Wednesday, March 15, 2017

On The Argument From Liberty On Health Care


On the argument from liberty re health care:

(Spoiler alert: I emphatically reject it.)

Some on the right claim that at the bottom of the issue of health provision the bedrock question is how many Americans should be covered. If, they say, the answer is everybody, then that will comprise a breach of the creedal American principle of liberty. Applied here, they say, every American will be forced to get insurance whether they want to or not. In so being coerced, they are being deprived of their choice as to whether to get health insurance. They may not wish to and then they'll have to accept the consequences. 

As put in part by one guy: (see link) 

...The right’s response: Our political system isn’t designed to ensure parity of outcome. It exists to enshrine the freedom of the individual from coercion by the state and to provide for the working of a free society outside government control....

What rubbish! 

It can't, I argue, withstand even mild analytic scrutiny. 

I say that as someone who has some sympathy for the *legal* argument that the Commerce Clause could not be stretched to the point of the federal government ordering, generally speaking, on pain of sanction, every adult American to purchase health insurance. States can but not the federal government.

But as a philosophical matter, the reasoning is different.

For example, philosophically, why ought the state acceptably compel everyone who drives to buy or be under a policy of car insurance? What is the principled difference between that compulsion and the requirement to buy health insurance? I can imagine an argument that people needn't drive and that if they wish to, that's simply a condition of that privilege. On the other hand everyone has to live. That's not a privilege and to compel health insurance is therefore necessarily to trench on individual liberty. 

But is that a good enough answer? What is it about driving that makes liberty lovers accept that state compulsion? What are the criteria for acceptable and unacceptable state compulsions when viewed from the angle of liberty? The broad point of insurance is to protect against risk. With driving, universal insurance rationalizes a complete system of fault and compensation for inevitable accidents with the state stepping in to fill in gaps as (say) posed by uninsured drivers. So whatever the precise criteria are, they have, extrapolating from the car insurance example, something to do with defining the public good by way of a systemic answer to the inevitability of loss and harm. 

We might ask the liberty lovers, why, philosophically, they're ok with compelling universal car insurance. Why not leave it to each individual to get insurance that addresses the contingency of an accident that involves uninsured or unlicensed drivers?  But we can imagine the result of scrapping the insurance requirement: many, many drivers likely won't get it; they'd just take their chances. And we can imagine the result: most generally utter social chaos; and, slightly more specifically, accident victims or their families left without a remedy. Driving is more than a privilege. It is woven into the very tapestry of daily life for most of us. 

So all that said, I have trouble seeing a principled philosophical difference between the car insurance and the health insurance instances. It's simply unthinkable that the uninsured sick, including of course their children of all ages, will be left to malinger and die from medical inattention, just as it's unthinkable that those injured, maimed or killed in accidents and their families as the cases will be left uncompensated. And there's an obvious parallel manifest public unfairness in allowing those without insurance to skate free from their faulty driving while likely the state, via tax revenues, provides compensation, just as there is in allowing those without health insurance and their defendants to get cared for regardless when ill and at the same public expense. 

So I argue that when seen from the standpoint of liberty, there is, philosophically, no principled difference between compelling car insurance and compelling health care insurance. 

As my friend D wisely once said; 

...But principles are not theories; they are action guiding , and normally there are contrary principals, also action guiding, and there are no super principles for selecting principles. That is what Aristotle meant when he asserted, against Plato, that values are incommensurable (correct spelling; the computer is wrong - see OED), i.e., there is no value that is a yardstick higher than all other values that can determine which of two conflicting principles should prevail in a given situation. So, if, say, freedom/liberty are in conflict with the demand for social security in a given situation, there is no principle that can resolve the issue; a practical decision has to be made by responsible men of affairs. That is why libertarianism/free market theory is so cockeyed; it elevates individual freedom over all other social values as the yardstick by which various proposals are decided. If  the necessities of freedom are in conflict with the need for social security, freedom trumps everything, and social security loses automatically. But I reckon that Aristotle knew a thing or two more than Milton Friedman ever did, or could...

There is even a stronger answer, I think, to the liberty argument, one that makes it entirely impertinent. And that is getting rid of insurance as the essential model for health care provision. That's the nature of single payer health care. The "risk pool" is every citizen  and the funding is by way of general revenues derived from taxes and I suppose state borrowing, which is also eventually repaid by tax revenues. That's the essence of Medicaid. Who's going to contend that those on Medicaid are being denied their liberty, are being coerced into anything. The notion is preposterous. The liberty argument in relation to single payer health care dissolves into a mere sloppy puddle of category error. 

And there you have it, as I see it.

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