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).
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.