with classical liberalism, with a basic respect for individual rights as we understand them. this vision of rights can drive a complete breakdown of anyone's actual autonomy in the face of state power: another reason to go to a tea party.