Isn't it time to start calling BS at some of the Libertarian arguments?

Great Debates
201

I like Eastern philosophy. In particular, I enjoy the work of Alan Watts. One of the things Watts frequently wrote about is the idea that words are just symbols, or tools; they’re not the actual thing or idea being symbolized. Of course, no one is going to disagree with that sentiment, but once you start looking for it you’d be surprised how often people unwittingly mix up the symbol with the reality. Especially, it seems, in online debates.

If you don’t believe me, check out an abortion debate sometime. “Those people aren’t pro-life, they’re anti-choice! Oh yeah, well you guys aren’t pro-choice, you’re pro-abortion! See, this is the only definition of ‘life’ that makes sense, therefore abortion is murder / the disposal of non-sentient organic matter.” Everyone understands the facts behind the symbols perfectly well, but half the time an abortion thread is completely wasted by people arguing about which symbols to use, as if whether the word “life” best fits at conception, at birth, or somewhere in between has any bearing whatsoever on the ethics and practicality of the thing commonly referred to as abortion.

So, thinking like this as I do, it’s always disappointing for me when I myself get sucked into a debate about symbols. They can be fun, and sometimes they can even be enlightening – sometimes they’re neat little logical exercises, and often the semantic debate becomes a decent shorthand for the practical debate, even the latter only takes place by proxy. Still, semantic debates are seldom ideal.

And so it is here. It doesn’t necessarily matter whether we use the word “coercion” to refer to societal/economic compulsion as well as government compulsion. It is important, though, that we acknowledge that the two kinds of compulsion aren’t identical, and that a person can, consistently, be generally tolerant of the former and generally disdainful of the latter, even if we label them with the same word. Likewise, it’s important to acknowledge that a limitation on one’s behavior which does not stem from government coercion is still a limitation on one’s behavior, and that a person can, consistently, seek to increase both government coercion and “freedom,” in the practical and comprehensive meaning of the word.
Damn, there’s really more I want to get to, but I’ve got a bus leaving for Atlantic City in under an hour. I’ll be back on Sunday night, if the thread’s still going I’ll check in then. In the meantime, though I hate to play hall-monitor (ok, I admit, I love it), think about what I said, and try to talk about ideas and things, rather than symbols.

202

The market system that we have in the U.S. today (which fails to deliver healthcare to a large swathe of people and has not so far introduced any government or market mechanism to rectify the problem).

Since you do not recognize the market as capable of coercion (apparently because it’s not a “who” but a “what”) you won’t ever see this fairly obvious point no matter how many times you ask me!

Sorry Renob but I think we should agree to disagree. I really can’t answer the same question over and over again. You are stumbling over something called “methodological individualism” which social scientists disavowed more than a hundred years ago. But that’s your right as it’s right to believe that yours is the correct perspective.

203

I have no problem assenting to any of this.

May the forces of cosmic coercion be with you ;). (By which I mean good luck, of course).

204

So “the system” is forcing people to go without? How? Please explain why you think this. You seem to be saying that because some people are without health insurance that the system forced them to go without it. That isn’t a logical statement. You don’t show the presence of force, you simply say that looking at the outcome coercion was involved. You are leaping to a conclusion. If you are going to come to a conclusion at least show me how you got there.

Because there is no obvious point to be seen. You think that a variety of individual, voluntary decisions (that’s what the “market” is, you know, it’s not some sort of super-individual who forces things on people) somehow end up coercing people.

The market isn’t capable of coercion. The market isn’t an actor. Or perhaps you’d like to tell me what, exactly, you think the market is.

All I’m asking you to do is support your statement. Simply saying that something is bad in society and that means coercion was involved is far from being persuasive.

205

Let me ask a hypothetical. Let’s say I have a chair for sale. Two people want that chair. One’s not going to get it. So I decide to let them bid for the chair, and the high bidder wins.

Now, the low bidder really wanted that chair. But he didn’t get it. Was he coerced? Did the high bidder apply force to him to prevent him from getting the chair?

If so, what would you propose as a remedy in this case? Remember, someone is going without a chair. How would remove the ‘coercion’ in a way that is more equitable than letting them bid with each other and put up their own money?

Let’s say they are both desperately poor and both have sore backs, and both really need a chair. But one has $1 more than the other, so he won the auction. How would you remedy this for the person who didn’t get the chair?

206

Sam, this hypothetical is not very illustrative of the stakes of the debate as I see them since in our current society the market does not fail to provide chairs for those who need to sit down.

If we really were living in a world in which chairs were as inequitably distributed as healthcare currently is then there would, most likely, be a demonstrable market failure in the provision of chairs. Market coercion would then apply to the condition of the chairless and government intervention might well be justified.

The funny thing is that while some are saying that I’m playing semantic games I’m not in the least invested in the usage of coercion or any similar word except insofar as it bears on real or suspected cases of market failure and the consequent need to consider government intervention.

Anything else might be interesting to some (perhaps to Dr. Love) from either a linguistic or philosophical point of view–but it’s not of personal interest to me. (But perhaps some other poster on the “liberal” side is more interested–I don’t know.)

207

Fine, give us a real-world example. All you’ve done is claim that health care exhibits a market failure that somehow involves systemic coercion. I’d like you to specifically illustrate this with a real-word example (or preferably a number of examples). All you’ve done is say that since some people lack health insurance that means the “market” has coerced them. That may sound nice but it has nothing to say about the actual realities of the health care marketplace.

208

I don’t think you understand what a market failure is. Unequal distribution of goods does not constitute a market failure. Do you know what else is unequally distributed? BMWs. I sure would like one, too. Is my inability to buy a BMW the result of market coercion? Is there a market failure in BMWs?

By definition, economics is the study of how societies deal with scarcity. By definition, this means that goods and services are always unequally distributed.

What you are really saying is that the market does not achieve the kind of social outcome you wish it did, so you’re going to define this as ‘coercion’ so that you can justify real coercion to correct it.

And by the way, the health care system in the US is not that inequitably distributed. Most Americans get damned fine health care. The poor are covered under Medicaid. The elderly are covered under Medicare. Most workers have some kind of job-related health care. There is private insurance available. We’re really talking about 15-20% of the population - the ‘working poor’ who are uninsured and whose jobs do not offer health benefits. Many of these people are young, and may have voluntarily chosen not to have health insurance. My suggestion is that you target your fix on them, and not use their plight to justify a wholesale government takeover of the health care system.

209

Well, if you’re really interested there are lots of examples in a recent book Money Driven Medicine, as well as any number of columns by Paul Krugman in the NYT which you can find yourself via a google search.

Here’s part of the Publisher’s Weekly description of the former book: “Mahar, a financial journalist…applies her keen analytic talents and economic savvy to America’s complicated and increasingly dysfunctional health-care system. Mahar’s diagnosis: our privately managed yet mainly publicly funded system produces the worst of both worlds—high costs, rampant inefficiencies and intense competition among providers that doesn’t benefit patients. She traces how today’s market-driven medical system emerged over the past century thanks to trends that gradually stripped power from doctors and gave it to corporations, turning patients into profit centers. No one is spared in Mahar’s thoroughly researched and carefully reasoned study: she criticizes frustrated (and increasingly money-minded) physicians, self-serving insurance companies, for-profit hospital chains and pharmaceutical companies driven by inflated Wall Street expectations. Mahar uncovers isolated pockets of good news, including the VA hospital system, which provides excellent care at modest cost thanks largely to its exemption from the pressures of competition. But her goal is not to offer any programmatic solution. Instead, she wants to show why the most common economic assumptions about health care—especially those that extol the magic power of free markets—are false and stand in the way of real reform.”

If you’re interested, here is a link to a review of the book which will you some sense of its arguments. And here is an even more detailed review.

I do recommend Krugman’s columns as well–so let me know if you have trouble finding them.

210

I wouldn’t bet the farm on that assumption.

What I’m saying that 15-20 percent is outrageous. And the majority of Americans agree–it’s consistently one of the most concernful issues. Nor is lack of coverage the only problem with our current healthcare system as the book I posted links to argues at great lenght.

Exactly where in this thread do I advocate a wholesale government takeover? Yeesh.

211

Based on everything you said, it seems clear that you don’t. However, I could be wrong. As I’ve asked in the past, please give me an example or two to indicate what you mean by the system coercing people into going without health care or health insurance. Also please explain the market failure at work here.

It may or may not be outrageous (the number is actually pretty distorted since it counts people who are only without health insurance for a small portion of time, like when they change jobs, but that is a topic for another debate). But even if it’s outrageous, how is that a market failure or coercion? If people don’t earn enough money to afford health insurance (not health care, those are two separate things) then why is that different from people who don’t earn enough money to buy a BMW?

The majority does not determine what’s a market failure.

Yes, there are many. So please tell us which of them involve coercion or market failures.

212

Indeed, you could.

Well, since you’re the one who is averse to dictionary definitions and common usages why don’t you tell me your definition of the term and we’ll see if we can reach a consensus. Otherwise, I think I’d rather not waste our time on pointless disagreement over terms.

Let’s agree at least on the meaning of the former, if we can. Then, if you wish go through some of the examples of market failure offered in the reviews I have already cited or in one of Krugman’s columns if you prefer.

Well since healthcare is a serious human need (some would say a human right) whereas ownership of a BMW is not, that would be one reason why the market’s failure to deliver the ability to afford health insurance–in a society in which that is the only reliable means of getting good helathcare–would be deeply problematic. Another it’s that it’s incredibly inefficient (in both economic and human terms) to deliver the kind of emergency care to the insuranceless which too often ends up being the only kind they have access to.

It’s always possible, of course, the lack of insurance for such a large percentage is not the market’s fault but the fault of some other factor–perhaps even a government intervention of sort. If that’s your claim why don’t you go ahead and come up the evidence and I’ll see if I agree.

As to coercion, we don’t agree on terms so what’s the point? If I adduce the market’s coercion you’ll say it doesn’t and can’t exist. If I provide examples of economists using the term, you’ll say they don’t know what they’re talking about. Your specialized definition of coercion is one I don’t recognize as being sufficient to address something like health care. So thanks but I think we’ve both got better things to do.

It remains to be seen whether we can agree on a definition of market failure.

The ball is in your court.

213

I find it funny that you say this since I am the one who has been pretty strict about keeping to established definitions of what coercion means. Or was I the one who brought up “cosmic coercion”?

Anyway, here’s a good definition of “market failure” – “A market failure results when the price of goods and services do not reflect the true costs of producing and consuming those goods and services.” There is also a good discussion of the issue here.

How about you tell me what kinds of market failures you think exist. If I want to debate Krugman I’ll write the New York Times.

The market fails to deliver the ability to afford health insurance, huh? The market is responsible for an individual’s ability to earn money?

While not exactly the same situation, the canard that more widespread use of preventive care will result in some huge amount of savings is not supported by the data.

The fact that health care is the most heavily regulated industry in the nation has nothing is a pretty good indication that government involvement has something to do with the high cost of health care.

So you can’t provide any example of “market coercion” for health care, is that what you’re saying? I just want to see what kind of “coercion” you think the market is doing to deprive people of health care. You say this coercion exists and I dispute it. So maybe if you actually give me an example I could see what you are trying to say.

214

No, but then you were not the one asked about the situation of those harmed by meteorites. You were the one who refused out of hand to recognize the Oxford English Dictionary’s primary definition of a word used in much the same way by economists, geneticists, philosphers, and psychoanalytists.

A good but definition, perhaps, but also, alas, an insufficient one representing one instance only of a market failure. Can we agree on this one (apparently by an economist)?

“Market outcomes are supposed to be efficient, both allocatively and productively. When they (market outcomes) are not efficient, we consider them failures.”

The same source goes on to specify five different categories of market failure.

Well since I’m not a journalist or an economist researching healthcare issues, I tend to form my opinions based on reading the published work of those who are. We’ve got a couple of reviews on the table for you to consider (note that I’ve only read about half of the book in question and a while ago at that) but since the columns are easier to manage we might consider one of them. (And by all means do write to the New York Times if you wish–don’t let me stop you.)

Here from a recent column, is a claim about the VA administration (which Mahar also praises). “… the Veterans Health Administration is one of the few clear American success stories in the struggle to contain health care costs. Since it was reformed during the Clinton years, the V.A. has used the fact that it’s an integrated system — a system that takes long-term responsibility for its clients’ health — to deliver an impressive combination of high-quality care and low costs. It has also taken the lead in the use of information technology, which has both saved money and reduced medical errors.”

If you disagree with this view perhaps you can explain why.

Methodological individualism again. The market is responsible for several categories of employment (e.g., certain kinds of part-time work, certain kinds of low-wage work, certain kinds of self-employed work) which, for a number of reasons, make it difficult if not impossible for individuals in those categories to afford healthcare for themselves or their families. Since we can’t expect, say (for argument’s sake), 10% of the workforce to relocate to other kinds of work and since someone would have to do these jobs even if these people were able to vacate them, I think we’ve got a demonstrable problem with the market’s inability to allocate a public good–if not an absolute human right. What’s required here is government subsidization of this public good (or positive externality) and I’d be fine with the Hillary Clinton approach to doing the latter.

All this says is that studies suggest that preventive care isn’t always so efficient as to pay for itself (and might sometimes be inefficient as when screenings are performed on low-risk patients). But it is silent on the question of human costs (as opposed to economic). Moreover, emergency rooms are simply not efficient providers of many kinds of non-preventive care. (Hence, my personal insurance company’s insistence that I not use the emergency room for those kinds of treatment.)

Perhaps according to Cato Institute, but not according to Krugman or Mahar. For example (from the same column linked above), while criticizing John McCain’s thoughts on healthcare, he writes:

*"…[E]ven if you buy the premise that competition would reduce health care costs, the idea that it could cut costs enough to make insurance affordable for Americans with a history of cancer or other major diseases is sheer fantasy.

Beyond that, there’s no reason to believe in these alleged cost reductions. Insurance companies do try to hold down “medical losses” — the industry’s term for what happens when an insurer actually ends up having to honor its promises by paying a client’s medical bills. But they don’t do this by promoting cost-effective medical care.

Instead, they hold down costs by only covering healthy people, screening out those who need coverage the most… They also deny as many claims as possible, forcing doctors and hospitals to spend large sums fighting to get paid.

And the international evidence on health care costs is overwhelming: the United States has the most privatized system, with the most market competition — and it also has by far the highest health care costs in the world.*"

Of course not. What I’m saying is that when I’ve made these points you’ve rejected my examples because you did not accept “market coercion” as being possible.

Shall we stick to market failure?

Let me warn you ahead of time that I will be out of town for the next couple of days and unlikely to post.

215

Where? I accepted your definition in both my posts #174 and #198. You, however, were the one who failed to comprehend that the definition you are using is predicated on force. If I use compulsion or threats or pressure or force that is the promise of violence if you do not act the way I want.

Fine. Point out some market failures.

So you admit you don’t really know much about health care and instead rely on the (often shoddy, IMHO) state of health care news reporting for your opinions?

I don’t necessarily disagree. The VA, from all I’ve read, does work fairly well now.

So the individuals in these categories are forced to work these jobs and forced to go without health care? Their low skills, say, or their desire to work longer hours or the places they choose to live are imposed on them by “the market”?

I’d still like you to show me how force is involved here. If some person is working a minimum wage job without health insurance and makes too little to afford it, they’ve been coerced into that situation?

Are you familiar with Medicaid and SCHIP?

True, but my point was that a lot of the platitudes offered by politicians and folks like Krugman about preventive care (or the uninsured, or Medicaid, or a variety of other things) are often contradicted by facts. The idea that increasing government health care programs leads to less usage of the emergency room is also false.

Cite? The aritcle you referenced does not give any evidence to dispute the notion that heavy government regulation increases the cost of health care. All it says is that we have the most privatized system (which isn’t saying much) while also being the most expensive. It is a leap in logic to conclude that even more government regulation will produce cheaper prices. It is quite conceivable that more government regulation and more government programs will further increase health care inflation. This paper by Amy Finkelstein lends support that assertion.

Where have I done so? The only “point” you made was that a lot of people lack health insurance, therefore coercion was involved. Or did I miss another example you gave?

I’d like you to actually support your idea that “market coercion” is behind our health care woes, to be honest.

216

Renob, the bulk of your post will need to wait until I get back. But just one very small point which I hope is the last word that needs to be said on the subject of coercion’s meaning. You are mistaken about my misunderstanding the definition I posted:

"Constraint, restraint, compulsion; the application of force to control the action of a voluntary agent. "

You’re missing the import of the semi-colon which separates the first clause from the second. As a synonym for constraint, restraint, or compulsion, the word coercion does not entail the application or threat of force in the sense of * physical violence*. That is why the term coercion need not necessary involve a direct relation between two individuals, why it can pertain to the relation between an individual and a “what” rather than a “who,” and why a term such as “cosmic coercion” can exist and be of use to a range of interesting commentaries.

It’s also why J.S. Mill can speak of the moral coercion of public opinion, why some Christians can write of metaphysical coercion, why feminists can define sexual coercion as “exist[ing] along a continuum, from forcible rape to nonphysical forms of pressure”, why legal theorists can define ideological coercion as “the use of hostile propaganda directed at the citizens of a foreign state,” and why critics of trade unions can describe the use of dues for Democratic candidates when some union members might be Republicans as a species of political coercion.

The above is a motely assortment of stuff gathered randomly from the web–all of which has only one thing in common: all use coercion in the sense of constraint or compulsion without any necessary tie to the threat/application of violence.

You are entitled to prefer to reserve “coercion” for your own particular meaning which is indeed a common enough meaning; but you should not misread the dictionary’s more inclusive definition or insist that everyone else is the world who is using this word in a non-violent sense is wrong while you alone are right. That is just wasting time which I’d be tempted to name temporal coercion had not James Fitzjames Stephen already used the phrase somewhat differently ;).

More on the VA et al when I return.

217

America spends more on health care than most other countries, and America has the freest health care market. To you, this means that government regulation would lower the cost of health care.

But do you know what else Americans spend more on than most countries? Cars. And televisions. And clothing. And pets. And movies. And hair care.

America is the second-most wealthy country on the planet. Only Luxembourg has a higher per-capita income. People value health care, and therefore spend a lot of money on it. America spends more because America has more to spend. Correlation does not imply causation. Or if there is a causative factor, I might say it’s the fact that the U.S. has the freest market - because the free markets the U.S. has are directly responsible for the differential in wealth that America has over other countries. Free markets made America rich, and rich people spend a lot on health care.

Americans try harder to save lives and to extend lives. They go to extraordinary and expensive lengths to save very premature babies - one of the reasons America has a higher infant morality rate than some is because America creates infants out of barely-viable short term fetuses. But some of them survive. Americans put artificial hearts in people, keep people alive indefinitely on kidney dialysis, and have an advanced organ transplant infrastructure and therefore do a lot of extremely expensive transplants.

Of course, many of these procedures are consumed by the rich. But they count in the statistics.

No country can afford all the health care it wants. Not even the U.S. Therefore, some people are going to go without. The market allocates resources to those willing and able to buy the services they want. Government systems allocate resources through rationing, restricting supply, or depressing wages and investment, which drives down the number of medical professionals and creates shortages.

One of these has to happen, unless you believe the government can wave a magic wand and make doctors and nurses and hospitals appear out of the ether. In Canada, we have long waiting lists as a means to restrict demand. Other countries have different methods. In Britain they might just Let. You.Die.

This is the most horrifying aspect of public health care - the notion that even if I have the resources to pay another person to sell me a product or service that may extend my life, some faceless bureaucrat is going to step between us and force me to die, because I don’t meet the qualifications for funding set by other bureaucrats, and I can not be allowed to use my own money lest I dilute the purity of the system. I’m sorry, but having the state make fundamental decisions about who should live or die is evil. I’m actually abhorred by how ready our society is to put its very life in the hands of the state in exchange for financial security. And they’re willing to force doctors and nurses and insurance people to do their bidding to achieve this.

218

I don’t think this is true. Do you have a cite for this?

From what I can tell, in many countries, cars, TVs, and, in general, goods, are more expensive than in the US. Not just on a relative scale (relative to someone’s income, for example), but in actual dollar terms.

And the fact that they are more expensive does not prevent them from buying them like there’s no tomorrow. See, for example, the high cost, and yet nigh penetration of cell phones in Europe, compared to the US.

If these are consumed by the rich, why is health insurance for the rest of the people going up?

AFAIK, health insurance premiums have been rising for the past several years at rates that far far exceed the rate of inflation. Why is this happening? Are health insurance companies providing a lot of extremely expensive transplants to the average Joe these days?

The free market also puts any price it wants on a good, as long as it makes money doing so. To take an extreme example, it could, for example be in the best financial interest of the medical corporations to have prices so high that only the top 30% of the people can afford medical care. They don’t care if the remaining 70% of the population gets no care when sick, as long as the 30% can pay high enough prices to hit the profit-maximizing point of the supply-demand curve.

Not saying that this is what is happening today, but that is the fatal flaw of a purely free-market based approach to health care.

(A purely government-based approach is not the best either, FWIW)

No, you have long waiting lines because you have an irrational system that does not allow any private health care, if I am not mistaken.

This is indeed horrifying. But so is the notion that you have cancer, but you cannot get treatment and therefore you will die just because you don’t have enough money in the bank.

Why can’t we have a hybrid system, where both of the above scenarios are addressed?

  • Have government provide a basic level of care to all citizens
  • Allow private health care to address people who have the money and (1) do not want to wait as long to have some procedures done and/or (2) want to have some extremely expensive procedures done.

The above would address the issue of your poor rich guy being denied care by a heartless bureaucrat. He can just skip the government option and go to private care.

Another benefit of this hybrid approach, is that it keeps the prices down in the private health care sector. If everyone knows that there is always the free government option available for most procedures, if the cost of the private care option gets too high, they will avoid it.

I believe this is the case in some countries that have a hybrid system similar to what I mention above.

But you’re OK with having the banks make fundamental decisions about who should live or die.

Because, if you need to take out a $300,000 loan to have some life-saving procedure done, guess who the bank is more likely to give it to: a cashier at 7-11 or a rich businessman?

And, in any case, the state already has the power to make fundamental decisions about who should live or die. E.g the justice system decides who among the guilty get to live or die by execution, and the military gets to decide, in the case of defensive wars, which cities are more worth saving during an attack.

People have decided that, in certain cases, it is OK for the state to have such power about who should live or die, because of the overall benefits of the arrangement. So, no need to use the scare tactics of “the state deciding whether we live or not”, as if this will be something new under government health care.

Don’t we already put our lives in the hands of the state (police and army) in exchange for security?

219

Fine, Dorothea, we can agree to disagree on what “coercion” means. I’m still waiting for you to actually give me an example about how coercion is used to deny people health care in this country. You can ramble on all you want about how the word is used in other settings that have nothing to do with this debate, but I’m curious as to what you are thinking when you use the word. Please, I’ll ask again, give me an example about how our system “coerces” people to go without health care. Simply saying that some people lack insurance does not mean they were coerced to go without it.

220

Renob, well, at least we agreed to disagree!

I think this debate has already passed its prime but did not want you to think I forgot to look. If you like the VA there is probably some consensus we can find beyond consensus over our disagreements. :slight_smile: