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Health Care as Distributional Right

August 24th, 2009 · 22 Comments

I’ve suggested before that the best version of progressivism—by which I mean, the most internally coherent version—would not include a distinct right to health care for competent adults as a moral or theoretical right, though it may in practice recommend that some degree of access to publicly provided or subsidized health care be afforded as a concrete or legal right in actual progressive societies. I want to try to cash that out a bit, because I’m curious how far self-identified progressives will agree that the account I have in mind does represent a clearer or more precise articulation of their values.

Just to reiterate a familiar point, to speak of a “right to health care” simpliciter presents some obvious difficulties, because “health care” consists of an array of heterogeneous goods and services that must, for the most part, be provided by others. These differ in cost, scarcity, and expected benefit to the recipient. Like other putative positive rights, a right to health care is different in an important respect from negative rights, such as the right to free speech—supposing we mean by this a right not to be coercively prevented from communicating with willing listeners. The speech right may be externally limited, insofar as it conflicts with other important interests that may be seen as trumping it in cases of conflict, as when, for instance, speech involves the disclosure of vital military secrets or the spread of malicious falsehoods that would wrongly destroy some private person’s reputation. But it is not internally limited in that, in principle, my exercise of the right does not use it up: It is not as though there’s a limited stock of social restraint, so that if I speak more, and you refrain from silencing my speech, society must squelch someone else’s to make up for it. Health care, or perhaps positive rights taken together, are not like this: When social resources are expended to satisfy one citizen’s claims, this generally reduces the stock of resources available to satisfy other similar claims.

One could argue that these are, in fact, more closely parallel than they first appear: The right to speech is bounded by other rights, which (depending on how you prefer to frame it) either trump the speech right in cases of conflict or, conversely, define the limits of the speech right. In the same way, any particular citizen’s right to health care is bounded by the equal right of other citizens to health care, perhaps along with other “primary goods” like education, food, adequate housing, and so on. Even if we want to think of it that way, practically speaking the natural way of conceptualizing the right when it comes to deciding what a particular citizen is actually entitled to is as a claim or share right against the stock of social resources, not—as with speech—as a “side constraint” right subject to certain exceptions.  The question “how much health care and of what sort” arises  as a matter of course, in the way the question “how much speech” does not. Assuming we cannot give everyone infinite health care, and that health care is one of a number of positive goods to which citizens are entitled, then any real-world attempt to cash out the right requires a determination of the share of social resources to which a claimant is entitled.

Now, to make this a bit more concrete, a thought experiment. (And just to preempt objections: I understand that this is far removed from the practical health care concerns of progressives; I’m shooting for a conceptual clarification, and not so deluded as to think the scenario I’m about to paint resembles our current situation in any important respects.) Suppose we have what I’m going to call a market egalitarian society. Suppose, in other words, that this is a society where economic life is generally market-based, but where a scheme of taxation and redistribution then ensures that all citizens have a fair share of economic resources, according to whatever conception of economic justice you think is correct. For the purposes of our example, suppose further that the correct conception seeks to neutralize to some extent the effects of bad luck, so that someone who is burdened with health problems, either congential or as a result of accident, may be entitled to a greater share of social resources by way of compensation. Also suppose that, unlike most social democracies, this market egalitarian society does not generally go in for direct government provision of goods, but instead, having ensured that everyone has their fair share of all-purpose resources—in other words, wealth and income—allows adults to secure these goods for themselves. Imagine that this is a generally affluent society, and in it there lives a Mr. Rich, who is as well off as anyone else—and perhaps, if this is compatible with your preferred conception of economic justice, economically better off than most. As he gets on in years, he is diagnosed with a serious condition that will shorten his life—though appropriate medical care can affect how much it is shortened. If necessary, according to your preferred conception and the specific facts of the case, his share of social wealth may be augmented through redistribution to compensate for this stroke of bad fortune.

Though he could expend some of his share on the appropriate medical treatments and be left with enough to maintain a perfectly decent quality of life, Mr Rich decides to use his resources in service of other projects: Perhaps he decides to travel to parts of the world he’d always wanted to see, or endow a library, or in other ways enhance the quality of his remaining years. As a result of this, suppose he reaches a point where he is no longer able to afford the medical treatments that would extend his life. Can he still claim a right against society to be provided with care? Or are his rights exhausted by his consumption of what, by stipulation, is his fair share of aggregate social resources? Can society fairly say: “We’ve given you what you had a right to already, and you opted against using it for health care”?

If we want to say that he is still entitled to care, then under the circumstances we must in effect say that he is entitled to more than his fair share of resources, which seems like something of a contradiction in terms. To avoid this contradiction, we might say that Mr Rich must not be permitted to expend his share on these other projects, but rather to devote it to his own health care.  Put it differently: If we want to say that what Mr Rich has is specifically a right to health care, we have to be prepared to say that he is not just entitled to the cash value, as it were, of his share of social wealth, but only to certain particular goods on which it might be expended. This would justify saying that the market egalitarian society is badly constructed—that we must provide the good directly, rather than providing fair shares and letting people decide whether they want that good or others.

On what grounds might we say this? We have a couple of options. In the real world, as opposed to our thought experiments, it might just be that it is easier politically to sell a system of universal health care than the sort of naked redistribution contemplated in our market egalitarian society—that in the absence of these political constraints, that society is a perfectly fine model. There might also, of course, be other more pragmatic reasons to say the society should provide care directly instead of fair shares. Perhaps a national scheme of health care provision will enable each of us to get more bang for the buck than a scheme in which each of us takes our fair share to the health care market. There are also some obvious externalities to certain kinds of health care: Ensuring that I am treated for infectious diseases in a timely way makes it less likely that I will inflict these ailments on others.But let’s see if there are other routes to take that preserve some kind of special status for health care.

We might say that certain goods—among them long life and good health—have an objective value or priority regardless of what Mr Rich might think. This is, I think, the view of many religious conservatives who oppose assisted suicide, not merely because they worry that people will come under undue pressure to prematurely end their lives, but because they see life as sitting atop an objective, divinely ordained hierarchy of value, so that it is not up to us mortals to decide that our lives are no longer worth living. While it is certainly possible for a progressive to hold this view, it sits uneasily with other widely-held progressive value commitments, so let’s put that aside for the moment.

We might alternatively say that while Mr Rich is not necessarily wrong to value other goods above health at some margin–an extra painful week or two bought at great cost might genuinely be a less valuable use of his fair share than some alternatives available to him—he is likely to misjudge his own best interests, perhaps because he underestimates how precious those extra weeks or months will be at the end. Some similar thought presumably motivates the decision to provide the indigent with goods like food stamps rather than direct cash payments: Because poverty is often bound up with problems like alcoholism or substance abuse, we want to ensure that people will use social assistance to acquire goods that are in their own long-term best interests (and, of course, those of their children—an obvious complicating factor) rather than in self-destructive ways that may only increase their need for future public assistance. Even if we think Mr Rich is perfectly capable of making the relevant trade-offs, rendering this sort of argument inapplicable to his case, we might well think it applies to younger people facing the choice of which health risks to insure against. We frequently do see arguments of just this sort, and they are plausible enough on face.

This second option is clearly, in some sense, paternalistic, though since I’m doffing my libertarian hat for the purposes of this post, this does not in itself constitute an objection. I do, however, want to try to disentangle the different strands of justification here—to see how far the motivation for a right to health care is a function of premises having to do with economic justice, and to what extent there’s a paternalistic element. If we want to say that the market egalitarian society does not go far enough when it allocates to each citizen a fair share of economic resources, then allows them to make their own health care decisions, it cannot just be that we are worried about the distributional injustices. (An alternative: We might say that prudence is arbitrarily inequitably distributed, and so some degree of paternalism is in fact a component of distributive justice. I leave this suggestion by the wayside for the moment, though it might be interesting to follow up in a future post.) Decomposed into these separate elements, though, only part of the “right to health care”—the part consisting of a claim to one’s fair share of social resources—actually looks like a right of the familiar sort, which it’s up to the individual to claim, use, or waive according to his own best judgment.

We can try to squeeze the square peg into the round hole. We can say, perhaps, that my “total” self, conceived as the aggregate of all the temporal parts of my life, has a right that consists of a claim against both society and against any particular short-sighted time-slice of the whole-life self, to be prevented from squandering my share of social resources in ways that my future self might sorely regret. Maybe some analogy to the right against self-incrimination or the right to counsel in the criminal justice context could be attempted, but this seems a bit forced. While it does not seem exceptionally weird to say that I have a duty of prudence to my future self, the language of rights seems like a poor fit. It seems more plausible to say that, on the one hand, I have a right to some fair share of social resources, and on the other, that it is simply better if, for my own good, society constrains my enjoyment of that right by ensuring that I consume it in the form of health care than by frittering it away on ephemeral pleasures.

As I suggested at the outset, the upshot of these considerations—if we find them compelling—may be that an actual progressive society should recognize a legal right to health care, rather than a right to the cash value of one’s fair share. More precisely, this would be a right to one’s fair share of health care resources, rather than resources simpliciter. But if, as I also suggested, we reject the notion that health or longevity are inherently or objectively better than other goods people might want to secure with their just shares, then this is not because there’s a higher-level moral right to health care. Rather, the better account will say that the moral right is to one’s fair share, but that some mix of paternalism (which, again, I mean to use without necessarily pejorative connotations here) and other pragmatic considerations should be delivered in the particular form of health care.

Given my own priors, I expect that this whole long post will be seen by some readers as a sneaky and disingenuous attempt to get progressives to admit that they are paternalists after all, at which point I leap out from behind a bush and scream “Gotcha!” And probably there’s nothing I can do but say: “No, really, it isn’t.” I’m genuinely curious whether this is an account progressives regard as a theoretically adequate representation of their own commitments, and perfectly open to the possibility that I’ve missed some better alternative account. I will re-don my libertarian hat this far though: If this account does ring true, then to the extent progressives see themselves as continuing the liberal tradition, I assume they’re more comfortable with the social justice strand of the argument than the paternalist strand. With the market egalitarian model at one pole and a fully government-run health system at the other, I think it would be interesting to talk about what the intermediate systems might look like for different assignments of weight to each strand. Of course, even if I’m not waiting to jump out from behind a bush, presumably others are, so I won’t take it too personally if folks are loath to take up the frame.

Tags: Markets · Moral Philosophy · Nannyism


       

 

22 responses so far ↓

  • 1 jre // Aug 24, 2009 at 4:41 pm

    Some types of paternalism are not only desirable but inevitable given that any attempt at egalitarianism springs from some concept of the good. If I were injured in a traffic accident and taken on board an ambulance, I might be tempted to say

    “Hey — since I’m injured, I’m morally and legally entitled to a ride in your ambulance, right?”

    “Right.”

    “Well, instead of going straight to the hospital, I’d really rather you took a couple of laps around the block with your lights and siren going, ’cause I’ve never been in an ambulance before, and I would value that experience far more than the same minutes spent in the ER.”

    Even the least paternalistic of EMTs might be unreceptive to that argument because, at some margin, the system has to weigh some set of values against yours or mine.

  • 2 Julian Sanchez // Aug 24, 2009 at 4:59 pm

    I don’t know if that’s an ideal example—in part I’d be turned down because their job is to get me to the hospital and then free up the ambulance for other people who might need it. Also, at the point where we’re saying that my injury gives me a specific right to ambulance servivces, the specific purpose of that service—to get me to the hospital quickly—is presumably already built into the right.

    But the more general point is surely sound. As Joseph Raz memorably puts it, there are many competing theories of equality, but there’s no plausible theory on which we’re entitled, as a matter of justice, to have equal numbers of freckles on our arms. By the same token, it is a shoddy theory of equality in which everyone is equally entitled to *precisely the sort of stuff Julian Sanchez values*, however uninterested they may be in philosophy books, Paul Smith ties, or Joy Division LPs. Which is to say, you need *some* theory of value to answer the “equality of what?” question, but it had also better be a *thin* theory if it’s going to count as a theory of giving *equal consideration* to diverse people. Hence—and perhaps this should be more explicit—the assumption that other things equal you want people to have general rights to social resources and let them decide what’s valuable.

  • 3 jre // Aug 24, 2009 at 5:41 pm

    Thanks for moving past a silly example to the underlying point. Many programs are market egalitarian in motive and unavoidably paternalistic in their restrictions; scho0l vouchers spring to mind. The childless may grouse about subsidizing other folks’ kids, but public education does enjoy very broad support precisely because those resources are paying for what we have all agreed is a social good. To construct a slightly less silly example, suppose the market egalitarian system is going to cut me a $2000 check (not a voucher) for each of my three kids, and I then decide that they would get more benefit from an above-ground pool than from any school that would take them. Would it not be just a tad perverse for the system to allocate an extra $6000 because my kids need an education, then allow me to take the money and disregard the need?

  • 4 the teeth // Aug 24, 2009 at 5:46 pm

    Until this post, I’ve been mildly perplexed by your recent posts which harp on difficulties involved using the term ‘right’ to refer to healthcare. In my mind, the meaning of a ‘right’ to healthcare was pretty obvious, and coherent — the actual care and procedures available would be entirely dependent on a society’s wealth, medical sophistication, and cultural norms, but within a given society, when an individual has certain conditions, there are certain procedures which they are entitled to. An individual’s ‘fair share’ doesn’t enter into it. We can’t predict whether any individual will get skin cancer, but we can predict pretty well how many people out of a large pool will get skin cancer; given limited resources which we’ve chosen to pool together to treat skin cancer, we determine what level of care each victim is entitled to. Healthcare is very different from food or housing, in this sense — people’s needs (or ‘needs’) vary by orders of magnitude, unpredictably … but a society’s aggregate ‘needs’ are pretty stable and predictable. Which makes it misleading and unhelpful to think about a given person’s fair share, from where I, as a ‘progressive’ (though I sort of cringe at the word), stand.

    Or, to put it another way — if the market egalitarian system allotted me $2k to pay for healthcare, my choice as an educated consumer, who might value healthcare less than the system expects me to, would be to purchase less health INSURANCE — not less healthcare. The problem is difficult because are needs are distributed so unevenly.

  • 5 Julian Sanchez // Aug 24, 2009 at 6:09 pm

    teeth-
    Right, so at the start I allow how shares might be determined in part by individual burdens. Either, as you suggest, people might have the same shares and the option to purchase various insurance packages, or people saddled with illness by misfortune might thereby be entitled to larger compensatory social shares.

    The underlying intuition here is that if people have a fair allocation of resources in light of their burdens, that ought to take care of the problem of *justice*. If we’re supposed to be giving them a specific good instead of an adequate share, there’s got to be something else going on—like a worry that they will use their share unwisely.

  • 6 the teeth // Aug 24, 2009 at 6:49 pm

    I think that this is a useful way of looking at it if the variation between burdens is relatively low — if you’re talking about housing, a paraplegic might have special needs, but there aren’t that many paraplegics, and the cost of an housing which can accommodate a wheelchair isn’t tons higher than the cost of housing which can’t. But in this arena, needs vary massively. The worry isn’t so much that individuals will be unwise with their share — it’s that they’ll act rationally, according to their self-interest, at least in the concrete iteration of a monte-carlo simulation of their life, screwing over the inhabitants of iterations in which they have debilitating illnesses.

    Though maybe I mistake what you’re suggesting — if you acknowledge that an individual’s equitable share is dependent on their personal condition, then a healthy 30 year old may need extremely minimal medical care, then maybe they’d be right to spend the $50 they ‘deserve’ on a new shirt rather than ibuprofen and cough drops for the year. And the guy w/ kidney disease might be better off spending ‘their’ $80k for the year on a massive bacchanal, rather than dialysis and unpleasant, invasive treatments. I don’t think I have a philosophical problem with this notion … but I’m also not sure what I’m conceding, and I’m pretty sure there’s still a fundamental division in our thinking.

  • 7 the teeth // Aug 24, 2009 at 7:07 pm

    Actually, to keep yammering — if you have a scenario where everybody is entitled to $X worth of insurance, I do think it’s a bad idea to allow people the freedom to spend their ‘cut’ on another sort of good. The reasoning here is paternalistic — humans are absolutely terrible at thinking probabilistically. I’m sure that there are people who would wisely spend some portion on something else, but the cost (to society at large) of the folks who would gamble on staying healthy, and lose, is too high to allow this freedom. I’m fine with the scenario described at the end of post 6, but I’m sure you agree that it’s impractical, not least because many people would find it grotesque.

  • 8 the teeth // Aug 24, 2009 at 8:54 pm

    Ok, so I’m going to yammer a little more — I feel a little bad making three comments in sequence, but here goes:

    To the extent that I believe there’s a ‘right to health care’ — I’m not 100% sure this is the case, and I don’t have a background in political philosophy, & may well be using terminology poorly, but my gut feeling is there is (or ‘should be’) a ‘right to health care’ — I don’t think that the basis of this right is economic justice. I think (or will claim) it’s a facet of a human right to self-preservation. We have a right to do what we can to continue living, and remain functional (ie, healthy) while alive. And we have a moral obligation to assist others in this. Our current system supports this intuition — our health care system will treat anybody in the ER, able to pay or not. Urgency is clearly an important factor; a big question is where the line should be drawn, ‘urgency’-wise. And after a person has invoked their right to self-preservation, what burdens can a society justly place upon him? To my thinking, a society which places crippling debt on people who take advantage of their rights is an unjust one. Via the right to self-preservation, a person should have the right to seek out healthcare treatment conventionally used and widely available within their society. And it’s the society’s obligation to maintain a system so that everybody can do this without overly hampering their right to self-determination. Most of the difficult questions are economic, but I’m doubting that it’s correct to view the right itself as a matter of ‘economic justice’.

    Which is all maybe a little naive, and obvious, and poorly articulated, and it’s surely not any sort of official party line. But it’s the current thinking of one person who could fairly if grudgingly be called a ‘progressive’.

  • 9 Dan // Aug 25, 2009 at 2:23 am

    Very thought-provoking post!

    I lean towards a similar thought as the teeth, although I’d define my goal less as a just society than as a compassionate society. I don’t think a compassionate society can refuse a request for the necessities of life. It’s the same reason we have soup kitchens and food banks. Most people who use them have been very unlucky, of course; but we don’t restrict our charity to the ‘deserving poor.’ It doesn’t matter how many opportunities you’ve thrown away or how badly you’ve screwed up, you don’t deserve to starve to death.

    Of course there’s no hard-and-fast definition of necessity. Even ‘healthcare’ covers a pretty broad range, and life-saving treatments are usually a matter of probabilities rather than a binary switch; plus there’s always the question of cost/benefit. But you proposed a clear-cut hypothetical, so I’ll just say that a standard-practice intervention that will prolong life for several years qualifies as a necessity.

    To credibly enter into a contract where a person says: “give me my share of global resources, I promise to make no demands on society ever again”, we need to be willing to sit and watch that person die when they want to be saved, and we have the power to save them.

    In the real world I would argue this pragmatically, as a matter of human nature, limited time horizons, changing preferences. But stripped to hypotheticals, this is an inherent tension between the fundamental values of freedom and compassion. I’m not enough of a philosopher to defend either choice, but I think the wiser choice is compassion.

  • 10 Julian Sanchez // Aug 25, 2009 at 2:52 am

    Thing is, that’s not on the table: At some margin, you ALWAYS have to sit and watch someone die, because you could always try *one more thing*. The only question is WHEN you sit and watch them die, not if.

  • 11 the teeth // Aug 25, 2009 at 10:21 am

    “At some margin, you ALWAYS have to sit and watch someone die, because you could always try *one more thing*. “

    Julian, I think you make this out to be a bigger problem than it is. It’s certainly accounted for within my understanding of a right to healthcare, as described earlier — everybody has a right to seek self-preservation, and in a just society, all people will have the resources to do so, according to the abilities/mores/conventions of the society. If a treatment or test is available to most people who have a given condition, it’s unjust to deny it to a less wealthy minority. This doesn’t imply that all people are entitled to all treatments.

    But even if you don’t buy this view of things, I don’t think this is some sort of difficult moral problem. Just say: “When I said you were entitled to any life-saving treatment, I really meant you were entitled to any REASONABLE life-saving treatment. That thing you asked for — that’s just crazy.”

    But also further — your claim is false. You can’t always try one more thing — eventually, everybody dies. There’s no logical impossibility implied by a society providing “infinite” healthcare to all members — mortality enforces a pretty inflexible upper bound on how much any person can consume. Now of course this is an entirely awful idea, and it’s troubling that so many people seem to think that we should have unlimited healthcare … I just think this isn’t nearly the problem you present it as.

  • 12 Tom // Aug 25, 2009 at 11:13 am

    I probably don’t have the philosophical vocabulary to fully engage with this post, but your account seems basically right to me. I don’t think the paternalistic aspects of healthcare can be ignored, but instead must be justified. At that point the liberal case becomes:

    “We have strong empirical reasons for thinking that, if left to their own devices, people will make choices that lead to situations in which they are suffering. Although we will not have caused that suffering, we will find ourselves able to alleviate it, and we will be entreated to do so. Biological and cultural realities mean that we’ll feel obligated to act by expending our own resources. Although this will be a choice in a certain sense, it sure won’t feel like one, and we’d rather not have our own freedoms impinged in this manner. This is particularly true given that the alternative — an earlier paternalist intervention — is probably more efficient and will therefore achieve a similar result at a lower total cost, which is obviously desirable (we can deal with the distributional problems later).”

    All of which is a fancy way of prioritizing my imagined right not to experience liberal guilt over the competing rights of others. But liberal guilt-reducing programs map pretty well to Mill-style utilitarian programs, so onward!

    Of course, I have no illusions that this argument is original, and suspect that you find one or more of the possible responses to it convincing. But I think that’s the root of it. Yglesias, for one, isn’t shy at all about embracing paternalism.

  • 13 Tom // Aug 25, 2009 at 11:20 am

    Wow — I should’ve refreshed before posting. New comments! I’ll refrain from wading in except to say that I agree that the “you can always do one more thing” aspect of the healthcare debate has been habitually overstated. Megan’s fond of asking how we can tell grandma that she can’t get a pacemaker, but in fact we already do this all the time: doctors are bound by codes of professional ethics that rule out additional action when it will clearly do more harm than good (such as heart surgery on an extremely elderly patient). It is likely that there are medical interventions balanced on the intersection of risk and payoff than critics are imagining — though of course the first step to establishing this is to grab the low-hanging fruit of efficacy research.

  • 14 Julian Sanchez // Aug 25, 2009 at 11:47 am

    Lots of fruitful stuff here; I’ll circle back to some of this stuff in a new post rather than here in case anyone following on RSS is interested…

  • 15 Julian Sanchez // Aug 25, 2009 at 11:57 am

    Well, one thing I’ll hit here: Yes, it’s true you can’t LITERALLY always do one more thing. But I think you’re underestimating the frequency with which there remain treatments with some probability (perhaps even a high probability) of providing some benefit and the decision is made—maybe by the patient, maybe by the insurer, maybe by the health care system—that it’s not worth it at the cost.

  • 16 the teeth // Aug 25, 2009 at 1:27 pm

    Pointing out that you can’t literally always do one more thing may have been a rhetorical mistake — it isn’t super relevant to the discussion, as no sensible system is going to involve all possible treatments all the time. I do recognize that potentially beneficial treatments are frequently eschewed and that, forgetting about any specific case, this is as it should and must be. I just don’t think that this fact is a source of any serious philosophical difficulty.

  • 17 OchoHa // Aug 25, 2009 at 3:29 pm

    The more I think about this the more I think that the notion of healthcare as a positive right isn’t quite correct. My feeling is that like most rights this one in some way is derived from a mostly shared emotion that we humans have. I’ve been trying to come up with a better way to express that innate (“god-given” anyone?) right, and so far this is the best I’ve been able to come up with:

    An individual has a right not to be left to suffer from a disease, injury, or condition when there is sufficient knowledge and materiel available to alleviate that suffering.

    That sounds about half-way between a negative and a positive right to me.

    Naturally someone has to have this knowledge and provide this materiel in addition to administering the actual care to apply them. In my understanding this is where the economic question comes in: society should find a way to reward this behaviour above and beyond any philanthropic gratification the provider feels. In fact given that the knowledge and materials involved might be hard-won then society should probably reward the provider quite well. Still I don’t think there’s much point in getting this secondary economic question mixed up with the first one, which is how to describe a “right to health care”.

  • 18 Saving Lives (or: Another Rambling Health Care Post) // Aug 25, 2009 at 6:16 pm

    [...] a previous post, I suggested that the most adequate conception of a purported right to health care is as really [...]

  • 19 mike // Aug 26, 2009 at 3:01 pm

    Whether health care is a “right” or not is actually quite irrelevant. The point is that it is infinitely more efficient to do it on a mass, public scale. There is no longer any argument about this point. This saves individuals and businesses massive amounts of money, which can then be invested in a multitude of other purposes, both public and private.

    In any case, the majority of the world has moved to some form of public health care, and the most prosperous companies in the world are now located in those companies. If the US does not adopt public health care, then the brightest and most competent people are going to move to those countries. After all, why locate a company in a country where you have to pay for health care for your employees, when you can easily locate it in one of the many countries where it is paid for through taxes. It’s simply more efficient.

    As far as the morality goes, no civilized person would tolerate denying life-saving care to someone who is ill, and no one who has studied human history or economics would ever claim, with a straight face, that all people end up rich and that there is no poverty in the world.

    I feel sorry for the people who don’t support public and citizen-based health care. They are not going to be able to afford to avail themselves of the advantages of modern health technology, which is extremely expensive. But then, evolution will come into play. These people will die, and eventually everyone will be descended from those intelligent to understand modern finance.

    Another issue is that the libertarians and others who oppose modern health care, apparently do not believe in democracy. You certainly are entitled to your opinion, but you definitely are a small minority at this point. If you believe in democracy you have to accept the decision of the majority, which is to move away from employer-based care to citizen-based systems.

  • 20 Julian Sanchez // Aug 26, 2009 at 5:48 pm

    I always wonder what people imagine they’re saying when they make noises like this. “Accept” the majority decision as opposed to, what, staging a coup? It’s not on my to-do list.

  • 21 Veering Off Course, or, A Long Rambling Post on Human Rights Evolution | ThePolitic.com // Sep 2, 2009 at 12:24 pm

    [...] a living wage).  I think Julian Sanchez, Research Fellow at the Cato Institute, put it well when he wrote: I’ve suggested before that the best version of progressivism—by which I mean, the most [...]

  • 22 K. Chen // Sep 4, 2009 at 1:20 pm

    It occurs to me, that when progressives say “you have a right to health care” they really mean “you have a right to (a certain minimum standard of) health.” In modern context, when we conceptualize the practical aspects of a right to life, freedom, and property, we not only see the limits on the government’s agents to constrain our freedom, life, and property, but we expect the active expenditure of societal resources to have those same government agents to protect those same rights.

    The appeal of the public option then, is it essentially deputizes hospitals as public agents, who work to protect our options, as do the police and firemen. They all have the same signals, its not a particularly far grasp, and they are all intuitively “rights.”

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