The job where I’ve been working since September 1 has kept me very, very busy, in a good, exhilarating kind of way. I find that I have less wattage available for reading. In days past, I could read a dry, disagreeable book, and really take to the pleasure of a future evisceration. My pen would go flying across the page, taking notes here, crossing out entire paragraphs there, sometimes telling the author to perform anatomically impossible acts on themselves.
Perhaps in time I will return there, but I have apparently lost the patience. It’s not that I’m looking for an echo chamber from my books; it’s that I think I’ve temporarily lost the ability to believe that “these are arguments which we must confront.” If I think they’re silly arguments, they’re cutting even more into precious, limited mental space.
All of this is by way of background to explain why Richard Epstein’s book [book: Mortal Peril?: Our Inalienable Right to Health Care?] sits forlornly back at home on my bed, while I ride the train up to visit my lovely girlfriend in New Hampshire. [book: Mortal Peril?] is based on libertarian axioms explaining why health care is not an inalienable right, and how it ought to be market-allocated like anything else. If this means that only the wealthy get health care, because only they can afford it, then so be it.
Perhaps this is unfair to Epstein, and is based on my not having given the book enough of a shot to have gotten far into it. In that case I blame Epstein. Whom is he trying to convince with his book? If it’s libertarians, then he has the right idea: begin the book by discoursing on the power of negative rights (freedom to contract without interference, basically). If he’s trying to convince those of us who want to raise the level of the poor, on the other hand, then he’s not speaking our language. His book is one of those dour, dryly theoretical books that declares — sadly, of course, ever so sadly, with condescension to those benighted souls who think government can help people — the futility of trying to help anyone out. This is an Axiom. Another of his Axioms is that voluntary exchange between two people is always win-win. Either there’s a lot hidden under the word “voluntary,” or I suspect drug addicts would have something to say about that. Yet if you take it as an Axiom that all exchange is win-win, it follows that even addicts benefit from the transaction; thus follows the idea of “rational addiction.” This would sound insane if it came from anyone but an economist.
Epstein has his axioms and I have mine. My first axiom would declare that the futility of a government program is an empirical question, not to be settled by theoretical arguments about negative or positive rights. My book [book: Mortal Peril] (I would drop Epstein’s question mark) would try to answer the following question: if positive rights, ensured at government gunpoint, are such a bad thing, then why has almost every advanced industrial economy instituted guaranteed health care as a right of citizenship? I would look at the relation — if there is one — between economic inequality and economic growth.
One thing I wouldn’t do is wave my hands at the economic scarcity problem — infinite wants, they tell us, and finite resources — and declare that this proves the impossibility of health care for all. I would look, for instance, at the actual cost of preventing cholera in a developing nation, or the cost of providing free lunch to every American schoolchild, or the costs and benefits of getting iodized salt into the bodies of children who would otherwise develop goiter. We’re not talking about getting a BMW into the garage of every poverty-stricken African (or giving every African a garage, for that matter).
Yet that’s exactly the sort of misrepresentation that Epstein’s book — the fraction of it I could get through, anyway — traffics in. If it descended for a moment to an empirical look at health care or aid to the poor, the whole charade would come tumbling down. Sometimes government hurts the poor; I think here of some housing projects. But not all housing projects! There are several perfectly clean, safe housing projects in Cambridge, and so far as I know they’re no more dangerous than the rest of the city. Surely there are successful housing projects all over the United States. Just as surely there are some dangerous ones that are drug havens. What makes Rittenhouse Square in Philadelphia lush and loved, whereas Franklin Park in Washington D.C. is weedy, filled with the homeless at all times of day, and a place you wouldn’t want to be caught after dark? These are questions for Jane Jacobs, not for Richard Epstein. Jacobs is doggedly empirical; Epstein is unfortunately theoretical.
If, like Epstein, I insisted on the use of private charity rather than government coercion to provide health care to the poor, I’d examine the efficiency of both alternatives. I wouldn’t, as Epstein does, wave my arms feverishly about the waste of government expense. I would collect data on these things. Government wastes money, surely, but how much it wastes is an empirical question. Do the scale economies of government programs let it waste less than competing private organizations? Insurance companies count every paid claim as a loss, and spend a lot of money trying to attract only the healthiest beneficiaries; do we count their administrative overhead as “waste”? If not, why not? Shouldn’t we count an expense as “waste” if it doesn’t go toward providing health care for a beneficiary? Let’s compare insurance companies and government agencies by the same standard, not by a standard calculated to make government lose.
Probably the level of government waste varies depending upon which program we’re talking about. Why is it always social programs which conservatives insist are so wasteful? Why not, say, the Department of Defense? I would like conservatives to be self-consistent and insist on cutting waste wherever they find it. Libertarians believe that self-defense is one of the few justifiable government expenditures, but do they really believe that the massive military-industrial complex we’ve built is entirely necessary?
There was a period in American history, Epstein notes, when thousands of charity hospitals filled the United States. Those seem to have largely disappeared, or at least been overtaken by for-profit hospitals that are required to admit all comers to their emergency rooms. Why is that? Is it that the government has crowded out private investment? Or is there some other explanation?
Being empirically minded allows you to keep from going entirely off the rails. Take a step, then look around and see if you’re off in the weeds; if you are, step back and try a different path. Epstein’s theoretical orientation — and the theoretical orientation of many libertarians — makes them follow a path until they drive off a cliff.
Yet we, as Americans, are expected to take libertarian ideas seriously, because this country’s deepest ideologies speak to the perfection of free markets. (Free markets are perfect. They also don’t exist.) So we’re expected to kowtow in the direction of the Epsteins and the Hayeks, rather than toward the Elsters or the Noves. Daniel Davies notes the timorousness of the American Left in this regard:
They’re [the Chicago school and friends are] always hacks, Brad. Always. Yes even Milton Friedman. The more independent-minded ones will occasionally come up with a liberalish or fair-minded idea or two, but this is purely for display, not for ever doing anything about if to do so would run the risk of a higher rate of capital gains tax. The ideological core of Chicago-style libertarianism has two planks.
- Vote Republican.
- That’s it.
Why are American liberals so damnably obsessed with extending intellectual charity to right wing hacks which is never reciprocated? It reaches parodic form in the case of those tiresome “centrists” who left wing American bloggers are always playing the Lucy-holds-the-football game with. Oh, but their politics are sooo centrist! They’re practically 50% of the way between Republicans and Democrats! Yeah, specifically they’re right-wing Democrats in non-election years and party line Republicans any time it might conceivably matter (note that here, two years after the White House ceremony at which Friedman apparently “spent most of his 90th birthday lunch telling Bush that his fiscal policy was a disaster”, here he is signing a letter in support of more of the same).
I wouldn’t mind, but it’s clearly not intellectual honesty that makes American liberals act pretend that Milton Friedman wasn’t a party line Republican hack (which he was; he was also an excellent economist, which is why he won the Nobel Prize for Economics, not the Nobel Prize for Making A Sincere and Productive Contribution To The National Political Debate, which he would not have won if there was one). If it was just pure scholarly decency that made Yank liberals so keen on recognising the good qualities even in their political opponents, then you’d expect that they would also be quick to recognise the good qualities, analytical insights and so on in prominent Communist intellectuals. And do they? Do they fuck. I won’t link to the Paul Sweezy obituary, because I think everyone involved agrees that this wasn’t Brad’s finest hour, but it certainly wasn’t atypical.
Of course the explanation’s quite sensible. American liberals kiss up to Friedmanites and kick down on Reds because they’re still, twenty years after the fall of the Berlin Wall, scared of being red-baited. One of the enduring reasons why I regard JK Galbraith as a hero is that practically alone among mainstream commentators of the era, he by and large refused to play this game.