‘This is not a tedious rehash of my reasons for opposing Obamacare, though two years in, perhaps such a rehash is due. If it is, I will provide it in a different post. This is just a post on why I don’t think that the argument for Obamacare can rest very securely on the argument that we are simply cleaning up some ugly negative externalities, in much the same way that we do with noise ordinance and anti-pollution laws. That is not what we are doing, and if it were, we wouldn’t be doing it’
You don’t have to be libertarian to find some of Richard Epstein’s suggestions…reasonable:
‘As I have noted before, there is only one type of reform that can make progress in meeting the three goals of a sensible health care system: cost reduction, quality improvements, and public access. That reform requires massive deregulation of the many market impediments that are already in place. Lower the costs, drop the excessive mandates, and thin out administrative costs, and people will flock back to the system voluntarily.’
Williamson suggests we should look to Helsinki, Finland, at least when it comes to technology and transportation:
‘Notably, the Helsinki model would end some transportation monopolies (the rail service would no longer have a monopoly on ticket sales, for instance) and would rely on competition among private providers to match resources with consumer demand.’
The larger principle he uses to get there:
‘American progressives love railroads and hate cars, and that is not without a political dimension: Railroads tell you where to go, which is very appealing if you see society as one big factory to be subjected to (your) expert management. And that’s really the basic question of liberalism in the better, classical sense of that word: Is the state here to tell you where to go, or is it here to help you get where you are going? And how to get there?
If you believe that you have a right to your own labor, and that your time is your labor, then why would you need a large, unresponsive, oft politicized monopoly deciding how much time you spend in transit now that technology is making other options available?
One appeal of the libertarian argument is simple: Don’t you want to pay less for a ride when you can?
Another appeal is also pretty simple if you believe in the above: Free citizens need to put the moral justification back onto the current laws, political players, and monopolies from time to time, forcing them to justify their involvement in our lives and in the markets. After all, beneath lofty ideals gather real interests seeking to bend the laws towards their own ends, and with a lot of self-interest besides.
Incentives matter, and while I’m guessing safety and public safety guide a lot of moral justification by local governments, and which a lot of citizens generally support, it’s necessary to do some house-cleaning now and again.
Airlines are partially de-regulated as Williamson points out (more responsive to consumer demand these days, so flying is much cheaper and more accessible and thus probably more like taking a Greyhound), but not all the way de-regulated. Yet, where is the money going again exactly? Who’s doing what and how much are they getting paid? Aren’t these regulations creating dead zones where technological innovation lags?
On that note, one of the main arguments behind the push to pass Obamacare was the idea that you don’t own a right to your own labor nor time enough to prevent the socialization of that labor when it comes to health-care: It’s no mere commodity nor economic exchange. You will have a tax/penalty levied and part of your tax dollars will now go to a centralized, redistributionist, oft politicized set of experts and enforcers promising to make sure everyone gets health-care on some level (ignoring many of the structural problems at the VA and various other incentives that prevent responsiveness at other bureaucracies).
Unsurprisingly, this hasn’t exactly worked as advertised so far, with a lot more bumpy road likely to come.
The Scandinavian welfare-state was held-up as a model by many progressives for Obamacare, so Williamson does try and justify his use of Helsinki as a model for deregulation here in the U.S.:
‘Imagine trying to implement such a thing in New York City or California — imagine the union friction alone — and you’ll have a pretty good indicator of why European-style policies are unlikely to produce European-style results in the United States. It is not as though Helsinki is a free-market, limited-government utopia — far from it. But on the liberty–statism spectrum, it matters not only where you are but in which direction you are moving — and why.’
Intentions matter as much as actions?
On the statism/liberty axis, I’m guessing many progressives believe that we need more Statism in order to secure more liberty, but from the libertarian perspective, such a definition of liberty is so utopian and idealistic/ideological that it can never be reached, only promised and over-promised. Many progressives also likely believe their intentions are pure enough for government work and during the last two Presidential elections, it seems a fair number of Americans agreed with them for a time.
‘The Obama administration has stepped up its enforcement of sexual harassment rules since 2010, starting with investigations that led to voluntary resolution agreements with Armstrong’s institution and Eastern Michigan University, escalating with high-profile inquiries at Yale University and the University of Notre Dame and a 2012 letter with regulatory guidance, and peaking this spring with a settlement with the University of Montana. The Montana case drew significant attention because, in a letter trumpeting the expansive and unusually aggressive agreement, the Justice Department characterized the settlement there as a “blueprint” for other colleges.’
I’m reminded of Sandra Fluke, and the rights-based victims, the Left-of-Center activist types, able to find common ground with this administration and its extension of civil rights logic as far as it will go:
‘Among the forms of expression now punishable on America’s campuses by order of the federal government are:
Any expression related to sexual topics that offends any person. This leaves a wide range of expressive activity—a campus performance of “The Vagina Monologues,” a presentation on safe sex practices, a debate about sexual morality, a discussion of gay marriage, or a classroom lecture on Vladimir Nabokov’s Lolita—subject to discipline.
Any sexually themed joke overheard by any person who finds that joke offensive for any reason.
Any request for dates or any flirtation that is not welcomed by the recipient of such a request or flirtation.’
This can make bad, overbroad law, and create incentives to use our Federal Government as an enforcer of activism, awash in patronage, constantly expanding, and pursuing the rather narrower ideological aims of those seeking more power.
If your overall political philosophy defines the public good so broadly that it allows some groups (teacher’s unions) to free ride on the public good, often losing sight of the children, then when do you stand up for the children, and the parent’s right to give their shot at the best choices possible?
Isn’t that right more closely aligned with our founding documents?
“My job is not to preserve and defend a system that has been doing wrong by children and families. My job is to make sure that every child in this city attends an excellent school. I don’t care if it’s a charter school, a private school, or a traditional district school. As long as it’s serving kids well, I’m happy. And you should be, too.”
Here’s the question we Democrats need to ask ourselves: Are we beholden to the public school system at any cost, or are we beholden to the public school child at any cost? My loyalty and my duty will always be to the children.’
Parents wanting the best for their children is one of the true engines of our society, and it is one of the engines that drives people out of poor, dangerous neighborhoods, leaving schools overrun by the problems of those neighborhoods. We give people the economic freedom to live in the suburbs, and to get out, which helps create some of the best schools possible. I submit that you can see the lure for what I call ‘excessive egalitarians,’ especially in education, those who want equality first, and often equality of outcome and a broad raft of rights no matter the cost, and in some cases at the expense of children.
When those public schools left behind become inefficient and mismanaged, wasting money on pupils with very little change in outcomes: What do you keep, and what do you change?
If a man in the state of nature be so free, as has been said; if he be absolute lord of his own person and possessions, equal to the greatest, and subject to nobody, why will he part with his freedom? Why will he give up this empire, and subject humself to the dominion and control of any other power? To which ’tis obvious to answer, that though in the state of nature he hath such a right, yet the enjoyment of it is very uncertain, and constantly exposed to the invasion of others. For all being kings as much as he, every man his equal, and the greater part no strict observers of equity and justice, the enjoyment of the property he has in this state is very unsafe, very insecure. This makes him willing to quit this condition, which however free, is full of fears and continual dangers: and ’tis not without reason, that he seeks out, and is willing to join in society with others who are already united, or have a mind to unity for the mutual preservation of their lives, liberties and estates, which I call by the general name, property.
*Locke, John. Two Treatises Of Government. London: Everyman, J.M. Dent, Orion Publishing House. 1993.
Click through for the arguments against the Patient Protection And Affordable Care Act, the Individual Mandate, and legal arguments against Obamacare (libertarians are leading the charge).
In the discussions I’ve had, if someone believes the idea that health-care is a right and not a commodity (some people argue that it is privilege, morally, but I’ll stick to a commodity, as with a commodity you get what you pay for in a world of limited resources), then they are usually supportive of the Law.
If upheld, I believe we would be inviting the government into our lives in a way we haven’t before, granting it the power to tax and penalize us for our very health itself (few things are more important). Because few things are more important, and because so many people do not have access to health care, or do have access but we are providing it to them inefficiently, or because some people abuse the care provided and do not have the ability to manage their lives accordingly, or because health-insurance companies are making end-of-life decisions sometimes based on the bottom line and the profit motive (which is what would happen under the new Law), because we’ve tied health-care to employment, or because costs are rising rapidly for all due in part to technology, longevity, and prescription drugs (all of which would become less available long-term under the law)…the supporters of this Law are willing to overlook the power granted to one group of people (their favored political and ideological interests) over other interests left to pick up the costs.
For many of them, the concept of a right is universal enough to enshrine their thinking into law, and the Affordable Care Act, passed as it is, will do. In digging, I sometimes find much ire against their political and ideological enemies rather than Nature herself, sickness and disease, the natural inequality of human gifts and abilities, and the unequal outcomes we allow in our society. They want the social contract to mean something quite different.
Of course, the idea that the Act won’t lead to greater fiscal insolvency and massive deficits, at a time when two other entitlement programs are increasingly insolvent, is a non-starter. It won’t.
The American Interest has a breakdown of the Supreme Court’s schedule here.
Addition: Richard Epstein has more here. More good coverage here. Price controls will drive insurers to compete to provide worst care for the sick, and destabilize health insurance markets by taking away the means insurance companies use to stay afloat.
Nussbaum implores Americans to respond to the idea of ‘global justice.’
‘Well, why not? It is a day when people, immersed in busy lives, may actually stop to think in ways that they usually don’t. So why not talk about a vitally important topic that usually occupies too little of most people’s time?’
Here’s where I would agree with Nussbaum:
Moreover, the intense compassion that was generated by the disaster never got translated into a keen interest in the mundane and boring problems that actually kill so many more people in the world than terrorism, or even war: hunger, malnutrition, chronic diseases, lack of sanitation and clean water, sex-selective abortion, and infanticide.’
These efforts can clearly be worthwhile, and the day-to-day struggle and the cost and risks are picked up by those who often volunteer their time, money, and resources to try and ease the suffering of others (and I agree they are generally morally good but the reasons as to why they are morally good are up for debate). I would point out that such work can also lead to Western and American interests involving themselves in other countries and potentially involving other parts of our societies (political, military) in those cultures.
‘In his terrific recent book Altruism in Humans, C. Daniel Batson summarizes years of experiments showing that the vivid imagining of another person’s suffering is strongly correlated with helping behavior.’
‘Batson concludes that compassion is necessary for morality, but woefully incomplete: We need principles and entrenched habits. Bloom comes to a similar conclusion: Morality has roots in “human nature” but is an achievement of culture that must go beyond our native equipment.’
But whence those principles? Clearly, some combination of nature/nuture leads to our capacity for empathy and development of the moral imagination and its duties to our civilization. Nussbaum argues that in the wake 9/11, we’ve failed to live up those principles:
‘But we also saw the distressing shortfall of the compassionate imagination: As soon as things returned to “normal,” most people went back to their old habits and their daily lives, continuing to put themselves and their friends first in the old familiar ways.’
On Nussbaum’s view, what is necessary is:
‘What, then, should we learn from these unsurprising and all-too-human failures? First, we need not just emotional responses, but then, tempering and correcting them, principles and habits. Second, we’d better turn those principles into laws and institutions that treat all people with equal concern and regard: at the national level, but also through global agreements and global work on human development and human rights.’
Why exactly should we turn those principles into laws and institutions? What obligations would they impose upon, say, citizens of the U.S.? Why should individuals like Bill Gates (who thrived due to innate intelligence, hard thinking and hard work, access to computers, shrewdness to say the least, business acumen, cultural opportunity resources ((laws and traditions)) and maybe just luck) be obligated to create an institution? Why should principles of positively defined justice and the power of the State through the laws be involved in deciding an individual’s moral obligations to his neighbor, and to unknown persons halfway around the world?
To my mind, just as vital to the moral imagination on this view may be the freedom from institutions and eventual bureaucracies that would enshrine these ideals (human rights and global justice). The pursuit of justice can unite people in common cause and tap into a deeply human need for fairness, especially on a global scale (and could be expedient in defining common U.S. and European interest). However, as the Continental Left in Europe has shown, it can also commit individuals to institutions and structures that can abandon those very same individuals (including the development of the moral imagination) in favor of rule by a relative few, hierarchy and injustice, (and the abuse of those institutions through fraud, rewarding friends and punishing enemies, maintaining power, creating a Eurozone bureaucratic class).
Nussbaum has done good work guiding feminism and liberalism back to our laws. She’s also tried to solve very specific problems in India’s young democracy with Amartya Sen (addressing that nation’s long history and the deep injustice of the caste system, its hundreds of languages and many, many religions with a platform of Western liberal equality and liberty). This brief piece, though, reminds me why I am generally not a liberal, and why I’m skeptical of distributive and re-distributive justice, and would rather have liberty much more negatively (defined) as regards the laws and the State.