I continue to find myself puzzled by John Holbo. This statement makes no sense to me:
In all seriousness: I realize I have been arguing, for several posts now, at an unsatisfactorily high level of abstraction. (I have seized on the strange case of McArdle because she started it, insisting on talking only at the philosophical level, thereby giving me an excuse to continue in that vein.) But there is a point. Philosophically, there just isn't a case to be made against reform unless it's this simple one: if you don't have any money, you shouldn't be entitled to any medicine. McArdle is very indignant when people accuse her of indifference to the fate of the poor, but - honestly - if it isn't that, then it's nothing. At the philosophical level.
This echoes his earlier post. John Holbo, who is, I believe, a professor of philosophy, seems to believe that you can develop a philosophical opinion on a policy issue without reference to particulars.
Imagine a universe consisting entirely of two identical blue spheres. Is there a right to national health care in that universe? Please show your work.
Obviously you need a very large number of specific priors before you can even think about developing a "philosophical" opinion on health care. Of course, we do need to operate at some level of abstraction. But Holbo's response to me consists of abstracting away all of the potential problems with national health care, and then demanding to know why I don't support it--I mean, apart from the fact that if millions of poor people die, there will be more room on the subway for me. Libertarians think like that, you know.
So I'm not sure that this conversation is likely to be productive, since at least one side of it has decided to substitute sarcasm for engagement. But let's see if we can't tone down the nastiness a little, and try to have a reasonable discussion.
I'm afraid, however, that any discussion will include our assessment of the likely outcomes of our policy decisions. It's not enough to defend the principles of communism if what you get in practice is a nasty, murderous dictatorship every time.
Some philosophic principles:
-- We have some obligations to future generations, if not necessarily future individuals within those generations. Extreme thought experiment to clarify the principle: we cannot strip mine the earth and leave them to die.
--People have no obligation to perform labor for others. I may not force a surgeon to save my mother at gunpoint. (To be sure, I might. But society would justly punish me for doing so.)
--States have an absolute right to tax their citizens to provide public goods, i.e. goods that are broadly beneficial but non-excludable. They have a right to enact other laws, such as public health rules, to achieve similar ends. Both rights are constrained by the basic rights of their citizens. You may perhaps quarantine Typhoid Mary. You may not shoot her.
--Societies have a right to organize themselves to improve the justice of their income distribution. That organization may include taxation. It may also include property rights, or outlawing behavior like blackmail.
--Property rights did not spring full-blown from the head of Zeus into a natural right. They're contingent, evolving arrangements that happen to work really, really well for encouraging many sorts of beneficial economic activity.
--Just income distribution is not just a matter of relative position, but also of how the income is acquired, and absolute need. I do not have any moral claim whatsoever on a dime of Warren Buffett's fortune, because I have a perfectly adequate lifestyle. I still wouldn't have any claim on his fortune if he suddenly got 100 times richer, provided that he acquired that money through means that we regard as licit.
--Societies should strive to organize themselves so that everyone in the society can, if they desire, acquire the means to provide their basic needs.
--There is no per-se right to health care, since "health care" is not a thing, but a shifting collection of goods and services with amorphous boundaries. Health care is a subset of the modern "basic needs" package, and therefore falls under broader distributional justice claims. No matter what your distributional justice intuitions are, it would be perfectly acceptable, if impractical, to give very sick people the cash required to treat their cancer, and let them blow it on a trip around the world.
--No one should have to work more hours for the state than for themselves. This should inform our approach to taxation.
--Taxation should strive to equalize the personal cost of taxation among all members of society, not the dollar amount or the percentage of income. That is, it is appropriate for Warren Buffet to pay a higher percentage of his income in taxes for shared public goods than I do, because the personal cost of taking 25% of his income is much lower than the personal cost of taking 25% of mine.
--An equal distribution of misery is not a good social goal. When policies to redistribute goods or money result in fewer or poorer quality goods being available, that cost should limit the redistributive impulse.
--If people will not comply with your regime, and their non-compliance may have unpleasant results for themselves or others, this is an important side constraint.
--The government should not interfere in voluntary transactions unless there are significant direct externalities. The fact that you get stressed or unhappy thinking about something does not qualify as a direct negative externality. Nor does the cultural miasma that emanates from these transactions.
--The government certainly should not forbid anyone to purchase something on the grounds that other people are not able to purchase that thing.I am sure that John Holbo would quarrel with some of these principles. But on the broad package that he thinks leads to national health care, we're probably in rough agreement.
Yet I do not think that they lead to national health care! How can this be?
Mr. Holbo's answer is that I am an evil idiot who hates poor people, doesn't understand how markets and governments really work, and is philosophically incoherent. My more boring answer is that we have different assessments of how the world to which we would like to apply these philosophical principles works.
For starters, Holbo has a very simplistic view of rationing--or perhaps, the objection to rationing that most libertarians have. Either it is Britain in World War II, and the government has forbidden you to purchase more than 6 bandaids, or we don't have rationing.
This is not true either philosophically, or technically. That last principle I articulated is only one of the possible objections to rationing--one that I take it Mr. Holbo and I share, unless he is simply unwilling to come out and say he favors letting rich people die if poor people can't get a given treatment. I might point out that rationing interferes with voluntary transactions, and that if the government wants to redistribute things, it should damn well raise the taxes and buy them. I could question the justice of whatever regime you come up with. These are all actual problems with any of the proposals that will be passed.