Tuesday, May 10, 2011

A Note from September 26th, 2009

I have now returned to doing all of the old things I used to do so far as paying attention to the world is concerned, which is terrible, for as it says in the rules of the Discalced Carmelites, news of the wars and treaties of earthly princes is spiritual poison. I shall not reanimate Dr Clam. But lately I have taken to frequenting the websites in foreign parts that I was once used to frequent, where there is much discussion about health care reforms in the Old Country. I am on record as an enthusiastic proponent of universal health care as part of the core business of government, which puts me well outside what is usually considered the ‘right’ in the Old Country. Yet, here I am considered a fire-breathing reactionary in most matters. Is my theory of government merely incoherent and lacking in self-consistency? Or is there a logic to it, not yet clear even to me? I shall have a go at making some assertions that may or may not hang together logically.

1. The business of the state is to defend us, collectively, against external enemies that are too powerful for us to defend ourselves against, individually.

2. Historically the defensive function of the state has always been employed against all four of the horsemen of the Apocalypse, in so far as it was within its power. Consider the story of Joseph and Pharaoh; consider the etymology of the word ‘quarantine’.

3. I think it is fair, if by good fortune or hard work I have more money than my fellow citizen who is on the dole in Arnhem Land, that I can eat out at better restaurants, go on more holidays, order more books from Fishpond, and have a better video card. But, something in me rebels at the suggestion that it is in any way fair that I live longer or be healthier than him.

4. Arthur Koestler has said something which I cannot find on the web exactly, but can be paraphrased: ‘The value of an individual to the state is zero; the value of an individual to himself is infinite.’ A market for a good on which everyone places an infinite value will be the most distorted market imaginable. There is no other good for which I have a stronger natural desire to spend more than my fair share of the national GDP than on ensuring my own survival and the survival of my family. Like other strong natural desires, this one is antisocial unless bridled.

5. The natural tendency of individuals to place an infinite price on their own lives means that a free market for health should be expected to consume an ever-increasing percentage of GDP. This percentage of GDP will be overwhelmingly directed towards those who are able to pay more, so health care will be distributed on the basis of who has the greatest capacity to pay. In times of famine, the governments of responsible nations place restrictions on the free sale of food and introduce some sort of rationing in order that the poorest are not crushed by the market. As far as the market for health care goes, it is always a famine year. Thus it is always necessary for the state or charitable organisations to provide health care for the poorest.

6. It should not be illegal to obtain more or better health care for oneself than society is willing to extend to its poorest members, any more than it should be illegal to climb Ayers Rock. But it is not laudable. It is immoral to obtain more or better health care for oneself than society is willing to extend to its poorest members, just as it is immoral to climb Uluru against the stated preference of its traditional owners.

7. I think those who oppose socialised health care in the Old Country are not so cruel as to think that financial capacity is a proper basis for allocating health care, nor so blind as to imagine that this is not the case. Rather, they do not trust their government. And strangely this is all the arguments against the Iraq War boiled down to so far as I can tell. It might seem logical to oppose both, on the grounds that the government is a bunch of untrustworthy weasels. I expect a small number of self-consistent libertarians are in that position. Yet, even this small number of self-consistent liberatarians must surely concede that as we must have some form of government, it would be better to work towards making that government trustworthy? If our government is animated by principles that we agree with, and displays reasonable competence, than we should trust it with our armies and hospitals; if our government does not share our values and is incompetent, then it will employ both in ways that are pernicious.


Cornelius Gallows said...

Goodness, a frenzy of NewClam, to pick some random pseudonomenclature to which I hope you will not object.

I want to share in your analysis of the US healthcare debate, but I honestly cannot understand it. Elements of opposition to even the current compromised healthcare deal seem so over-the-top in their counterproductivity to the wellbeing of the state that I can only assume there is some element of the big picture that I fundamentally unable to see. I just do not understand what it is that some people think government is *for* if not for large physical and social infrastructure (which, sure, must include defensive infrastructure).

I don't get the equivalence of universal healthcare and other welfare structures with "socialism".

Marco said...

This must get a comment of some sort. It makes sense to me too, I guess. Health care is something that doesn't easily fit into an infrastructure/commodity box, so I don't automatically think it should be private. My only note is that government priorities should be preventitive medicine and the youth over the elderly. This is because the these are longer term investments compared to emergency care and elderly care (which in my mind can be serviced well, if not fairly, by private health funds)

Preventitive medicine fits into the "infrastructure" type of investment because it is long term and tends to benefit a large percentage of the population.

Age bias, although practically impossible to enshrine in law, is something that is a constant theme amongst doctors, and discretion tends to take care of that regardless who is footing the bill.

Dr Clam said...

Hmm, I don't see any meaning for servicing 'well' except 'fairly'. I agree with preventative medicine being a priority because the government is the only entity with the authority to put drugs in the water.

I'm not quite sure what you're saying about age bias but it sounds deeply frightening. When I get older I am sure the nets of totalitarianism will have tightened to the extent that it will be easy to commit 'suicide by cop' rather than allow myself to fall into the hands of any crummy doctors.