Consumatopia: “There’s a flipside here in that if some insurance company started denying coverage to people with homosexual partners then liberals would immediately want the company shut down, but I guess libertarians would be theoretically okay with it?”

Good question. Most libertarians generally believe that markets will punish discrimination so the government doesn’t have to (ie, if you won’t hire homosexuals or blacks or whatever, you can’t hire the most qualified people, and so your business suffers while a non-prejudiced competitor flourishes), with caveats onto that. If we accepted the premise that homosexuals actually are more expensive to insure than demographically similar heterosexuals (and there probably are at least some demographics in which this is true), then that kind of market force wouldn’t act on a discriminatory health insurance company.

So, I don’t know. It seems clear that we haven’t figured out a relatively free-market-based approach to healthcare which lines up with our moral intuition about what kind of care people deserve.

No, we actually believe, you just misunderstood it. The subsidy gives us the right to regulate it, not the obligation or even suggestion that we should. We have the right to ban people from stepping on the cracks of a public sidewalk, but no reason to actually do so.

Sanchez’s point makes logical sense, but is unfortunately extremely brittle in the that once you’ve abandoned anarcho-capitalism the government has its foot in the door of the subsidy-justification for any regulation. Did you parents send you to public school? Did you drive on public streets or walk on public sidewalks this morning? Did you benefit from the public good of police protection? Kevin O’Reily’s point 2 is critical here, in that once the government starts subsidizing your productive capacities (and if you’ve spent any reasonable amount of time in America than at some point they’ve already done that) then the government has a stake in both your public and private costs for the rest of your life. The government funding for the hospital you were born in becomes the Original Sin of collectivism.

I’m not sure anyone here has made that claim. However, when Sanchez draws a broad sphere of autonomy around the body to avoid Adler’s decision of which freedoms are sufficiently important, while the sort of endeavor I would support, doesn’t really avoid that ranking of freedoms at all–it’s just another way of encoding your rankings. By making such a sphere, you’ve decided that my choice of what chemicals to put in myself outranks my neighbor’s choice of whether he’d like to live in a society that allows people to put chemicals in themselves. And, indeed, I would agree with that ranking, but the only reason we want a sphere of autonomy is because we happen to be sympathetic to ranking freedoms according to their radius from the center of the sphere of autonomy.

There’s a flipside here in that if some insurance company started denying coverage to people with homosexual partners then liberals would immediately want the company shut down, but I guess libertarians would be theoretically okay with it?

Hence, liberals invoke the public health argument with respect to smoking, trans fats, and seatbelts, but not to poor kids having children, or forcing a non-vegan diet on people.

This is also why Europeans don’t go for the same arguments: it’s an essential part of the French national identity to drink wine and eat awesome-if-not-particularly-healthy food, and so there’s no existing large base of people agitating for the ban of wine and awesome food, so they don’t seize on this excuse of an argument.

Similarly, in the US, there’s no large popular base that’s opposed to poor people having children, so you probably won’t see the argument Julian outlines above.

But you know what there is a constituency for in this country? Oppressing gays. And it’s only a matter of time before the public health argument gets trotted out as a rationale for teaching kids that homosexuality is wrong and shameful (er, make that “disease prone”), or whatever, on the grounds that being a gay male is strongly correlated with increased risk of HIV and other STD’s. Probably the only reason this hasn’t yet become an issue is that the Right is uncomfortable with public healthcare anyhow, and doesn’t tend to seize on it as a means of advancing their agenda. But if we get to the point where everyone accepts a reality of public health, you can bet that social conservatives will use it as a club against anyone who diverges from their idea of righteous living.

Other than the 70% of total health care spending that is done by the government (mostly through Medicare), you mean?

I could be crafty and suggest that this was due to the fact that the American health care system is incredibly inefficient compared to those in other nations, thus making the “imposed costs” of “bad” behaviour much larger. Instead I’ll just point out that maybe these laws you hate are more a function of cultural norms (and the American proclivity for puritanism) than any sort of linkage with government subsidy, regardless of how they are justified.

Also, you can pre-emptively opt out and be freed from those restrictions. We could legalize drugs, and convert the entire drug war into a National Healthcare Deprivation punishment.

“Then again, smokers may cost the state less when savings in Social Security are taken into account. Perhaps smoking should be subsidized.”

The problem with smoking and other drugs (from society’s standpoint) is not that they’re dangerous, it’s that they aren’t dangerous enough. Why are we demanding that tobacco companies make less unhealthy cigarettes? We should be dumping more rat poison in! Permanently “opt-out” those evil, evil smokers!

On a non-joking note, you are completely right. The more that the government handles healthcare, the more the government must restrict the rights of those who use that healthcare, in order to keep costs down. I don’t see any other way around it, and I think that most people would find the argument for that regulation compelling, even though the idea of controlling people’s lives on that level is horrifying to me.

(2) Your opponents do not recognize a distinction between private and public costs. So even if a rich person is able to pay for the consequences of his poor choices, in their view he still makes everyone else worse off inasmuch as that capital is going to pay for health care rather than being invested in a more productive activity. By dying earlier, he deprives others of his contributions to gross domestic product and the tax base.

(3) Your opponents refuse to, or do not know how to, count the subjective value an individual derives from a pleasurable albeit risky behavior so their calculation of costs is totally one sided.