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More Dworkin!

September 3rd, 2009 · 2 Comments

Chris Bertram reminds me that Ronald Dworkin’s view of justice in health care is actually quite similar to the “distributive-justice-plus-paternalism” account that I’ve argued is a more coherent progressive position than a nebulous “right to health care.” On this view, what society should do is, in effect, buy for each person the sort of insurance coverage that it believes people would buy for themselves at the start of their lives under conditions of full information, rationality, the absence of extreme present bias, and so forth, assuming each had a fair allocation of resources with which to purchase that coverage. And what he concludes, I think correctly, is that there are many types of coverage rational and informed people might not choose to cover, though they might be able to afford it. (I have some serious doubts about the meaningfulness of an attempt to divine what a hypothetical market would look like under a system of baseline government provision, but the core inuiition here seems sound enough.)

Contrast Megan’s approach, which seems to ask what people would want after they know that they’ll get sick in such-and-such a way. Now, if I have no other extremely attractive uses for my money,  it might well seem worth spending what I have remaining on a very low probability of extending my life by a month, which from that point of view will no doubt seem extremely valuable. It will almost certainly seem worthwhile to ask my insurer, whether public or private, to pay. But that doesn’t mean I would’ve chosen to cover that eventuality even with a perfectly clear understanding of how much I’d want it if and when it arose. Now, Megan is surely right that in the real world people don’t have this kind of clarity of understanding. Ex ante, we tend to underweight how highly we’ll value additional time late in life, but also to overweight the detrimental effect various kinds of disability would have on our happiness. But time bias cuts both ways. Someone who consumed a lot of resources or took on debt in early life will naturally wish they had more resources and less debt—and may well discount too heavily the now-distant past benefits they enjoyed. We have, I think, an unjustified tendency to regard inconsistency between earlier and later assessments of a tradeoff as evidence that the early assessment was colored by temporal bias, while the later one is more fully informed and so more objective. I’m pretty sure that’s a mistake; time bias can take the from of irrational regret as easily as prospective imprudence. Though I should caveat that I’m not sure the use  of “irrational” works here, as I’m not sure there’s some objective “view from nowhere” way of aggregating inconsistent judgments across time that would count as the benchmark of rationality.

Tags: Moral Philosophy



2 responses so far ↓

  • 1 K. Chen // Sep 4, 2009 at 12:32 pm

    The problem with intellectual coherence is that it exists on the level of abstraction. Telling people that we’re going to fairly distribute resources to fight cancer based on what you would have done a long time ago if you were a reasonable person without extra foreknowledge means nothing to the person who’s mother is dying of cancer. That same person however, would probably buy the argument in the case of say, Alzheimer’s disease. People don’t particularly cares how much money each extra day of life and health is going to cost for themselves and their family members. Fewer will ever admit that their are better uses for their money, (even noble ones: funding a school for starving children, supporting the arts, squirreling money away for your own children) What greater social sin is their than to say “I don’t want to save money to save your life?”

    Irrational is as good a word as any.

  • 2 Glen // Sep 10, 2009 at 6:51 pm

    This is a point I’ve made repeatedly about the behavioral economists who reach paternalist conclusions. Quite often, their evidence of irrationality is the existence of an intrapersonal conflict or inconsistency. And they’re not wrong, insofar as economists often define rationality in terms of internal consistency of preferences. But identifying an inconsistency does NOT give the behavioral economist grounds on which to choose between the inconsistent elements. There is no Archimedean point from which to judge which of two conflicting preference sets is the “true” one.