« Personalized Medicine and inequality in health | Main | Moving to Canada, Staying in America »

07/01/2011

Comments

Feed You can follow this conversation by subscribing to the comment feed for this post.

Brendan Saloner

Hi Paul,

I thought this was really interesting. I want to make two points.

First, I don't know how to evaluate your (highly qualified) statement: "Philosophical claims are, in themselves, harder to vindicate than straightfoward claims empirical claims about how reform works, who it helps, and who will be burdened." If all you mean by this is that we have lots of published estimates (like the one you showed) of the redistributive consequences of reforms, and that people don't pay enough attention to those, then I definitely agree with you. But there are plenty of empirical questions about reform that are difficult to settle, because they aren't straightforward questions -- and sometimes even the metrics that we choose to evaluate those questions are themselves irreducibly normative ("affordability" of health insurance is the example that comes to mind). For these questions, and the debates that arise, we should be prepared to engage with ethical principles and defend them in a clear and coherent manner.

Second, I think the degree to which ethical appeals will resonate with the public is grossly underestimated. We have some opinion poll evidence that the public would have been receptive to certain reforms that are framed in terms of helping others, WHEN the concept of fairness that accompanies that reform is also articulated. We've sort of reached a point of consensus that the American people care only about how much they themselves will benefit from health reforms. That doesn't cohere very well with the complex way in which average taxpayers and voters think about values in public debates.

Thanks!

Paul

Thanks for the comments, Brendan! On the first point, take the Lynch and Gollust aritcle you linked to yesterday on Twitter. They note evidence that there is agreement on various moral claims, but they themselves put forward the moral view that everyone is entitled to an equal opportunity to pursue a worthwhile life (I forget their exact language and the mobile device I'm using makes it hard to check right now). As you know, I have signficant philosophical doubts about an equal opportunity based argument, and I would have cringed if we had gotten into that sort of argument during HCR. Perhaps I should have just bit my tongue and agreed for strategic reasons, since the reforms we got do move the US toward justice as I see it? In a sense, I guess I'm saying that's exactly what happened, and why I'm skeptical that what we really needed was *more* appeals to philosophy and "conceptions of social justice" than we got. I took that to be Marmor's suggestion, Perhaps I misread him?

I hope we'll (you and I) will spend more time analyzing the poll evidence you cite. But it is one thing for people to agree that something is unfair, and quite another to explain *why* it is unfair. Again, I took Marmor to be saying that we should explore the Why Question. After all, he admits that Obama and the Democrats claimed that there was unfairness in the status quo.

My worries about digging deeper into the nature of fairness are also connected to my claim about philosophical versus empirical propositions. Of course there are highly contentious and uncertain empirical propositions. But we cannot help but seek the truth about them and then rely on that understanding in policymaking. The case is different for philosophical claims, however. Often--but not always--when philosophical are contentious, the truths we might discover by thinking harder about them will be so parochial that we should be reluctant to base laws on them.

My own view about social justice depends on the hope that the empirical issues that bear on it are in fact tractable, and that the moral/philosophical claims are sufficienly ecumenical that, when combined with the empirical claims, no reasonable person could disagree. There is no way to prove that this hope can be vindicated. The most I can do is keep offering rationales and hope others find them compelling.

Beth Haynes, MD

Paul -- as a philosopher promoting Rawlsian social justice, I am curious if you are familiar with Friedrich Hayek's critique of social justice both in The Road to Serfdom, and more in depth in Law Legislation and Liberty vol 2 The Mirage of Social Justice? If you are, I'd be very interested in your thoughts.

Paul Kelleher

Beth, you are mistaken. I did not defend Rawlsian justice in this post. The one paragraph on it critiqued Rawls. That said, I am not a libertarian, and do find the arguments of Hayek, Friedman, Nozick, etc. to be predicated on a flawed conception of liberty's point and value.

Beth Haynes, MD

Paul--Rereading the paragraph on which references Rawls, this time following through on the links, I apologize for misinterpreting your points. I also find Hayek's use of liberty flawed but I am not sure what you mean by "liberty's point and value." The point of Hayek's I do find worth consideration is how the implementation of distributive justice conflicts with equality before the law.
I will check out Buchanan's article. Did you ever finish writing the "completion" mentioned in the linked comment?

Paul Kelleher

Hi Beth, I expect to have opportunity to address libertarianism more full here in the future. By "liberty's point and value" I meant that, in my view, a proper understanding of liberty and why it's valuable does not demand libertarianism and laissez faire economic arrangements.

Of course it matters what conception of social justice we're working with we say that it conflicts with equality before the law. That said, I do not believe that sensible left-liberal conceptions of social justice conflict with equality before the law at all. I can see someone saying they conflict with a libertarian understanding of liberty, but that again is a point I don't agree with. (Of course a lot more needs to be spelled out before anyone should believe me!)

Harold Pollack

Hey cool post. We need to have a beer halfway between our universities

Paul Kelleher

Thanks Harold. And I'd love a beer. Maybe the Pres can moderate the discussion.---I may actually be at U of Chicago in the fall. I'll touch base on Twitter.

Beth Haynes, MD

Hi Paul--I look forward to reading more of what you have to say on this subject. Thanks for responding.

The comments to this entry are closed.

My Photo

Become a Fan