When will liberty's day arrive?
Life without socks would be... "undignified," but no one recommends government provision or even sock vouchers. Relative to income, socks are sufficiently cheap. There is some inequality of socks, but it seems that just about everybody -- even the poor -- "has enough." We don't even force people to buy socks for their kids.
Might there come a time when health care and education fall under the same
rubric?Yes, I know that, due to rising labor costs, health care and education might continue to eat up an increasing percentage of national income. But still, can't "rich enough" people make do? Living in Aspen might cost half your income, but if you're a multi-millionaire no one weeps for you.
Of course today's poor aren't rich enough for us to remove government aid. But when will the splendid era of libertarian freedom be possible? Today's poor are much richer than the poor fifty years ago, and the poor of the future are likely to be richer yet. Won't the welfare state, at some point, simply become unnecessary?
Readers, please tell me in the comments when the time will come for dismantling the welfare state.
Will you sign your name to a pledge: "I am a left-winger, but only until 2078"?
More elegant would be: "I'm a 2096 libertarian."
Social democracy is but a mere transitional strategy.
If this were 1890, what Year of Libertarian Freedom would you have named?
In the comments I answer:
Health care is a unique case. The idea that our bodies are so special as to
justify any expense in keeping them healthy and well functioning, and doing any
less is undignified, puts it in a different category than socks. We don't fret
that the wealthy may purchase $200 cashmere leggings while the poor make do with Hanes that cost $3 for a six pack because it's not a matter of our sacred bodies.Likewise, in developed states we are less concerned about hunger,
because very few go hungry. This despite the fact that the wealthy can enjoy
luxurious food that the poor cannot even imagine; they savor $500 bottles of
wine while the poor swill their Natty Light. This doesn't strike us as tragic
because the poor, while fed with less tasty and interesting food, are not being
physically injured the way they were when they were hungry. Notably, most
concern about the inequality of food in the U.S. now revolves around the way the
poor are experiencing health problems from eating cheap fast food and processed
snacks.But of course hunger used to be an issue, until technology and better
law and institutions brought us above the substistence level of calories per
capita, and now the inequality seems less troubling to most, and we are less apt
to use government intervention to end that inequality. Will technology and
instutions do the same for health care, make it so cheap that we won't care
about the inequality?I am skeptical. There is no natural "good enough" point
for health care. Unlike socks and other clothing, there is no "no longer naked
and cold" point. Unlike food, there is no "no longer hungry, emaciated, and
bloated" point. Unlike housing there is no "no longer shivering on the street"
point. At least not that I can think of. As long as a given procedure or drug
has a nontrivial better chance of saving a life, it will seem uncomfortable to
most people that your chances at a healthly life are determined by your
wealth.A related observation is the way we view conspicuous consumption.
Even if we are against strong redistribution, most view popping a Jeroboam of
Veuve or buying a $5000 handbag with a bit of distaste. But far less people
would complain about someone getting the best, most expensive heart surgery or
treatment for brain cancer.The only other thought is that there may be some
point where we reach a point of diminishing returns in health care so dramatic
that the new drug is actually trivially superior if at all the the old, public
domain, one; the new imaging device does not provide any advantage in diagnosis
over the previous. We may reach this point as we bump up against the limits of
the human body. But I wouldn't count on it.
Your thoughts?
2 comments:
I guess the criticism I would offer is that judgments about what sort of medical treatment is economically justified are made on a regular basis by insurance companies. Riding into work today, there was a story about MRI scanning for breast cancer--since the MRI can reveal abnormal blood flow to tissues, it is apparently ten times more efficient at detecting cancer than a mammogram alone. But, at $1,000 extra a pop, insurance companies will only subsidize the MRI scan if the patient has a family history of breast cancer. Is it a "natural" point? Maybe not. But it's definitely based on some halfway reasoned cost-benefit analysis.
I think you're right, though, in asserting that government-subsidized access to health care (and in my opinion, education) rightfully enjoys special status. Public health care and public education also ensure a certain standard of care and education (though that standard is admittedly sadly variable). Imagine if we reached the libertarian promised land, and every person in the country was above what we now refer to as the poverty line. Heck, imagine if right now, public health care consisted of giving money to participants to engage in whatever treatments their budget permitted. Chaos, in my opinion, would ensue. Not because poor people are constitutionally incapable of handling their own health care, or idiots. But, generally speaking, the people you know are people of your own social class. And I know I would have made several notable bungles by now in procuring my own health care if I didn't have a father who was a doctor, and friends who had access to the same sort of health care available to the middle class in this country, and a social network that enabled me to make intelligent choices. Without that network, I would no doubt by now have injected myself with some sort of snake venom for a toothache complaint, and be lying flat on my bed, hallucinating mambas.
This is what I find problematic about dramatic, bare-bones libertarianism. Beginning from a premise that it would be better if everyone was wealthy enough to pay for their healthcare, any other contributing factors to the fact that those in higher income brackets and social classes tend to have better health and live longer are ignored in pursuit of the blissful Rapture of a time when the oppressive hand of the State will be lifted, and the law, in its majestic equality, will only forbid rich and poor alike to sleep under bridges, beg in the streets or steal bread. Which will be unnecessary, since we'll all be rich enough to buy homes, support our dependents, and buy Fritos. Right?
All of which says (in response to both Josh and BDK), that we have to fight for both rational and structural change. In addition to taking sensible instrumental measures to raise the minimum extant standard of living in our society to whatever we can agree it should be, we have to ask critical questions about what random and systematic distortions exist in our system that are unnecessary and undesirable. Libertarianism is functionally rational, but it's not socially radical enough.
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