Tyler Cowen on Health Care Egalitarianism

post by Bill Gardner

From a post by Cowen arguing that "conservatives and libertarians... should have been looking for the following qualities in a health care policy." As is often the case, it is not entirely clear whether he is expressing his own view, as opposed to trying to clarify others' views. In any event, he proposes

A rejection of health care egalitarianism, namely a recognition that the wealthy will purchase more and better health care than the poor.  Trying to equalize health care consumption hurts the poor, since most feasible policies to do this take away cash from the poor, either directly or through the operation of tax incidence.  We need to accept the principle that sometimes poor people will die just because they are poor.  Some of you don’t like the sound of that, but we already let the wealthy enjoy all sorts of other goods — most importantly status — which lengthen their lives and which the poor enjoy to a much lesser degree.  We shouldn’t screw up our health care institutions by being determined to fight inegalitarian principles for one very select set of factors which determine health care outcomes. 

This is thrilling writing: how often have you read anyone defend "the principle that sometimes poor people will die just because they are poor"? When someone embraces a principle that you thought was an argument for your view, what do you say?

Well, you can point to a number of problems here.

1. Health care egalitarianism doesn't need to imply that we are seeking to "equalize health care consumption." I can't think of a serious egalitarian who either proposes this or whose view implies it. I can see a line of thought that would argue that people with equal health care needs should have equal health care consumption. This would argue for greater health care consumption by the poor, because they have poorer health. To my mind, a far more plausible health care egalitarianism would argue that everyone should have access to sufficient health care, with sufficiency determined through democratic deliberation.
2. "we already let the wealthy enjoy all sorts of other goods... which lengthen their lives and which the poor enjoy to a much lesser degree."  One might have thought that equitable access to care would be important precisely because the poor suffer so many insults to their health.
3. Consider also how the previous line of argument might be extended. 'We already let the wealthy have much more influence in politics; why should we try to guarrantee the poor equal access to the ballot box?' 'We already let the wealthy have much better treatment by the police and the courts; why should we try to guarrantee the poor equal access to justice?' Really, given that inequality will always be with us, why care about it at all?
4. "We shouldn’t screw up our health care institutions by being determined to fight inegalitarian principles for one very select set of factors which determine health care outcomes." I too think we shouldn't screw up our health care institutions. However, the premise that "fighting inegalitarian principles" (does he actually mean 'institutions'?) will "screw up our health care institutions" assumes precisely what needs to be proved. 

 

Comments

[Brad F]

Bill
I have read this line a number of times, even prior to your post (when Cowen put it online I was initially stymied as well), and for the life of me, cant understand what he means:

"Trying to equalize health care consumption hurts the poor, since most feasible policies to do this take away cash from the poor, either directly or through the operation of tax incidence."

What does he mean?

On your #3 and #4:
Suppose you have voting precinct in a town where 90% of the inhabitants live--20% are poor, the rest are middle class plus. Turnout is 80%.

10% of the population, all poor, live in the sticks, and they are unable to vote due to transportation limitations.

Suggestion is made to move the polling center towards the 10% of lesser means. As a result, turn out will tank, and in the end, representation of entire town plummets. In this case, trying to fix the problem for the few does more "harm."

Is this an analogous screw up to which Cowen refers, mainly, fighting inegalitarian principles, perhaps, harms more than helps?

I am not saying I agree or its apples to apples (after all the point is to solve and not just assume permanent dysfxn, like you the sentence you close with), but maybe this is what he is alluding to in his statement?

Brad

[Rio]

Your weird polling place/voting example is severely flawed anyway. Why does it have to be one or the other? Set up a second polling place. Or find other solutions--absentee ballots, for example, or have a bus route on election day to get the rural voters into town.

Similarly, there are many ways to solve the problems that these fearmongering Chicken Littles think are going to impact the "health care institutions". They just require creative thinking and a willingness to solve the problems rather than saying, well, it's too haaard so screw the little people, let 'em die.

[Bill Gardner (@Bill_Gardner)]

I think Cowen is baiting us. It's difficult to know what TC is advocating, but reading the whole post suggests that he may support a mandated sufficient level of health care of some kind. But he draws attention with the inflammatory line and an attack on a straw man version of egalitarianism.