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Bill Gardner

Well done, Paul! As you note, "silly" is the wrong way to characterize the problem. Silly suggests that they have missed something obvious. If it were so, there would be little need for moral philosophers.

Brendan Saloner

I agree with much of what you say here, but I think it may be unfair to beat up on the use of the word "value" in welfare economics. In the Pauly quotation he is referring to the willingness of low-income households to pay out-of-pocket for certain medical services, and surely we can agree that for whatever reason these households purchase fewer services with their limited incomes than is societally optimal. That does not mean that the reason for providing subsidized services has to be to get closer to the social optimum (although it would be fortunate if it were pareto optimal to offer a subsidy to low-income households on the margin). It also does not mean that these households care less about being healthy than people with more money (in fact, we know that people will consume more beneficial services if they are given a subsidy or more income).

Paul Kelleher

Thanks for the comment, B. My emphasis is indeed on "value," but it is most strongly on Pauly's use of "can"--I can make no sense out of that word choice unless he's drawing on a welfare econ framework that would also help explain his reliance on "community benefit" to justify helping those who, by virtue of their circumstances, "cannot" value health care. For example, he makes no indication that the people he's referring to cannot value health insurance because they are weak-willed, or uneducated, or the like.

Thoughts on that reading of Pauly?

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