Practical philosophy and national health care: a response to Megan

by Matt Flaherty

[Ed. note: Matt is a liberal friend of mine and a grad student in English at the University of Minnesota. He originally sent this to me as a personal email, and I decided it was about time I ask him on to guest blog at his leisure.]

Megan McArdle's post on practical philosophy and national health care is a good one. It's quite helpful for her to initially ascend to the philosophical level of abstraction so as to deflate these objections from liberals, as she does here:

"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!"

This is a better argument technique because it takes the thunder out of the opponent's sails; even if now she can't score as many ideological points for her identity (she herself calls the libertarian position a "boring" one; one that only arise after her assessment of the way the world has ended up to be rather than provides the foundations for incontestable ahistorical value and truth).

Philosophers want to get people to agree on first principles.  It's our specialty—if everyone already agreed, we'd be out of a job. We're good at helping people to get rid of their ideologies that rationalize the status quo as necessary and inevitable so that they can be exchanged for (hopefully) policies that do a better job of promoting the greatest happiness, justice, and equality of opportunity for the greatest number. In fact, Megan has pretty good first principles—though I might describe these principles as socially democratic rather than libertarian:

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.

Societies should strive to organize themselves so that everyone in the society can, if they desire, acquire the means to provide their basic needs.

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.

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.

Perhaps the problem with the humanities/humanistic academia is that we are so invested in our discussion about first principles (and, like all people, we want to emphasize and discuss what we have expertise on) that we sometimes forget to do the grunt work of tracking down the economics, the nature of the world as it really is. Thus, while we may get our first principles right, half the time, we don't take the time to get an inadequate model of the world, and thus end up recommending programs (e.g., some marxist inspired tomfoolery) that don't work (of course, this would be more of a problem if people took us more seriously than they do). That's why teaching people to critically think for themselves is always going to be the most important thing we do in the humanities. We're better at getting cultural questions than economic questions right.

Though Megan and I (and Gherald, I'd wager) agree on almost all of these first principles, perhaps the problem with libertarianism is that it sometimes clumsily abstracts from (real) patterns it observes in the nature of the world up to identity-forming kinds of principles. Though this is merely a quibble, I do wonder what justification Megan has for this as an a priori principle (rather than a heuristic for action that fell out from the way that the world, governments, and human nature, happen to generally be?):

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.)

This, in my view, should not really be a first principle, but, as Megan aptly states elsewhere simply a "contingent, evolving arrangements that happen to work really, really well for encouraging many sorts of beneficial ...activity." The reason that people don't have an obligation to perform labor (if that is true) for others would only be because that arrangement more often, given the way that government works in the real world, leads to more aggregate happiness for the parties concerned. I would in principle, be certainly fine with forcing a surgeon at gunpoint to save my mother if I could not get him/her to agree through any other means. The only problem with this principle is its real-world application in practice (allowing people with guns to force doctors to do things would probably end up being a bad deal on the whole, thus the government prudently, though not "rightly" or "justly," limits the practice).

Also, Gherald's support for a flat tax (which he mentioned as his main disagreement with Megan's principles) always makes me nervous. Perhaps my fears are motivated by me overemphasizing the identity/first principles side of the equation. In other words, my nervousness stems from my belief in this principle: "the gvt should care nothing about intrinsic rights to money, or what people have earned for themselves, but should care only about balancing the promotion of happiness for its citizens (while, given the necessities of government in the empirical world, taking care to minimize the controversy and coercion necessary for this implementation and maximizing public support for any policies that it thinks might do this)." However, if my emphasis on this philosophical point obscures me from thinking coolly about the potential results of a flat tax (and these results actually would result in more happiness and less suffering), then my identity is a problem.

However, I sometimes worry that Gherald as a libertarian might be committing a similar error in emphasis, but on the opposite end—overemphasizing the world as it is part (e.g., flat taxes lead to more more innovation; survival of the fittest is human nature) and then clumsily abstracting from the way the world is to a first principle (flat taxes and inequality are thus always good, even if more innovation ends up arising at the cost of more suffering).

And, if that even describes his position at all, would be my philosophical quibble. There the expertise of all us liberal philosophy folk ends: we simply have to use critical skills to get on with evaluating the nature of the world like everyone else. I've agreed with Gherald in the past that I think the libertarian side has done a better job of evaluating the world as it is part on this issue of health care. The Atlantic article by the businessman is roughly my current position now.

But to end this love-fest of agreement, here's a provocative response from the liberal side. No doubt it's too vague on many particular economic points that are key to the libertarian position, but it may, at least, make one more suspicious of how charitably minded folks in the actuarial profession really are, and more nervous about the potential of badly regulated but "free" business lobbies.