« Beyond the ACA, Beyond the USA | Main | Am I my brother's insurer? »

07/03/2012

Comments

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

Brendan Saloner

A very important post, Bill. Red states are generally poorer too, but the wealthy in those states still pay lower taxes.

Paul wrote about global justice this week, and I wonder whether the federalism issue could be viewed through the global justice framework:

Your final sentence is "Americans need and deserve health insurance regardless of where they live." But, EVERYONE needs and deserves health insurance whether they live in Manhattan or Madagascar. Many people believe (and I am one of them) that although such people are equally deserving, they are not equally entitled to redistribution. You may disagree, which would itself be interesting, but that would imply that differential treatment between countries is illegitimate (barring some other practical administrative barrier).

But then why draw the boundary at national borders, why not argue that claims of redistribution are stronger within other administrative entities? Do uninsured people in Cambridge, MA have a stronger claim to subsidized coverage from their fellow Cantabrigians, than do the uninsured in the Mississippi Delta? An affirmative response could hold that duties to others are limited by shared institutions -- in Massachusetts, we all abide by the state tax system (which supports us if we are young, very old, or low income), and which we pay into at other stages of our lives. These institutions do not bind us with people in other less generous states or localities -- even though we share a national connection, and are ultimately bound by the same sovereign authority. Nevertheless, in our constitutional system, much is left up to the states to affirm their values, and to create institutions that reflect them.

Bill Gardner (@Bill_Gardner)

Brendan,
Great comment -- I am drafting a post in response -- stay tuned.

The comments to this entry are closed.

My Photo

Become a Fan