UPDATE: Some interesting theories advanced in the comments here and over at Megan McArdle’s blog:

• Opposition is grounded on symbolic or “slippery slope” grounds: Industry wants to resist anything that could be viewed as a reversal of the persistent march toward ever greater copyright protection, and in particular, anything that would remind people that copyright is in many ways not like ordinary physical property, and exists primarily to maximize the stock of creative works available to the public, not simply to give authors maximal control as an end in itself.
  
  
• Some authors are more concerned with control than revenue: They simply do not want their works to be used without their express permission, whether or not they are currently getting any economic benefit from these works, and don’t want to be burdened with taking affirmative steps to “opt out.”
  
• There are particular difficulties with certain types of works, such as photographs, for which it’s more likely to be the case that the work is still enjoying an active commercial life, but someone in possession of a single copy is not able to easily locate the rights holder. (With books and films, of course, you typically at least have a title and author to search on.) Creators of these types of works fear that “orphan works” will become a loophole for infringers to avoid liability.
  
  
• Rights holders would prefer not to have their works face competition from more freely available orphan works, the stock of which is enormous. Again, this may be of particular concern with respect to things like stock photographs.

With the possible exception of the third item—which seems like a reason to devise some ad hoc solution for types of works where identification poses special problems—these don’t strike me as particularly compelling reasons to keep huge quantities of 20th century culture locked up, but your mileage may vary.

What Rawls doesn’t see is how [a society based on the Difference Principle] would create conditions for an uncontrolled explosion of resentment: in it, I would know that my lower status is fully “justified,” and would thus be deprived of excusing my failure as the result of social injustice. Rawls thus proposes a terrifying model of a society in which hierarchy is directly legitimized in natural properties, thereby missing the simple lesson of an anecdote about a Slovene peasant who is given a choice by a good witch: she will either give him one cow, and to his neighbor two cows, or take from him one cow, and from his neighbor two cows – the peasant immediately chooses the second option. (In a more morbid version, the witch tells him: “I will do to you whatever you want, but I warn you, I will do it to your neighbor twice!” The peasant, with a cunning smile, asks her: “Take one of my eyes!”)

Friedrich Hayek knew that it is much easier to accept inequalities if one can claim that they result from an impersonal blind force, so the good thing about “irrationality” of the market success or failure in capitalism (recall the old motif of market as the modern version of the imponderable Fate) is that it allows me precisely to perceive my failure (or success) as “undeserved”, contingent… The fact that capitalism is not “just” is thus a key feature that makes it palpable to the majority (I can accept much more easily my failure if I know that it is not due to my inferior qualities, but to chance).

I don’t think anyone would (or should) seriously try to justify a market society on these grounds, but it seems psychologically accurate. Suffering an injustice at least comes with the consolation of indignation; a misfortune you genuinely believe to be perfectly just becomes far harder to bear.

Update: As commenter Tim notes, Zizek is also taking substantial liberties in characterizing the Rawlsian view, presumably for dramatic effect.  The “worst off” are not some specific set of people doomed to misery by dint of their essential characteristics—who is in the group will depend on the specific set of rules and institutions selected.  And it is Zizek’s own somewhat melodramatic gloss to say that in a Rawlsian society “hierarchy is directly legitimized in natural properties.” The intuition underlying that characterization, I’m assuming, is that in practice the typical effect of the difference principle will be to license disparity in incomes as an inducement for people with exceptional natural talents and capacities to bring them to bear. To be sure, you might equally say this is the point of the market society as well. But I think the psychological effect Zizek’s talking about depends to some extent on how obviously the social distribution is “patterned” (to use Nozick’s word) with a particular end in mind.  The “natural hierarchy” stuff is actually somewhat behind the point, I suspect. It stems, really, from the implicit message: “In this best and fairest of all possible worlds, this just distribution that we scrupulously seek to enforce precisely for your benefit, you are nevertheless at the bottom of the ladder.”  Maybe not, of course. People might still point to the ultimately “lucky”distribution of “natural endowments” or the inescapable environmental differences that dispose them to make effective use of those endowments.  But it would seem to require a good deal of reconstruction of the way non-philosophers think about desert.

“When people come together, germs can come together too,” said Dr. Anne Schuchat, director of the CDC’s National Center for Immunization and Respiratory Diseases.

“There are not that many studies about flu spreading on airplanes and trains, but anytime people are close together, there’s a possibility of germs spreading.”

So it may be unsettling to discover that 51 percent of respondents in a recent online poll by TripAdvisor.com would fly while sick with the flu rather than pay a flight rebooking fee. About 2,300 people took part in the survey.

Frequent fliers say the results are disturbing, but not surprising.

“I do think that’s an unfortunate attitude, because the airplane is like a petri dish in the sky,” said Rene Foss, a flight attendant for 25 years and the spokeswoman for the Association of Flight Attendants.

“[But] people really are resistant to paying any extra fees.”

Only Delta waives rebooking fees for travelers who have a doctor’s note saying they’ve got H1N1 (or, presumably, another serious contagious illness). In an ideal market, informed consumers would prefer not to be exposed to such risks and favor airlines with policies like Delta’s. (The airline might also benefit more immediately, from reduced sick days, but I’d expect flight crew to be disproportionately likely to be vaccinated.)  In the meantime, though, this does seem like a disproportionate cost to drop on a plane full of people for the sake of saving a rebooking fee. At the very least, it seems like they ought to be subject to public pressure to change their practice.

Without the bailouts we would have had many more failed banks, very strong deflationary pressures, a stronger seize-up in credit markets than what we had, and a climate of sheer political and economic panic, leading to greater pressures for bad state interventions than what we now see.  Milton Friedman understood all this quite well, which is why argued bailouts would have been a good idea in the 1929-1931 period. [...]

If you are a libertarian, is not our current course more favorable for liberty than would have been a repeat of 1929-1931?  If not, I would be curious to hear your counterfactual version of how matters would have proceeded, without the financial bailouts.  Is it that you think the regional banks would have raised the financing to pick up the entire bag and keep the banking system afloat?  Or is it that natural market forces would have somehow avoided a wrenching surprise deflation?  Or do you think the authorities for some reason would have not nationalized the major banks?  Please let us know.

I’m not inclined to debate economic policy with Tyler and Megan, so I won’t presume to take a position on the ultimate wisdom of the approach that was taken, but this sounds an awful lot like the old debate trick I’ve previously referred to as the fiat shuffle. Just to refresh: The way the trick works is that, for the purposes of arguing the merits of a given policy, you assume away various real-world political barriers to the policy’s being enacted—in debate lingo, you get to “fiat” the policy and restrict the argument to whether this would be a good thing without fussing over whether you could get the votes in the House (or whatever) to do it. The shuffle comes when you assume the same political constraints back in again as part of an argument that the proposed policy would create pressure for other salutary reforms, or to dismiss alternatives as infeasible.

Now, this isn’t a clear case of fiat shuffle, because it’s easy to imagine that we might have had the political will to resist the bailouts, but that this would not have been sufficient to forestall still more aggressive intervention later assuming things would have gotten far worse. Still, despite a an initial defeat in the house, the bailout ultimately passed by a 3-to-2 margin there, and by an even more lopsided 3-to-1 vote in the Senate. Which is to say, the world in which we didn’t do the bailout is clearly a world with a pretty radically different political culture, presumably populated by legislators with a very different average worldview. When would the inhabitants of that world have given up their resistance to intervention, and how much more dramatic would the intervention have been when they did? Damned if I know, but projections based on the current composition and views of Congress probably don’t apply.

Update: I didn’t think this post made the claim that “if legislators had had the guts to stop the first bailout, they would also have had the backbone to stop a second one,” but I suppose I should train myself to start talking that way in case I ever need to do cable news.

Discussions of a right to care often come down to talk about “saving lives”—which has a certain air of cinematic finality to it. Zoom in and fade out on the kiss, and the last moment of the story lasts a celluloid eternity. Morbid as it feels to keep saying so, though, lives are never really “saved”—just shortened or extended by some finite amount. And a huge amount of medical care is about quality of life, not longevity. Sometimes those two goals are at odds, and the patient has to decide which is more important.  To reflect this, when bioethicists want to wade into the hard questions, they are inclined to talk not about “lives saved” but about QALYs (pronounced “Quallies”) or Quality Adjusted Life Years. And I think a great deal of clarity would be gained in discussions of health care if this way of talking became more widespread. Another distorting factor in discussions of health care, I think is the tendency to think of some individual in isolation and just reflect on what we feel we’re morally obligated to do for that person. On most progressive views, though, health is one of many competing goods to which people have positive entitlements, and each person’s right is constrained by the countervailing pull of the equally valid demands of others. So we always need to ask, not whether this person deserves to have his life “saved” (or extended or improved) but how to allocate resources across all the different moral claims on them.

If we switch from “lives saved” talk to QALYs talk, and if we preserve a holistic rather than a case-by-case perspective, I believe the distributive-justice-plus-paternalistic-constraint conception of the health care right becomes much more appealing. At the individual level, it’s easy to get lured into thinking in binary terms of a “right to life”: “Should this person live or die? Live, of course!”  If you’re looking at a system of entitlements in which QALYs are one kind of benefit, though, the question “what exactly does the right to health care amount to?” ends up looking quite different—something along the lines of “what is the value of a QALY, bearing in mind the opportunity cost of all the other purposes to which social resources might be devoted?”

Now, for all sorts of purposes, governments do actually have to assign universal dollar values to QALYs for, among other things, regulatory cost-benefit analysis. But I’m enough of a subjectivist that I just don’t think these questions have any general or abstract right answer—which is why the denial of an objective hierarchy of values played the role it did in the last post.  The value of longevity, mobility, education, and other goods we might think society ought to provide is the value they have to people. People can, to be sure, make mistakes—they can predict wrongly how happy they will be with a particular tradeoff, and if the mistakes are systematic and common, there may be an argument for paternalism. But these are mistakes relative to their own later assessments: There’s no external or objective standard for whether a college education or a hip replacement or any number of other goods is of greater value to someone. We focus on goods like health care because health is of enormous value and importance to almost everyone. (Whether much of the health care we consume actually provides any value turns out to be a shockingly open question.)  But the fact that health, in general, is a good doesn’t tell us how to weigh everyone’s competing claims to specific treatments providing specific increments of longevity or different types of quality of life against every other positive good people might have some right to. So–this is obviously an idealized account, not how actual governments work—the way we decide whether someone is entitled to social provision of the slightly-more-effective-but-much-more-expensive treatment or the second hip replacement or whatever requires weighing the benefit of expending resources on that against the other claims we might satisfy instead. Or, to be sort of stupidly simple about it, suppose you have a limited supply of painkiller and a ward full of people in different degrees of pain. You cannot answer, in isolation, how much of the painkiller this patient has a right to. You can only start to answer the question when you know what sort of pain everybody is in, how much good the drug will do them, and so on.

This need not just be a matter of utilitarian maximizing. It might be that some person has had a very bad life in general, so that fairness requires us to confer a benefit on him even if, at the same cost, we could provide greater benefits to others who have not endured such hardships over their lives as a whole. Alternatively, there might be some upper limit to how much any one person can draw on the common stock, even if the greatest net benefit still comes from spending the marginal dollar on them. I want to be neutral between the many different conceptions of fairness bioethicists defend and argue over. The point is that whatever your standard for weighing interpersonal claims, the question is inherently distributive. And because society is trying to provide a range of heterogeneous goods, and because the benefits conferred by health care are themselves heterogeneous (again, in the simple case, longevity and various aspects of quality), this means trying to compare diverse particular benefits in order to figure out how strong all these different-in-kind claims are on a common resource pool.

Now just for the sake of argument, again as an aid to conceptual clarification, assume away the motivation for paternalism: Suppose you have a society of people who can perfectly well assess their own long-term best interests. If the question of how much health care people are entitled to ends up being inherently distributive in the way I’ve described—if it depends on a judgment about how to fairly confer heterogeneous benefits on members of society given limited resources, where the individual’s subjective valuation is ultimately the only determinant of what counts as a benefit—what grounds could you have for saying that an individual has a right to consume X% of social wealth for the purpose of providing a health benefit, but no right to devote the same share to some alternative use that this person considers a still greater benefit? How to weigh diverse benefits between persons is an extraordinarily hard moral problem—and its intractability one reason I lean libertarian, incidentally. But if, arguendo, we suppose we’re dealing with people who are not subject to the various common biases that lead us into misjudgments about probability and future benefits, then we at least have one metric for determining which use of a given quantity of resources provide the greatest benefit to a single individual: The person’s own subjective report.

Now, certainly there are grounds for thinking it might be socially optimal to insist that people take their share of the common stock in the form of health care rather than other goods. Perhaps, for instance, we want people to stay healthy enough to keep working, or perhaps other people feel uncomfortable seeing people who are sick or disabled, even if the people themselves would be happier staying disabled and putting the cost of treatment to another use. But now we’re not speaking the language of rights anymore. My moral right to health care, on the usual way of speaking about individual rights, is a matter of how having it is good for me. And indeed, one common way of characterizing rights is as trumps against social optimization. So, to pick a clichéd example, we might say that someone has a right not to be chopped up for organs, even though five other people could thereby be saved—the individual right to life (or not to be killed, anyway) trumps the goal of optimizing the total number of lives saved.

There’s a lot going on here, so let me try to step back and provide an overview that disentangles the different issues in play here. There is an argument that even in a world of perfect distributive justice, people would not make wise judgments about how to use their fair shares, justifying intervention to direct more of those resources than some might choose to health care. But that is not, in the ordinary sense, an argument about rights—about what people may claim or demand as a matter of justice. It is an argument for why we should override people’s claims for their own long-term good. There are a variety of reasons we might think it is socially optimal in various ways—because of externalities or economies of scale or whatever—to have social provision of health care, and even to call this a legal right. But this, also, is not an argument about moral rights—about the claims each individual may press as a matter of justice. What we owe each member of society as a matter of right will be a function—we can debate which function, but some function—of the way a treatment is a benefit to that person. And within each person’s life, it is a matter of subjective assessment which use of resources provides the greatest benefit. If it is the benefit a treatment provides that grounds the individual’s claim, then if we agree to bracket all these other considerations in order to focus on this one narrow issue, it is hard to see how it could be that someone would be entitled to some share of social resources in the form of a health benefit, but not to use the very same quantity of resources for a different benefit. From which it follows that the underlying moral right cannot be to a health benefit, but to some share of resources insofar as this provides a benefit.

One way my earlier post may have gone astray is that, while I tried to stress that people’s fair shares may vary over time because the burdens they bear as a result of misfortune give them stronger claims, my approach may have made it sound as though I was imagining everyone as having some fixed quantity of resources they’re entitled to. Moreover, if we look at the way just shares would vary to compensate for bad luck, it may seem that this is a needlessly convoluted way of talking about it, because it ends up looking an awful lot like a right to care superfluously mediated by resources.  Consider someone who is born with a seriously disabling condition: On my account, in order to compensate for this, they may be entitled to a greater share so as to enable them to enjoy a quality of life more closely approximating that most others experience. But suppose one day somebody develops a relatively inexpensive treatment that will eliminate this disability. Now, of course, we would say that if they are still entitled to a greater share, it is only as much as would be required to supply the treatment. Isn’t this just a roundabout way of saying they have a right to the treatment?

I think it is not, because the key point is that people’s share claims may vary depending on—among other things—the way those shares contribute to quality of life. If we found some way to elevate people’s quality of life through means other than treatment, then the fair share might be what was required to bring the disabled individual up to the prevailing level by that other means, rather than through treatment. So if you’ll indulge me with another quite fanciful thought experiment: Imagine that at some point in the future, we have developed incredibly convincing shared virtual worlds like the one in the Matrix movies—except, you know, not run by evil robots. Suppose people end up happily and voluntarily spending large portions of their lives in these vivid worlds. Now, perhaps someone is born with an array of very serious physical disabilities that do not affect longevity, but seriously impair his ability to function and enjoy a decent quality of life in the physical world. There are, suppose, highly invasive and extremely expensive treatments that will mitigate these disabilities and restore some function in the physical world. But for much lower cost, we can provide access to these virtual worlds where many people live and work most of the time anyway.  Suppose that people with such disabilities are able to enjoy lives as good as anyone else if they have this access, and are happier than people who get the treatments and remain in the physical world. Does this person have a right against society to health care, or has society satisfied its obligations if this person is, by the alternative means of access to the Matrix, the person is provided with the same quality of life enjoyed by everyone else?

I know a lot of readers are thinking this sounds like airy-fairy hypothetical wankery; certainly it’s light years removed from the practical issues of the current health care debate. But these admittedly fantastical thought experiments, precisely because they take us away from the complex tangle of different issues that make those debates so thorny, let us focus more clearly on isolated moral questions.  Then, ideally, when we return to the real world, we have a better grasp on each of the individual strands in that tangle and can think more productively about the more practical issues—unlikely as that may seem.

I am acutely aware that this is all a bit muddled; ideally I’d sit down some time and rework all this in a clearer and more rigorous way. But I hope some of those who took issue with the previous post have at least a somewhat clearer sense of what I’m trying to get at. Note, for what it’s worth, that a progressive can probably accept this whole argument without thinking it makes much difference to the contemporary policy argument. None of this, in other words, necessarily has any direct implications for whether the public option or single payer or any other health care regime is a good idea. You can perfectly well say: “Well, forget about an abstract moral right to health care per se; our moral obligation for practical purposes is to provide people with more equitable access to health care than we currently do, and the reason is that it’s more socially optimal, or that people are entitled to share social resources in whatever way gives each a fair shot at a decent quality of life, or whatever other way you want to talk about it.”  And then we’ll have all sorts of other things left to debate.  But it will probably be a better, clearer debate.

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.

This, I think, is at the core of what bugs me about the Whole Foods boycott. It’s not necessarily that I agree with Mackey—health care isn’t really my issue, so I don’t know whether I do—and it’s certainly not that I think he’s somehow entitled to have people shop at his stores rather than Trader Joe’s. It’s more that I think it’s actually a significant achievement of liberal societies that, not only do we refrain from clapping you in irons if you’ve got the wrong religious or political views, but that we’re more generally disposed to bracket those things in our non-intimate relationships and just take them out of the calculus when we’re engaged in most forms of polite interaction and market cooperation, at least when we’re not talking about views that are really wildly beyond the pale. One of the ways markets and liberalism more generally dovetail is that they function by giving us the luxury of ignorance: I don’t need to know why the goods I’m selling are suddenly in greater or lesser demand, or what particular purpose they’re being put to, and vice versa for the money I give others for goods—I just need to respond to the price signals generated by that demand. And in social life more generally, I treat my neighbors with a certain level of respect just as fellow citizens without much bothering about what they do in the bedroom or whether it’s Ronald Dworkin or Michelle Malkin on their bookshelves, even if I happen to know these things.

In economic life, it’s clearly to a certain extent a good thing if, being better informed about the practices of the companies we deal with in the information age, we make our consumption decisions not just on the basis of the price and quality of the product, but on what we know about how they treat workers, whether they’re ecologically responsible, and so on. To the extent that Whole Foods has taken advantage of this, I guess you could argue Mackey’s being hoist on his own petard: Live by the lifestyle brand, die by the lifestyle brand. But I get uneasy when this starts getting extended to disapproved expression less obviously related to the company’s practices. I think most of us would find it upsetting if an employer declined to hire someone because he didn’t want some percentage of the salary he paid out to be donated to the Mormons or the Heritage Foundation or Move On or whatever. Obviously it’s not really symmetrical: Unlike most prospective employees, John Mackey’s going to be a multi-millionaire no matter what, so at some level, sure, boo-hoo. But insofar as I think the disposition to bracket is a good thing, I’m unhappy to see it eroded.

Tangent: As I mentioned in a previous post, Mackey has given money to my former employers at Reason and it seems likely he’s done the same for soon-to-be employer Cato. In the past, my policy has generally been that I don’t want to know who the donors are because I don’t want that even in the back of my head when I’m writing. Of course, the problem is that you can’t do these sort of “full disclosure” caveats when you don’t know that—I’m curious if folks have thoughts on what a good approach to this is.

On a related note, looking at some of the sad, strained attempts to stretch advisor Zeke Emmanuel’s pretty unexceptional bioethics writings into support for “death panels” makes me wonder how an academic philosopher could ever get involved in politics. What they do, after all, is concentrate on difficult ethical dilemmas where any of the options has some morally unattractive features, and then make the case for one of them.  A vision of confirmation hearings keeps running through my head: “Isn’t it true, professor, that you’ve endorsed flinging the obese in front of runaway trolleys?” To be sure, I don’t share the horror many bioethicists seem to at the prospect of allocating scarce medical resources to the highest bidder… and I tend to think that the defensible progressive position is that this is objectionable because of background distributive injustice, not because health care is some sui generis magical good.  That said, other things equal I think it’s sort of a no-brainer that if there’s one kidney available, and you’ve got a 90-year-old and an adolescent who both need it, the morally better result is for the kid with many more decades ahead of him to get it. If anything, it’s the reverse position that seems ghoulish. Anyway, under the status quo, your “productivity in society” sure as hell does determine whether you get care—Steve Jobs is productive enough to fly out for his cancer treatment in Tennessee where the waiting list for a liver transplant is 80% shorter than in Cupertino. Obviously, there are incentives as well as the purely allocative questions to consider, and I’m not especially sanguine about passing the ball to government either. But it would be nice to see both sides talking in a way that recognized that there’s no foreseeable health care system under which resources are infinite and people don’t die eventually.

Like a lot of my friends in this town, I spend a lot of my time dealing in arguments and ideas. I produce them for a living, and then I knock off and have some more arguments over drinks for fun. Does this mean I’m actually supremely confident that my own beliefs are right, and all the smart people who radically disagree with me are wrong? Fuck no; I’m a primate with a couple nice neckties just like the rest of you. Does that mean I throw my  hands up and float in a kind of humble agnosticism about everything? Clearly not, because that’s not how the Great Wiki works. I plant a flag and do my best to defend the truth as I imperfectly perceive it, because that’s how the ball gets moved forward even if I’m wrong about everything. Or, anyway, everything but the Great Wiki.

Think, by analogy, of the wisdom of markets. A lot of people blame the financial crisis on a misguided belief that the market, like evolution, is always cleverer than you are. Usually they mean the problem was that regulators held this belief—a diagnosis that seems mostly wrong from what I’ve read, anyway. But it may have contributed to the problem that market actors held this belief. If the market always aggregates and processes more information than your models can crunch, it’s mook’s game to try to outsmart the market by picking the stocks and securities that will turn out to be underpriced winners. Just diversify and roll with it. If everyone’s gobbling up those AAA-rated CDOs, the market’s confirmed that they really are that safe. But of course, the reason that the market is smarter than any individual participant is that all those individual participants struggling fruitlessly to outsmart it end up contributing their information to the larger process by their efforts. If everyone tries to free ride on the premise that the cloud knows best, market optimality turns out to be a self-defeating prophecy.

A rarity among greater powers, then, the Great Wiki demands our neglect rather than our worship—requires us to forget, in our day-to-day lives, that we’re aware of its existence. It is an anti-Tinkerbell drawing life and strength from our disbelief. The ultimate surrender to the Great Wiki is the will to hubris. And if that faith too turns out to be misplaced, at least you had fun arguing along the way.