Why no free healthcare?

But it’s not different. The issue is that you aren’t any different, either.
Bush, you and me choose a set of moral values and want to see it enforced. More specifically, you want an absolute “right to property” to be enforced. You want it to be enforced despite most other people thinking that there’s no such absolute right to property, and that your right to property is trumped by other considerations. You want it to be enforced even if it has serious adverse consequences on other people. You want it to be enforced even if you have to coerce other people into protecting it. You want it to be enforced even if it’s not efficient. And you don’t realize that you’re trying to push your arbitrary moral principle down our throats?
What would be the “absolute moral authority” that could determine whether or not you have an absolute right to keep your property? Or could determine what exactly is rightfully your property and what isn’t? Or even that you have any right to privately own anything? See for instance my “private ownership of land” question in the other thread.
The problem here is that you’re under the delusion that the set of values you picked isn’t arbitrary while the sets of values Bush and me picked are.

This issue is better adressed in the “inalienable rights” thread.

I’d suggest it was more like massively overpriced building work being done by a monopoloistic (or, at least, disproportionately dominant) contractor, and using democratically mandated taxation to acheive a minimum build-quality threshold universally since using taxation solely to enforce property privilege results in that threshold being met selectively.

Here is the difference: I want to shove as little of my moral positions down your throat as possible, and for no person (you OR me) to have any more than the absolute minimum shoved down their throat. I want us to agree that shoving moral positions down each other’s throats is bad and try to minimize it. I want you to be free to attend the Church of Christ and me to be free to attend the Church of Satan, and I want us to agree not to burn down each other’s churches. There is no way for either of us to have total freedom, because our interests and desires might overlap. So the idea is for each of us to have as much autonomy as is possible without having to interfere with each other. You want to say, well I know the Church of Satan is wrong, so there is no reason for me to let you attend it.

My set of things I force you to do is the absolute minimum. Yours is arbitrary based on your personal beliefs. I say that it DOES matter whether you think wealth should be shared. You say that it DOES NOT matter what I think.

To me, this is a huge freaking difference.

-VM

Can we rewind here?

Sure, a hard liberterian would like no involvement in healthcare … or education … or environmental protection or minimal wage laws or labor protection laws or … etc. We’ve had lots of liberterian threads. But many of us have some soft liberterian leanings but would like to have some pragmatic balance between societal good and individualism. This society has so far come up a few instances where we have decided to infringe somewhat on individualism for what is percieved as the greater good …

Basic security. Police are for us all. Not flawless but the goal is that they protect all of us to some basic level. It isn’t free but it is worth it. You can hire extra security for yourself if you want and can afford it. Some do.

Education. Uneven to be sure. Costs lots. Many choose to opt out of the public system and pay for a private education (in addition to what they have paid in taxes) rather than go public schools. Or to home school. But some minimal basic educational opportunity is open to all.

Environmental protections. Yup we all pay for protecting our environment by making it more costly to business and that gets passed on. To some degree it impedes our ability to compete. But we do it anyway.

Healthcare. Yes, healthcare. We are paying for some healthcare for all of our members insured or not. Right now we are doing it stupidly and poorly. We are getting very little bang for the buck paying for the uninsured and uncovered (either via tax dollars or buried in hospital and other medical costs) when they show up very ill in hospital Emergency Rooms where their care is obligatory. For what we pay we could do lots better. There are ways to provide healthcare coverage to the currently uninsured that would be very cost effective and does not require a complete overhaul of the system. Ways that would increase the quality of care to all and decrease the burden on American businesses. I offered up one approach a page or so back. It wasn’t socialized medicine.

There is no liberterian option open for healthcare in this country. Like it or not you are paying for healthcare for others now. This society would not allow an ER to refuse to care for a critically ill indivdual on its doorstep. The decision is whether you want to spend it foolishly by pretending that you are not paying for it (“I see nothing, I hear nothing!” -Sgt Schultz), or if you accept that you are paying for it anyway and rationally figure out how to get the most for your money (both in health outcomes and in benefit to the nation’s economy).

I think that is true for most people. Part of the problem lies in defining what constitutes “societal good” and there is no provable answer. Like most libertarians, I believe that the most societal good comes from letting the market operate as freely as possible. I believe that this results in the “most good” for every person–including those with less wealth. It is not because I believe in some sort of “every man for himself” credo, but it is because that I believe that most of us do NOT operate that way.

It is not a disagreement with the idea of providing healthcare to those who cannot afford it. It is a disagreement with the necessity of using government force to achieve it. I imagine the various original approaches the supporters of socialized medicine would come up with if the use of government power were not an option. Again, I am not saying that it is bad to try to solve this problem, I am saying it is a bad way to go about it.

But where do you draw the line? How do you justify “stealing” from me to pay for someone else’s healthcare without justifying giving the government control over homosexual’s freedom to choose how they want to live? I would say that the same mechanisms that open us up to one open us up to the other. How do you treat something as a right without making it an entitlement? How do you give someone something for free (in particular, something that requires work) and then realistically expect them to work for it?

By enshrining basic rights, it gives us a way to draw the line, to have police that are more powerful than we are and yet curb that power. Now that we’ve “erased” the line, can we really feign astonishment at the amount of wandering outside of it that the Bush administration is doing?

This is a bit of a misrepresentation. I can opt out of using public education, but I cannot opt out of buying it. In fact, it ensures that less wealthy people can ONLY get crappy education while wealthy people have options.

Contrary to popular belief, protecting the environment is not counter to libertarianism. Before we recognized the problem, we never worked out how environmental pollution impacts our rights, but that does not mean that it doesn’t. For one thing, if you are polluting the air over your own property, you are not harming me, but if you are polluting the air over my property, you most certainly are (from a “rights” standpoint). Libertarians are definitely in favor of people bearing the costs and consequences of their actions.

As has been mentioned before, I don’t agree that the fact that the current system is messed up is a justification for messing it up worse. This is based on my firm belief that socializing services does more harm than good and more socialization leads to more harm.

There is no such thing as a “libertarian option” for provision of any service. Libertarians believe in the power of markets to explore many options and discover the best ones. In other words, the “libertarian option” is every option you (or, more importantly, anyone) can imagine, as long as it doesn’t depend on using government force.

I looked at your proposal for healthcare, and I find it practically indistinguishable from socialized healthcare. From a practical standpoint, my primary objection to it is that, like so many schemes, it relies on selecting “one best solution”, whereas a marketplace continually “tests” multiple solutions and rushes resources to the one that is the best so far. Once you select one best, you pretty much remove the possiblity, likelihood, and motivation for providers to continue to improve–you turn producers into rent-collectors.

And no, I am not foolish enough to think of what we have now as a free market by any means. But if we change it, I would rather change it in the market direction than in the socialism direction.

-VM

Smartass: *How do you justify “stealing” from me to pay for someone else’s healthcare without justifying giving the government control over homosexual’s freedom to choose how they want to live? I would say that the same mechanisms that open us up to one open us up to the other. *

Nope, it’s pretty easy to avoid that slippery slope. We have a certain range of individual rights, such as the right to privacy (which is the one that covers the freedom of consenting adults to pick their own sex partners), within which individual freedom trumps social preference. This is where liberal “civil libertarians” and the various breeds of more hardcore economic libertarians are in agreement: this is the sphere in which we concur that majority decisions may not infringe upon individual choice.

Where liberals like me part company with the libertarian view of social morality is over the libertarian view that society is somehow morally obligated to treat all choices as inalienable individual rights.

I don’t agree at all that society should have to regard the desire to help other people and preserve public health exactly the same as the desire to buy a new DVD player. On the contrary, I think it’s perfectly reasonable for the society to decide that the former desire is more fundamental and important than the second one. And therefore, it’s okay to legislate it as a social obligation to which everybody is required to contribute, just as they’re required to contribute for national defense and law enforcement.

Libertarians seem to worry that if governments are allowed to do that, they’ll get the bit in their teeth and run around legislating the social validity of all desires and you’ll end up having to submit a three-page application before being allowed to buy a DVD player. However, in mixed-economy democracies, I really don’t see this type of “giant squid” scenario as worth worrying about. People will always argue about what sort and extent of social obligations the government can legislate (as we’re doing right here), but that’s healthy and normal, IMO.

And in terms of personal morality, while I try very hard not to fall for the “libertarians are selfish” stereotype, I have to say that I do find it kind of shocking when somebody maintains that they have no social obligation to help pay for healthcare if they’d prefer to buy themselves a DVD player instead. I really think members of a society need to officially recognize their mutual obligations and interdependence, as well as their individual rights and independence, if they’re going to remain decent people.

And the extent of one’s obligations isn’t determined solely by one’s own choice. That’s why they’re called obligations, after all, because you’re obliged to fulfill them even when they’re uncomfortably burdensome. Everyone should certainly have a say in the extent of their social obligations, but they’re not necessarily being “robbed” or “enslaved” if their obligations aren’t exactly what they happen to prefer.

I understand that the argument you’re making here isn’t the “I have no social obligations” one, but rather the economic “I could meet my social obligations more efficiently through the market than through government” one. I don’t find that one morally repugnant, but I’m skeptical about its validity. Certainly, as many posters here have pointed out, many societies with socialized medicine actually provide health care much more efficiently, with much less expense, bureaucratic waste and overhead, than the US’s more free-market byzantine system of private insurers does. So I think the “get the government out of healthcare and we’ll all be better off” line rings pretty hollow.

The 16th Amendment to the United States Constitution.

smartass states

Hmmm. You sound more like an idealistic communist than a liberterian! They too believe in the kindness of the individual, each would produce according to their ability and take only according to their need. Me, I’m not so idealistic. People cheat. Sometimes they cheat on family, more often on extended kinships, and often and without any remorse on unrelated strangers that they don’t personally know. And if I know the other guy is going to cheat, then I don’t wanna be a sucker - I’ll cheat too. That is human nature. This is the nature of society - to provide the means to enforce certain sets of rules that only work if we do not allow the cheats to get away with it.

Exactly right. Society defines what it considers to be the public good and debates how much intrusion is worth how much good. It either does this explicitly by open debate or implicitly with its actions. The American way has historically been to answer the slippery slope with balance. The slopes are slippery on every side. We balance ourselves along, sometimes lurching, but moving forward nevertheless.

I’ll decline to debate the individual examples; the point was that our society has chosen, well or not, to put percieved public good over individualism in certain venues. Some explicitly and some implicitly by action. I’m a pragmatist. This is what is. I want to deal with it. Since we are paying for healthcare for all in some way, can we do it in a way that is more fair, more just, more cost-effective?

Well maybe I misunderstand the hard liberterian POV. My take would have been that a liberterian POV would say that society will not pay for healthcare or mandate healthcare in any way. Market forces only. You can’t pay then you are left to my charity only. No consequences to me if I let you bleed to death in my ER. That is not an option in this country. I also must be confused on what is “socialized healthcare” if my proposal is “indistinguishable.” Which doesn’t mean that government does not have a role in my plan. It mandates particular behaviors - very non-liberterian - it enforces no cheaters. Everyone has to play by the same rules. It provides a graded assist to those farther down on the ladder to make private purchase of health insurance (or assurance - saving plans would qualify) affordable. Not very liberterian either. But it relies on the private markets to provide the healthcare and the health insurance/assurance products competing on the basis of price quality and package offered. It mandates a minimum service, just like auto insurance must meet some minimum standard coverage, but people can get anything above that they want. Not very socialized. Docs and hospitals openly compete for patients and for payors to contract with. Payors compete for lives to cover and for docs and hospitals to contract with. Both can walk away from the table at any point. Not very socialized either. Pretty market driven actually.

Truth is that I’d like to keep government as out of it as much as possible. I see government as the enforcer of minimum standards, the enforcer against cheaters, and the enabler for those trying to climb the ladder from below, especially if they would otherwise be swinging on the bottom rungs so unevenly as to make the whole ladder unsteady. Otherwise let the market do its job.

Not exactly. What I’m saying is that people will be kind or unkind as it suits them. If 25% percent of people think it is “kind” to give healthcare to those who do not have it and 75% think it is “kind” to burn them in the public square, who is right? People keep saying that IF we are an enlightened society, then we will help the less fortunate. And I keep saying that IF this is true, then there is no need to force everyone to share. If you see someone who needs help, then your beliefs determine whether you are obligated to provide it. If you are “enlightened”, then you should feel obligated and should choose to offer help. However, being enlightened, in my opinion, does not entitle you to take MY money and use it to help, because your definition of “enlightened” may not be the same as mine.

In the same way, if I believe that “enlightened” people give 20% of their income to the Church, then it may make sense for me to give 20% of my income to the Church, but it doesn’t follow that I should take 20% of your income and give it to the Church.

An overdramatization would be you saying, “Someone has to help that guy” and me saying “Then get you hands out of my plate and go help him.” Something like that, anyway.

I don’t think it’s a question of cheating. The question is, do I have a moral obligation because you (and a bunch of other people) say that I do? If I don’t believe that it is kind to give away free healthcare, why does your definition of “kind” trump mine?

How about another approach: If 60% of the population believed that it was immoral to give money to the poor, do you think it would be “fair” to pass a law to forbid people from sharing? If I believe that taking drugs is immoral, is it “fair” for me to forbid you from taking antibiotics when you’re sick?

If someone needs help and you help them, how are you a sucker? If I don’t help, doesn’t that just make me an asshole? It sounds a little like you’re saying “Some things are more important than money, but I’m not going to let you trick me out of mine.”

If your sense of morals does is not “strong” enough to keep you from cheating, how do you justify imposing it on anyone else? Do we not all have to answer to our own conscience? Is it “fair” that I answer to yours as well?

Am I not a member of society? Or am I only a member when I am part of the majority? Are Democrats not members of society for the next 4 years?

The American way has been to walk down the slope, one step at a time, and say, “See, it’s not slippery at all.” And my answer is, I don’t care if it’s slippery, I don’t want to walk down the hill. You have already dragged me closer to the bottom than I want to be.

How do you know which way is forward? Let me guess: You took a vote.

Someone has chosen, but it wasn’t me. Apparently, I am indeed not part of society.

My answer would be yes, and the best way to achieve this would be to get the government out of it.

The libertarian point of view is for one person or group not to presume that he/they speaks for society. Or, alternatively, society will pay for healthcare if it chooses to, and there is no need to start pushing people around with government.

Markets are how we achieve things–they do not determine what is achieved. The market does not have an opinion about God or healthcare, but people do. In fact, market forces are nothing more than people choosing what is important to them. You seem to think that people will choose something that they do not want, or that they do not know what they want.

And the poor get crap and rich people have choices. What’s the improvement?

-VM

So this is to be a discussion about liberterianism more than healthcare. So be it.

Let me illustrate my POV with the example of pollution. A dozen of us own companies competing in the same marketplace. We each want clean air (a shared resource) and we each want our companies to succeed. I know that my company will fail if my product costs more than yours. What are the options?

I can impose environmental restrictions on myself and have my company fail.

I can hope that everyone else does but not do it myself and reap the benefits of others while succeeding myself.

Or we can agree that we will all play by the same mutually beneficial rules and all impose the same protections on ourselves with some sufficient motivation to prevent cheating.

It is similar in healthcare. Take just one set of players, the insurance companies. They’d love to not have to expend the resources to cherry pick. If only the others weren’t doing it and no new player could come into the game doing it. Assure them that all the players will play by the same rule in some enforcable manner and then they can put those resources to other uses … compete more on product and price.

Well, I’ll shy away from “morality” and fixate on how societies develop rules. We indeed have rules to prevent people from access to drugs that they want to take if our experts have shown that they are more dangerous than helpful. We remove products that are shown to be harmful. (see Vioxx fr example). Now I am happy that our society generally respects individual rights to make stupid choices so long as they do not infringe upon the rights of others. (And I wish we did abetter job of respecting the right to stupidity.) But the border between my right to be stupid and your right to be free of the consequences of my stupidity is constantly open for debate and renegotiation.

I am a member even when I lose the debate and things go the way that I disagree with. We are still in the same car even if we are heading in a direction that I feel is the wrong way. Yup. My side lost and he’s still my president too and I need to follow the laws that get passed during his administration without whining about it too badly. The key is to have a system that rules by the majority without allowing the tyranny of the majority. A hard balance to hit but the system was designed well enough to come close much of the time.

(Specific to a minimal basic healthcare requirement)

There is crap and there is crap. “Crap” under my proposal is a reasonable package of basic services that promote cost effective resource use in out patient settings rather than catestrophic care. Honestly I think that is not crap even if those with more to spend can afford to have more choices. Currently crap is well crap. No care until the care is expensive and unlikely to help much and then we all pay in various ways. Fragmented care which costs more in human capital even if it is not paid for in dollars. Crap and costly crap at that.

Your synopsis of the problem known as the “tragegy of the commons” is not an accurate description of how libertarianism approaches it. Unfortunately, I’ve about used up my posting time–and this is not an area of expertise for me. If you honestly want to to know more about actual libertarian thought in this area, this link will take you to a number of items written by libertarian thinkers who are probably smarter than I am:

“Reason” articles

In the same way, if you want to burrow into details of economic theory, there are other posters here who are better equipped and enjoy that aspect of the debate more than I do.

I’ll just say that I believe libertarianism does exactly this.

There are similarities. I’ll just point out that 1) the government is distorting this market in many ways and 2) corporations are a distortion of every market (one area where I have a lot of sympathy with Michael Moore).

I’ll also say that the fact that there are problems does not lead to the assertion that only government power can solve them.

I just wrote several long posts on this in the “inalienable rights” thread.

Thread link

Me, too.

Should I not have a right to be completely free from the consequences of your stupidity (and vice versa)?

If he didn’t have so much power, it would be such a problem when a “bad” one is elected.

Wouldn’t it be better if people were less subject to the “whims” of the majority? Why must the majority rule at all?

I am not unsympathetic to what you are saying. Unfortunately, I am growing quite cynical about the chances of “tinkering” with a bureaucratic nightmare making it noticeably less nightmarish. Everyone propose “solutions” that sound like an improvement, but in implementation, they tend to just create more bureaucracy and more nightmare for more people.

In other words, I am not critical of your goals or your logic so much as I am convinced that you are trying to fix your watch by hitting it with a different hammer.

-VM