• Your life is not your own

    In commenting on a libertarian take on health care, Ezra Klein notes,

    Health-care services are somewhat unique in that they’re a rare form of consumption that you often get and get charged for, even if you haven’t asked for them. If you collapse on a street, an ambulance will rush you to a hospital. If you get into a car accident, you’ll wake up in intensive care. If you start suffering from dementia, your family will ask the doctors to help you.

    The (or a) libertarian view may be that I ought to be able to live as I wish, purchase insurance or not, and be free of impositions of the choices of others, even if one of those choices is to save my life.

    Ezra is right that our society doesn’t quite work that way. A simple reason for that is that my life is not entirely my own to the extent (some) libertarians may think it is or ought to be. I am not the only one who cares about the consequences of my decisions. I am not the only one who suffers or enjoys what comes of them. I am not the only one who cares about whether I live or die. I am not the only one who matters.

    It’s not just some vague “society” that cares about my life. It’s much more concrete than that. It’s the people I see every day, that I live with, for whom I’m, in part, responsible and on whom I rely. It’s my family, friends, and co-workers. They all care about my life. I care about theirs. My life is not entirely my own.

    Some may say that’s all by choice. I could have been a hermit. That’s quite a presumption of the extent of my feasible set of lifestyles. I am human and therefore social. All or most of you are too. Consequently, your life is not entirely your own either. You are not a hermit. I will send the ambulance for you. Welcome to a society that does at least that. Yes, somebody has to pay for it. If you (we) reject a socialized payment mechanism in favor of a private or libertarian one, it may be you who gets the bill. Consider it the price of being human, social, and surrounded by people who care. You can’t have it both ways.

    • I think we’ve hit on the main ideological difference here. I think a libertarian would reject your argument entirely. By taking away his (her) right to his (her) own life, you are taking away his (her) motivation for excellence. I think libertarians are more willing than others to sacrifice the closeness to people for whom they care, because they see that closeness as tainted by conflict of interest. If everyone relies on everyone else, every relationship is partially contaminated by a subliminal transaction. I tend to side with your point of view, but I don’t think we can argue away conflicting ideology.

      • A libertarian cannot take away my concern for my fellow humans. I will send the ambulance. Somebody will pay for it. Though I am not aware of a poll, I do believe most Americans, most humans, would also prefer to see emergency medical care provided. Libertarians may not like the world they live in, but that doesn’t change reality.

        I do not see how this takes away motivation for excellence. I think it takes away motivation for free riding.

        • I don’t think I was articulate on the concept of motivation for excellence. I believe the libertarian’s motivation for excellence comes about in a convoluted way. You see every achievement you make as something you have done by yourself and tend to avoid reliance on society because it comes at a price. Or at the minimum, you would want to each individual to choose how much they rely on each other. If you don’t even have the choice to opt into the collective system, then it doesn’t matter what you achieve. You still owe the tax(say on medicare), and your contributions are perceived to have been assisted by the collective regardless of how much you used that assistance. I don’t really know, but I think this is the Ayn Rand point of view. If your life isn’t your own, then the incentive to be good at what you do is reduced.

          Your issue with freeloading sounds a little to me like moral hazard. If society will save the lives of the uninsured, then people will act differently – they will not buy insurance and free load when ill. These people aren’t likely to be true libertarians, just opportunists who may or may not claim to be libertarians.

          I will also send the ambulance… but I like to think about the issue from the other side. The argument that health care will be provided regardless of your desire to participate in the system probably doesn’t convince Ron Paul to abandon his worldview.

    • I think libertarians (I lean libertarian) would say that there is an intrinsic desire to help fellow man, but that government should not be involved. Libertarians think it will do more harm than good. I think Erza is a little off-base to assume that libertarians do not care about people or that libertarians do not think humans are social.The libertarians I know are just as involved as liberals in my local shelters or being generous in giving.

      If you watch Ron Paul’s response to the healthcare question that bothered so many liberals, he says that he cared for people who could not afford treatment all of the time. He believes that private organizations will take up the slack.

      I do not think they deny humans being social or that humans want to help their fellow man, rather they do not think the government should be involved because it is the community’s responsibility. I actually think libertarians rely heavily on man’s desire to help fellow man, probably more than what is rational. Liberals actually do not think people will make the right decisions and be generous, that is why government is needed.

      • At the time you have a heart attack at my doorstep, it would make no difference to me if I took you to a public or private hospital. I would not care if the fastest vehicle was a private ambulance or a public bus. Either way, I would get you some help. That’s my choice. Now, who will pay for it? If you say that I should, do you like the incentives? If you say you should, you’d better plan accordingly.

        If you don’t even like the idea that I’ll try to help you when you’re in distress, you’d better check out of society. But, if you’ve decided not to, you are stuck with some of the consequences of that choice.

    • It seem as though you’re suggesting that because people care about you, they have some control over how you live. So that you can’t choose whether to be picked up by an ambulance or not, or I guess that extends to Do Not Revive or whether you want to live in a vegetative state.

      • I think there are plainly limits to how much control you have over your life. If you collapse at my feet, I will call 911. I will not search your pockets for instructions for me not to do so.

    • This all stems from the libertarian fantasy that people make free choices, and then should bear whatever consequences result from these choices. This is a false perspective, in at least two ways:

      1) Many of our choices are NOT free. Kids don’t choose to be born to poor (or wealthy) parents. If you don’t have any money, you can’t choose to buy medications. If you live in a poor neighborhood, you can’t choose to have a good school.

      2) None of us can accurately estimate the consequences of our choices. The choice to forgo health insurance is smart for those who stay healthy, dumb for those who get sick. Can you predict whether you’ll be diagnosed with cancer next year? I can’t. The world has too much chance embedded in it to make drawing the line between choices and consequences possible.

      There is a kind of Social Darwinism inherent in this whole attitude that I find repugnant. People are poor because they deserve to be poor — they are lazy or foolish, or dishonest. They are sick because they made bad choices. This attitude completely ignores the reality that there are huge external factors that influence our wealth, health, and well being.

      As you can see, you’ve touched a nerve with this post.

    • The cost of providing ambulances and emergency rooms for the victims of accidents and heart attacks — assuming the government paid the entire amount — is probably less than $40 billion.

      There is a long, list of Defense Department waste, federal pensions, and earmarks on which we spend $40 billion.

      In other words, the cost of being generous in emergencies, even to those who gamble on insurance , is not worth much debate.

      The real issue is whether we should pay for CT scans, biopsies, MRI’s, dialysis, chemotherapy, et al for those who gamble on insurance and choose not to buy it.

      Now we are talking hundreds of billion. Pure compassion tends to run a little dry in the face of such large amounts.

      Avik Roy had a good post a few months ago on the huge contrast between what he says conservatives call basic health care — i.e, ambulances and hearing aids — versus what liberals call basic health care, i.e. blood pressure medications, insulin, regular physicals,and all the other aspects of ‘premium medicine.’

      Put it another way, a little blunt but we need bluntness.

      I have a basic social interest in paying for the universal treatment of contagious disease and ER care for accidents. I might be next.

      I have a minimal sense of decency-type of obligation to pay the universal treatment of sick children.

      But do I have an obligation to pay for the victims of self-contained illnesses, which in many cases the patient has brought on themselves by years of smoking, overeating, or overdrinking?

      Comments welcome!