On a sufficient level of health care

post by Bill Gardner

Josh Barro (@jbarro) writes to defend a now famous post by Tyler Cowen (@tylercowen) that included the flamebait sentence, "We need to accept the principle that sometimes poor people will die just because they are poor.…" (my comment on Cowen is here).

Barro writes,

Cowen is right. As both inequality and health-care costs rise, it becomes more difficult to equalize health-care consumption through transfer payments. The size of the transfers eventually becomes untenable. They also become wasteful: You end up providing hugely expensive health-care transfers to people with low incomes who would be better off with cash, housing or something else. 

Agreed. First, I don't think that transfer payments can be the primary solution to the problems of poverty. Second, and more importantly, egalitarianism is only one of many principles that define a just society. (Liberty is even more important.) There is no transcendent order that harmonizes all good things, and trying to equalize everything would be destructive and futile. Therefore, defining a sufficient minimum level of access to health care as a human right is a way to make egalitarianism practicable and consistent with other human goals.

Barro links to my post on this point, and I think he agrees with the overall argument. But he raises a point that is worth discussing:

Of course, [the fact that you can have 'too much' equality] is not consistent with the idea that there is a “right to health care.” A right to what health care? Well, “basic” health care, is usually the reply. Or, if you prefer, “sufficient.” So what does “basic” or “sufficient” mean? That this is a question subject to political debate and cost-benefit analysis is your clue that we’re dealing not with a right but with a strategic question of how to best improve public welfare, in which health care is only one of many goods available.

It is true that specifying a sufficient level of health care requires democratic deliberation. Necessarily so: what is required for human dignity changes as humanity progresses. Again, there is no transcendent order of justice that we can visit to read up on our rights. This does not necessarily mean that sufficient access to health care is not a right. Most things that are widely held to be 'rights' are subject to democratic negotiation and their scope expands as we make progress. Consider freedom of speech and freedom of religion.

Finally, a point not related to Barro's post. One of the irritating points about Cowen's post is that he was attacking a straw man. Where, exactly, is the US close to a destructive level of health care egalitarianism? Not, I think, in Texas.

Comments

[Dino]

Is it too egalitarian to give poor people the same protection from fire that everyone else gets? Is that a philosophical debate worth having? Should we work to define sufficient fire protection?

[Bill Gardner (@Bill_Gardner)]

Good question.

I would argue for every neighborhood in a a city having similar good public services for fire, ambulance, and policing. (Which is far from the case in the US today.) I wouldn't argue for the _same_ protection: if wealthy neighborhood X wants to privately support better security, etc., that is their prerogative.

[bmw 1]

Would a poor child need to die because they where born into this world poor? I work in the health field in an ER. The current system is YES. If a child needed a specialist and they are on public aid. That specialist in more caes then not. Would not be on call. Why are they not available? Under the current system. They don't get paid from public aid. If they are on call. They can pick and choose who to see. if you have not used your insurance until an Emergency. Your Insurance will find ways to not cover you. I could go on and on. Battling over the phone to get a specialist for a Patient. It all depends on Insurance and what it will cover. People have benn from all wals of life. Health Care needs a fix. Obamacare is start.