So ultimately I'm saying, I think this is the way that our government works, and this is the way that markets work, and for all the screaming, these are not crazy positions. There's plenty of evidence for government crowding out. There's plenty of evidence for price controls. There's plenty of evidence for what happens to markets that are largely governed by price controls.
You may disagree. You think government works better than I do. You think we'll be able to draw a line in the sand and keep the government from crossing over it to take over more of the market. You think government spending can substitute for R&D, because you don't find the socialist calculation debate compelling. Or maybe you say, hey, yeah, well, 0.7 years off the average lifespan isn't a bad tradeoff for covering the uninsured.
I can't talk you out of it. You can't talk me out of thinking that 0.7 years of life is a whole lot of life when you apply it to 400 million people. Numbers like that seem kind of meaningless-it's just eight months!--but this is composition fallacy. Some people won't live longer. Some people will die sooner, because treatment is iatrogenic in at least some cases. And some people will get extra decades of healthy life to hug their children or compose symphonies.
It's a judgement call. Not all values are commensurable. There are multiple theories of politics. And justice.
So why talk any more? I can't believe how nasty this debate has gotten. I can't believe that people who claim to value a classically liberal market society, on the one hand, and people who say that all they want to do is help people, turn into such screaming, hate-filled lunatics when the subject comes up. A debate over health care should not remind me so much of a debate over the Iraq War. I write thousands of words on innovation, and John Holbo boils my concerns about lost years of life down to "indifference to the poor"--as if, first, the poor will not be helped by new treatments, and second, we should do anything at all, no matter how horrific the results, as long as it helps the poor. Well, and third, as if the poor weren't on Medicaid, but that's another rant. This is about as useful as my saying that John Holbo's basic philosophical premise is a desire for my grandchildren to die young. I devoutly hope that if any of his freshmen said anything remotely this silly in a paper, Mr. Holbo would flunk them.
I'm actually happy to be at the impasse, which I knew was coming. All I wanted to do was get some liberals to admit that there might be some reason that someone with basically progressive ethical priorities might be worried. I don't think we'll go beyond that, because progressives also have a lot of priors about the market that I don't share, to wit that it rarely produces anything really useful.