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The Problem of "Externalities" Caused by Government Financing:

One of Michael Kinsley's criticisms of libertarianism is based on "externalities" caused by government financing. He argues that people should not be allowed to drive without wearing seatbelts because their risky behavior creates an "externality" - a cost that they don't bear themselves. The externality in question is the fact that government may end up financing their medical treatment.

These kinds of "government financing exernalities" are commonly used to justify government regulations that restrict individual freedom. Liberals use these arguments to justify such regulations as mandatory seat belt laws, smoking bans (because government may end up subsidizing smokers' medical treatment if they get lung cancer), and most recently restrictions on morgage terms (because the government may bail out people who end up defaulting). Conservatives have their own favorite government financing externality arguments. For example, many argue that we should restrict immigration because otherwise the immigrants might collect welfare benefits that are paid for by taxpayers. Obviously, the greater the role of government in financing a wide range of activities, the greater the number of potential government financing externalities. The expansion of government spending facilitates the expansion of government regulation intended to curb the negative effects of the spending.

Government financing externality arguments generate their appeal from the fact that they seem not to be paternalistic. We are willing to let you hurt yourself, advocates implicitly suggest, but we can't let your bad behavior hurt the taxpayers.

The libertarian solution to this problem is to eliminate the government financing that created the "externality" in the first place. If you are worried about taxpayers having to pay for smokers' medical expenses, then argue for the elimination of government subsidies for the treatment of illnesses caused by smoking. Ditto for injuries caused by not wearing a seatbelt. The 1996 welfare reform law already eliminated even legal immigrants' eligibility for most welfare state benefits. But if you think there are still problems in this area, then argue for further reductions. Most immigrants would be more than happy to accept a deal under which they are allowed to stay in the US legally only on condition that they forego welfare state benefits.

In some cases, eliminating the government financing externality by eliminating government financing may be impossible for political or technical reasons. In such situations, there really is a difficult tradeoff between individual freedom and taxpayer interests. However, if government financing externalities are your true reasons for favoring any given type of regulation, you should at least consider the possibility of getting rid of the externality without restricting freedom.

Related Posts (on one page):

  1. The Problem of "Externalities" Caused by Government Financing:
  2. Michael Kinsley on Libertarianism:
  3. Kinsley on Libertarianism:
FantasiaWHT:
Out of curiosity, how comparable/parallel are the arguments libertarians use to combat the externalities associated with, say, insurance premiums compared to government subsidy?

I'm sharing my risk with drivers who don't wear their seatbelts, sadly. I wouldn't mind seeing policies (or laws) that severely restrict or eliminate coverage altogether for accidents where insureds weren't wearing seatbelts.
1.13.2008 9:20pm
Waldensian (mail):
I have seen it claimed that a driver wearing a seatbelt is safer to third parties because s/he is less likely to be thrown from behind the wheel as the result of a collision. If true -- even in a relatively small number of cases -- that would, to me, justify a mandatory seat belt law. The seat belt law would be at least as justifiable as a mandatory state vehicle inspection, anyway.

Meanwhile, in my perfect world, you would be free to ride a motorcycle without a helmet, but after an accident, you or your estate would only get to recover against other motorists if they were grossly negligent or worse. Really just a modified contributory negligence rule there.

I've wondered about one thing with motorcycles: is my interest in not killing somebody worthy of being considered? I.e., if I hit a motorcyclist and he dies because he had no helmet -- perhaps with his brains splattered on my windshield -- I'm going to feel just awful, even if it was the motorcyclist's choice not to wear a helmet, and even if the accident was his fault. Does my interest in not feeling awful count in the equation, or should it?

I realize that this argument shades into paternalism, and goes a long way into bad places, but still, it doesn't seem completely ludicrous to me. Spilled brains are gross.
1.13.2008 9:28pm
Ilya Somin:
I've wondered about one thing with motorcycles: is my interest in not killing somebody worthy of being considered? I.e., if I hit a motorcyclist and he dies because he had no helmet -- perhaps with his brains splattered on my windshield -- I'm going to feel just awful, even if it was the motorcyclist's choice not to wear a helmet, and even if the accident was his fault. Does my interest in not feeling awful count in the equation, or should it?

Presumably, you would take that interest into account when you decide whether or not to wear a helmet. It's not an externality because the person who bears the harm is the same one who makes the decision.
1.13.2008 9:36pm
Ilya Somin:
I'm sharing my risk with drivers who don't wear their seatbelts, sadly. I wouldn't mind seeing policies (or laws) that severely restrict or eliminate coverage altogether for accidents where insureds weren't wearing seatbelts.

In an unregulated auto insurance market (which the status quo is far from being, based on my limited knowledge), insurance companies could indeed offer policies that required higher premiums or lower benefits for people who don't wear seatbelts, motorcycle helmets, etc. Health insurance firms already offer different terms to smokers vs. nonsmokers.
1.13.2008 9:37pm
Waldensian (mail):

It's not an externality because the person who bears the harm is the same one who makes the decision.

Well, the person who bears the MOST harm is the one who makes the decision. But you can't tell me that I'm not "harmed" when a helmet-less motorcyclist splashes his brains all over my Lexus. There's the gross out factor, and the mess.

But seriously, spilling your brains on an unappreciative public IS an externality of not wearing a helmet. If we're going to ignore that externality, let's do so explicitly.
1.13.2008 9:42pm
Waldensian (mail):
Meanwhile, the State of New York, in its drivers' education materials, makes the following claim about seat belts:


A seat belt can help you avoid a crash. It helps you stay in position behind the steering wheel and near the brake pedal if your vehicle goes out of control. With a belt on, you may be able to regain control. Without it, you may not even be able to stay in the driver's seat.

There is no citation to any study, and I am no expert in this area. However, this claim sounds quite plausible to me. If it is indeed true, then I have no libertarian qualms about a seatbelt law. The argument would be that wearing your seatbelt is no different from having operable brakes: it reduces the likelihood of you smashing into MY car.
1.13.2008 9:53pm
Richard A. (mail):
When it comes to cigarette smoking, the libertarian argument seems to avoid all logic. We are a country that bans all smoking of drugs other than those containing nicotine, yet the typical libertarian will argue there is a right to smoke cigarettes in all places public and private. This would be a valid argument in a nation where pot and crack can be smoked openly, but here in the U.S. it seems a bit illogical. Instead of complaining about the pot smoker who is thrown in jail, they obsess about the cigarette smoker who merely has to smoke outside. NORML contends its members would be glad to accept such restrictions as long as potheads could smoke their drug of choice in private.
1.13.2008 9:57pm
Ilya Somin:
Well, the person who bears the MOST harm is the one who makes the decision. But you can't tell me that I'm not "harmed" when a helmet-less motorcyclist splashes his brains all over my Lexus. There's the gross out factor, and the mess.

But seriously, spilling your brains on an unappreciative public IS an externality of not wearing a helmet. If we're going to ignore that externality, let's do so explicitly.


Yes, I misunderstood your original point. My answer to the actual point is that I don't think that we have the right to restrict other people's freedom merely because we are grossed out or angered by their conduct. Damaging your lexus is a different issue, but could presumably be dealt with by ordinary tort liability (just as can other damage inflicted on your car by negligent drivers).
1.13.2008 10:13pm
Ilya Somin:
When it comes to cigarette smoking, the libertarian argument seems to avoid all logic. We are a country that bans all smoking of drugs other than those containing nicotine, yet the typical libertarian will argue there is a right to smoke cigarettes in all places public and private. This would be a valid argument in a nation where pot and crack can be smoked openly, but here in the U.S. it seems a bit illogical.

Since libertarians oppose the War on Drugs as well as restrictions on smoking, I see no contradiction or "illogic" in our stance. And if we can't get rid of both sets of unjust regulations at once, I don't believe that "logic" requires us to forego getting rid of one unless and until we can also get rid of the other.
1.13.2008 10:14pm
Waldensian (mail):

I don't think that we have the right to restrict other people's freedom merely because we are grossed out or angered by their conduct.

That's a reasonable position, although I think I disagree with it. E.g., I'm fairly glad we can lock a guy up for running around with no pants on.
1.13.2008 10:19pm
FantasiaWHT:

Since libertarians oppose the War on Drugs as well as restrictions on smoking, I see no contradiction or "illogic" in our stance. And if we can't get rid of both sets of unjust regulations at once, I don't believe that "logic" requires us to forego getting rid of one unless and until we can also get rid of the other.


I was about to say that. I disagree with it, but I at least understand that the position isn't illogical.

For my part, if forced to try to make the policy "fair" (really, I can't see much difference between tobacco and marijuana smoking) I would choose banning more drugs over legalizing more.
1.13.2008 10:25pm
Mr. Liberal:

Ditto for injuries caused by not wearing a seatbelt.


That's right.

Just let people who can't pay bleed to death.

It is worth sacrificing their lives to satisfy the ideological needs of libertarian fanatics.
1.13.2008 10:31pm
A.C.:
I think it's important to distinguish between the government financing externalities that were the topic of this post and the "nature of the world" externalities that can't really be removed by eliminating a government program. The motorcyclist who won't wear a helmet and runs up huge medical bills on the public tab is one thing, and the motorcyclist who freaks out the driver who hit him is another. Likewise, illegal immigrants on welfare are one type of problem, and illegal immigrants who drive down wages just by showing up to work are another.

I'm definitely in favor of eliminating government programs that are subject to widespread corruption or that create perverse incentives, but that doesn't get rid of all externalities.
1.13.2008 10:35pm
Oren:
Ilya, just to be clear, would you advocate the abolition of the duty of hospitals to treat the gravely injured irrespective of their ability to pay?
1.13.2008 11:08pm
greenish (mail):
<blockquote>
yet the typical libertarian will argue there is a right to smoke cigarettes in all places public and private.
</blockquote>

Will we now
1.13.2008 11:15pm
Jake (Guest):
I think sometimes people react negatively to this line of argument because it can seem like a bit of a trojan horse. Take the illegal immigration example--one problem that gets brought up is that illegal immigrants will go to emergency rooms for treatment and then not pay, which creates a lot of follow on problems. The logical solutions to this are either to (a) reduce the number of illegal immigrants (reducing the load on the ER) or (b) to grant them amnesty/bring them out of the shadows (so they can purchase insurance, etc.). When the debate is between those two choices, it's not very helpful for the libertarian to come in and say "We should let all the illegal immigrants in, and deny medical care to anybody who can't provide proof of insurance. Problem solved!"

Since 90+% of the population would automatically reject the idea of hospitals letting people die from treatable conditions, this is a complete non-starter. It's so unrealistic that it looks more like a dodge, designed either to disingenuously bring people around to position (b) or so that the proponent can avoid making a difficult decision.

A lot of libertarian position arguments have that sort of college kid who's never had to deal with the real world flavor to them.
1.13.2008 11:19pm
TerrencePhilip:
However, if government financing externalities are your true reasons for favoring any given type of regulation, you should at least consider the possibility of getting rid of the externality without restricting freedom.

So long as you are comfortable with your proposals not being taken seriously in the real world, that is a fine idea. But everyone knows there is no significant sentiment for ending all public financing of medical care for the indigent and uninsured. There is not even sentiment for rules such as "if you are injured and were driving a motorcyle without a helmet, or are an illegal immigrant, if you're not insured we will wheel you out of the ER onto the sidewalk." So advocating behavior that leads to minimizing these costs is a practical argument. These arguments are a concrete reference to the high costs of disfavored activity such as illegal immigration.

But sure, if you are a libertarian, it only begs the question of why we should finance such activity in the first place.
1.13.2008 11:22pm
Oren:
A lot of libertarian position arguments have that sort of college kid who's never had to deal with the real world flavor to them.
Now here you are, throwing away a decently good point with this kind of bullshit. While I happen to agree with you, there are quite a number of libertarians that have thought these things through and are quite willing to accept the results of a philosophy that is consistently and evenly applied.

Also, don't underestimate the Libs on Volokh - they may disguise their intellect with snark only to pounce at the last second on their unsuspecting prey.
1.13.2008 11:29pm
mrshl (www):
"A lot of libertarian position arguments have that sort of college kid who's never had to deal with the real world flavor to them."

Yep. Admittedly more elegant and persuasive than Marxism or Socialism. But just as unlikely triumph over the massive, squishy center of American politics.
1.13.2008 11:42pm
Colin S (mail):
Doesn't the example of smoking bring up the issue of secondhand smoke? This is almost the purest form of an externality: nonsmokers are medically harmed by the behavior of smokers in a way that is both involuntary and uncompensated.

How do you explain the "right to smoke" in this light?
1.14.2008 12:00am
It's not just about the money (www):
Yes, I misunderstood your original point. My answer to the actual point is that I don't think that we have the right to restrict other people's freedom merely because we are grossed out or angered by their conduct. Damaging your lexus is a different issue, but could presumably be dealt with by ordinary tort liability (just as can other damage inflicted on your car by negligent drivers).

Ilya- while Waldensian framed his concern in light terms, it seems like we might want to be open to considering more than just the financial costs of repairing the structural damage caused by foreign brain impact to Waldensian's Toyota. It strikes me (and not my windshield) that the emotional damage caused by killing a cyclist (who would not have died, in the hypothetical situation, if s/he was wearing a helmet) is a cost unaccounted for in your response.

Libertarianism often draws itself towards economists and economical factors, but it seems like a libertarian discussion should also factor in such real emotional damage as blood on one's hands (in a death that could have been easily averted, presumably). I'm guessing that this is Waldenisan's real concern. It is a real concern, in any event.
1.14.2008 12:12am
mrestko (mail):

Doesn't the example of smoking bring up the issue of secondhand smoke? This is almost the purest form of an externality: nonsmokers are medically harmed by the behavior of smokers in a way that is both involuntary and uncompensated.


Explain to me a situation where a nonsmoker would be unable to avoid secondhand smoke. The recent smoking ban in Chicago made me furious because so many people used your argument. The response is this: in free society, no one is exposed to secondhand smoke against his will. If you dislike that smoke is allowed in a certain restaurant, then don't eat there or don't work there. Your preferences do not justify government coercion on private property.
1.14.2008 12:18am
BGates:
That's right.
Just let people who can't pay bleed to death.

Or, let people decide who they should help and how much with their own money. You are assuming that no one (yourself included) will help the helmetless motorcycle wreck in the absence of government coercion. I don't know you, so I'll have to assume your low opinion of yourself is justified; but please don't project your lack of charity onto the rest of us, ok?
1.14.2008 12:18am
Waldensian (mail):

Libertarianism often draws itself towards economists and economical factors, but it seems like a libertarian discussion should also factor in such real emotional damage as blood on one's hands (in a death that could have been easily averted, presumably). I'm guessing that this is Waldenisan's real concern.

It is. I'm guessing I did an even-worse-than-average job of explaining myself.

Meanwhile, nobody is contesting my view that a mandatory seatbelt law is consistent with libertarian principles, so at least we have that settled. :)
1.14.2008 12:30am
Colin S (mail):


Explain to me a situation where a nonsmoker would be unable to avoid secondhand smoke. The recent smoking ban in Chicago made me furious because so many people used your argument. The response is this: in free society, no one is exposed to secondhand smoke against his will. If you dislike that smoke is allowed in a certain restaurant, then don't eat there or don't work there. Your preferences do not justify government coercion on private property.



Public transport. Streets. Government buildings. Courthouses. Airports. Etc, ect, ect. I can see your reasoning in instances of private businesses. However, would you at least consent to a ban in places that there exists a legitimate need of use?
1.14.2008 12:34am
Wayne Jarvis:

Just let people who can't pay bleed to death.


Low wattage strawman argument. Who said anything about withholding treatment? I think Prof. Somin said that the government should subsidize the treatment.

If you don't have the money in your blood soaked wallet at the time of the accident, there are plenty of pretty simple solutions (installment plans, credit cards, wage garnishment if need be).
1.14.2008 12:36am
Wayne Jarvis:
Umm..that is "should NOT subsidize..."
1.14.2008 12:40am
wuzzagrunt (mail):
Waldensian:
I have seen it claimed that a driver wearing a seatbelt is safer to third parties because s/he is less likely to be thrown from behind the wheel as the result of a collision. If true -- even in a relatively small number of cases -- that would, to me, justify a mandatory seat belt law.

I don't know of any studies done on the subject, but it happened to me and I can see numerous scenarios that make that a logical position.

While driving my 4x4 on a farm road, without a belt, I hit a series of ruts crossing the road. The bounce caused me to come down hard on the gas pedal, thereby causing me to accelerate over the next rut. After a few like that, I ultimately smacked my noggin into the overhead and landed on the console between the seats. No longer in control of the vehicle, I went off the road and stopped against a tree. All this happened at low speed, so it seemed pretty funny at the time.

However, I am convinced that even some very minor collisions could be made serious if a driver is not strapped in. You can't drive the car from under the dashboard.
1.14.2008 1:00am
mrestko:

...a driver wearing a seatbelt is safer to third parties because s/he is less likely to be thrown from behind the wheel ...If true -- even in a relatively small number of cases -- that would, to me, justify a mandatory seat belt law.



Many of these things come down to matters of degree as well. I'm sure that if the government banned all cars, pedestrians would no longer die in car accidents, this doesn't mean that it is something that should be done.
1.14.2008 1:07am
mrestko:

Public transport. Streets. Government buildings. Courthouses. Airports. Etc, ect, ect.



I'd be okay with banning smoking in truly unavoidable places such as government buildings and courthouses. But I don't think the banning smoking on the street is acceptable because of the transient nature of any exposure as well as the low level and quick dissipation of smoke.

I think most libertarians would say that airports and "public" transportation should both be functions of private enterprise. I'm not a smoker and I wouldn't want to ride on a bus with a bunch of people smoking cigarettes, but I don't think the government should prohibit it. If there were enough people like me, then smoke free buses would be created by the market.
1.14.2008 1:14am
Waldensian (mail):

Or, let people decide who they should help and how much with their own money. You are assuming that no one (yourself included) will help the helmetless motorcycle wreck in the absence of government coercion. I don't know you, so I'll have to assume your low opinion of yourself is justified; but please don't project your lack of charity onto the rest of us, ok?

I don't know you or you outlook on life, obviously. But in general, and in one respect, I can't help projecting that lack of charity.

After spending a number of years closely observing the American public's reaction to, and attitude toward, people with developmental disabilities, I am convinced to a moral certainty that, in the absence of governmental coercion, the developmentally disabled would lead horrifying lives characterized by terrible neglect and even active abuse. Worse than what they face now, I mean.

Just look around. See what major corporations are willing to sponsor on TV. Check out what famous people can say without getting fired. Listen to the XM comedy channel for a day. Then tell me we don't need government watching out for the developmentally disabled.
1.14.2008 1:17am
Waldensian (mail):

Many of these things come down to matters of degree as well. I'm sure that if the government banned all cars, pedestrians would no longer die in car accidents, this doesn't mean that it is something that should be done.

I don't disagree. For example, if there has only been one known instance of an accident caused by the lack of a seatbelt, that wouldn't suggest everyone ought to wear seatbelts all the time. I just mean to argue with the assumption that a mandatory seatbelt law is necessarily paternalistic and anti-libertarian. I'm really not sure that's the case.
1.14.2008 1:23am
Mr. Liberal:

Or, let people decide who they should help and how much with their own money. You are assuming that no one (yourself included) will help the helmetless motorcycle wreck in the absence of government coercion. I don't know you, so I'll have to assume your low opinion of yourself is justified; but please don't project your lack of charity onto the rest of us, ok?


I don't believe that greedy libertarians should be able to get away without contributing anything to the care of people who are injured.

I think that hospitals and doctors who care for people without means should be compensated by society. The full burden of such care should not fall on their shoulders alone.

Lets get down to it.

Libertarinism = selfishness.

End of story. What if the charity you assume to exist is not at hand?

You let the person bleed to death, all so you can satisfy your stupid ideological needs.

There is another group that was willing to let people die in order to satisfy strange ideological fixations. They were called communists.

Communists and libertarians have a lot in common. They are both a threat to civilization. Happily, in present times, they are both properly marginalized threats.
1.14.2008 1:33am
Mr. Liberal:
The libertarian position:

"We rely on charity exclusively.

Those who are generous should have the full burden of helping those in need. Those who are selfish should have none of the burden, even while enjoying the benefits of civilization and the charity of the generous."

I don't think so. Doctors and hospitals should not be expected to work uncompensated. At the same time, no one should be allowed to bleed to death in a car accident.
1.14.2008 1:36am
Frater Plotter:
Liberals usually defend smoking bans partly as a workplace safety argument, based on the notion that employer and employee do not bargain in the market as equals: employers can replace a worker (even an injured or dead one) more easily than a worker can find a new job. Because of this inequality, workers should (or so the argument goes) be protected from harmful conditions that employers could impose upon them as conditions of employment.

For instance, a worker might agree to work on unsafe machinery, if he had no other available employment and needed to feed his children. The employer's only risk is losing an employee and a little bit of reputation, while the worker risks losing his hand or his life (and thus, also, his ability to feed his children). Workplace safety regulations exist to prevent employers from imposing harmful working conditions.

But workplace safety regulations have another feature as well: they protect employers from legal claims by injured employees, by allowing employers to demonstrate compliance with the regulation. If you cut your hand off with an OSHA-compliant bandsaw, you can collect workman's comp -- but if you sue your employer, claiming the bandsaw was in fact unsafe, he can just point out that it was completely compliant with both industry standards and the law.

Enter the smoking question. Most advocates of smoking bans are acting chiefly out of aesthetics: they don't like the smell of smoke and would like to enjoy various public accommodations without it. But they additionally cast the argument in terms of workplace safety: employers should not be allowed to subject their employees to known carcinogens as a condition of employment.

It's not unreasonable, if you accept the market-inequality basis of liberal advocacy for these sort of laws anyway. But it's interesting to note that smoking bans lack the second prong of other workplace-safety laws. They don't offer very much to employers in the way of protection.
1.14.2008 1:49am
Brian K (mail):
They don't offer very much to employers in the way of protection.

Why should it? the bandsaw in your example is integral to the employees job. The government needs to balance protection of workers against loss of jobs due to compliance costs or litigation. However, I am unaware of any job with the exception of a small number of researchers and scientists whose job requires smoking. Employers don't need protection because smoking and being around smokers is not integral to any jobs (with the above exception).
1.14.2008 3:03am
Falafalafocus (mail):

I think that hospitals and doctors who care for people without means should be compensated by society. The full burden of such care should not fall on their shoulders alone.


Mr. Liberal's argument is so persuasive that I suggest we incorporate it to other fields:

I think that taxi drivers and bus drivers who drive people without means should be compensated by society. The full burden of such care should not fall on their shoulders alone.

What, precisely, is the difference? Oh yeah, those taxi drivers are selfish!

In any event, what, precisely, gives doctors the right to demand payment from me when they cannot obtain it from the person they contracted with?
1.14.2008 8:20am
Wayne Jarvis:

Libertarinism = selfishness.


Not to burst your bubble, but there have been studies showing that those on the right tend to be considerably more charitable than liberals.

So should be we conclude that all liberals are selfish jerks who would rather shirk their personal responsibilty to the poor in favor of letting a cold, faceless beauracracy deal with it?

No. We shouldn't. Ad hominems like that are stupid.
1.14.2008 9:04am
chrismn (mail):
Thank you Mr. Liberal for confirming my prejudices regarding liberalism and self-righteousness: everyone who doesn't agree with Mr. Liberal simply isn't as morally good a person! "I am so good, I am so good." Wonderful.

The usual stereotype of the self-righteous is some Southern Christian minister. They can't hold a candle in this department to many on the left.
1.14.2008 9:08am
Aultimer:

I've wondered about one thing with motorcycles: is my interest in not killing somebody worthy of being considered? I.e., if I hit a motorcyclist and he dies because he had no helmet -- perhaps with his brains splattered on my windshield -- I'm going to feel just awful, even if it was the motorcyclist's choice not to wear a helmet, and even if the accident was his fault. Does my interest in not feeling awful count in the equation, or should it?

The negative externality created by the motocyclist riding without a helmet into your SUV is well compensated by the positive externalities created by the same splattered cyclist, thanks to Sir Isaac Newton - lack of damage done to you and your vehicle in the collision, plus the benefits to your environment, lower gas prices you enjoy, reduced traffic, etc. created by the substitution of a car by a bike.
1.14.2008 9:14am
JamesWN (mail):

You let the person bleed to death, all so you can satisfy your stupid ideological needs.

There is another group that was willing to let people die in order to satisfy strange ideological fixations. They were called communists.


Yes, and communists used the state apparatus to kill and enslave, while supporters of the libertarian position only argue for the right to be left alone.
The problem with most liberals is there their inability to distinguish between passive action by the state and the unavoidable though not necessarily natural consequences of no state action.
Killing under communism was not due to inaction on the part of the state but due to abuse of the state. Socialists always attempt to blur the distinction between action and inaction, so they can win the argument by endorsing the more "respectable" statist position.
1.14.2008 9:15am
Aultimer:

I think that hospitals and doctors who care for people without means should be compensated by society. The full burden of such care should not fall on their shoulders alone.

Lets get down to it.

Libertarinism = selfishness.


"Society" passed a law that says if a hospital accepts money from CMS, it can't turn emergent cases away for lack of means to pay for care.

Most hospitals make the business decision to accept money from CMS, and as a result take indigent cases without compensation.

How does that make libertarians selfish exactly?
1.14.2008 9:24am
louisvillelawyer (mail):
Wasn't London in the Victorian era a good example of a libertarian paradise? Shall we go for a metaphorical stroll through the tenements? See the children begging and old people dying? What a great time that was! How come all those rich aristocrats didn't give to charity??!

Personally I'm not willing to watch people starve on the street no matter how much they "deserve" it because they didn't work hard enough or didn't save money. If you are, more power to you. Get the votes and we'll try it!
1.14.2008 9:48am
Wayne Jarvis:

Wasn't London in the Victorian era a good example of a libertarian paradise?


How so? I'm not following you? Was the English Monarchy somehow a libertarian form of government? Wouldn't 18th century America be a much better analogy (i.e., move out of the slums of London, into the slum of New York on the way to making a better life for yourself.)

But go ahead. Equate liberatianism with poverty. It makes it much easier to win an argument that way!
1.14.2008 10:00am
J. F. Thomas (mail):
Wouldn't 18th century America be a much better analogy (i.e., move out of the slums of London, into the slum of New York on the way to making a better life for yourself.)

Oh please yes, where a quarter of the population were chattel slaves. A much better example!

I really look forward to the accident scene in Ilya's libertarian paradise, where competing ambulance services show up and rifle through the victims' wallets to decide who they will help instead attending to the most seriously injured first.

You know fire services used to be privatized until people figured out that if your neighbor's house was burning and they hadn't bothered to pay for private fire protection suddenly the externality of them taking the calculated risk was your problem.

Also how come no one ever wants to answer my questions about how sewer, water, electrical transmission, and other basic services are going to be handled in a libertarian paradise?
1.14.2008 10:29am
J. F. Thomas (mail):
Really, it's all you need to know about libertarianism that the University that is renowned as the hotbed of libertarian thought in this country is a public institution, yet they apparently are incapable of appreciating the irony in the situation.
1.14.2008 10:32am
bittern (mail):
Good post.
1.14.2008 10:34am
Justin (mail):
But society has rejected some of the major foundations of liberterianism. Going back to seat belts, society has made decisions that, to at least some degree, we do not let people bleed to death for lack of health care, we do not let them starve to death due to lack of income, and we do not allow children to become abandoned or helpless because of bad choices of the parents.

So your "solution" to the idiot-on-motorcycle, though coherent, is going to be unacceptable to society. The question is what is liberterianism's next best solution, and can that be acceptable to society?
1.14.2008 10:45am
Mr L (mail):
So should be we conclude that all liberals are selfish jerks who would rather shirk their personal responsibility to the poor in favor of letting a cold, faceless bureaucracy deal with it?

You forgot the most important aspect: a cold, faceless bureaucracy largely financed by someone else. There's crude selfishness inherent in soak-the-rich tax policies, government-funded thing-that-I-want (higher education, healthcare, whatever), and all manner of other liberal programs.
1.14.2008 10:48am
J. F. Thomas (mail):
Employers don't need protection because smoking and being around smokers is not integral to any jobs (with the above exception).

bartenders, waitstaff at restaurants.
1.14.2008 10:49am
louisvillelawyer (mail):
Victorian London:

a) no or few regulations on businesses for worker safety

b) few taxes

c) drugs (opium, etc.) and prostitution were legal

d) very little help provided to the poor or unemployed by the State -- workhouses being the ending for the destitute

http://www.victorianweb.org/history/sochistov.html
1.14.2008 10:52am
Wayne Jarvis:

Oh please yes, where a quarter of the population were chattel slaves. A much better example!



10 Point for snark. 0 for substance. Slavery is anathema to libertarianism.
1.14.2008 11:12am
SenatorX (mail):
I would just like to point out that not all libertarians are against regulation. I (and Hayek for example) believe there is a role for government regulation in the libertarian perspective. The question for people like us is more in the methods and reasoning behind the implementation. Specifically regulatory laws should be applied with the rule of law where the laws are applied to everyone (and not against or for specific segments of the population), be advertised to the population so they can negotiate the laws, and not be changed after the fact, among other things.

The libertarians who want to privatize everything often make great arguments and I pay attention but I still believe in a role for government and regulation. In my opinion this separates a libertarian from an anarchist.
1.14.2008 11:29am
Richard A. (mail):
When it comes to secondhand smoke in bars, there would indeed be a choice if the government didn't control liquor licenses. But in my state they are limited to an artificially low level. A good alternative to banning smoking in bars would have been permitting new licenses for non-smoking bars. But try and get that by the liquor lobby.
So the only way I could get clean air in a bar was through the law. The libertarian would have had me wait till his fellow libertarians took over government, i.e. for all eternity.
1.14.2008 11:48am
J. F. Thomas (mail):
Equate liberatianism with poverty.

Well, libertarians don't have a good answer to how poverty is going to be dealt with. Obviously, there won't be any poor people is a ridiculous assertion to make and makes libertarians look just as ridiculously utopian as your most hardcore Marxist. Charity will take care of them is just as ridiculous (government got into the business of taking care of poor people because the traditional charitable institutions just couldn't handle it at an acceptable level anymore). So apparently, the libertarian answer is, "let them starve in the street or reintroduce workhouses and debtors' prisons", although you will rarely get them to admit that.
1.14.2008 12:15pm
J. F. Thomas (mail):
When it comes to secondhand smoke in bars, there would indeed be a choice if the government didn't control liquor licenses.

Again, this is an example of libertarianism gone wrong. While Ilya (and you) deride the horrible inefficiency of government, I doubt either one of you would want your next door neighbor to open a 24 hour bar and the neighbor across the street to open a brothel. Sure, you might be able to sue them for being a public nuisance. But hey, in libertarianland, property rights are everything, and if they want to open bars and brothels in residential neighborhoods, who's to stop them?
1.14.2008 12:20pm
Dco W (mail):
After a night's sleep and a morning's work, I'm prepared to declare that seatbelt use is substantially on the "none of the government's business" side of the line. The increased risk is virtually entirely on the non-seatbelt-wearing occupants of the car, and therefore their business. If you blow a tire and the car swerves so badly that you will lose your grip on the wheel, you'll lose it with or without a seatbelt on. Maybe when front seats were smooth benches, there would have been an outside chance that the seatbelt makes the difference between holding on or sliding away, so that there's some even smaller chance that it would make the difference between whether you swerve into another vehicle, but not with modern bucket seats. A major accident will result in a major traffic jam with or without seatbelts, and if you are more than a few car lengths back in the jam you will not have to see anything you don't go out of your way to see. EMTs see injured bodies—that's what they signed on for.

Thus, even if researchers have done multiple regressions that demonstrate the effect of seat belt laws in reducing highway fatalities, it is of little relevance. And any such demonstration does require careful data analysis because there are other factors: modern cars handle and brake much better, modern roads are safer, and drunk driving is taken much more seriously than once was the case. Furthermore, while increased seatbelt USE may decrease fatalities, that doesn't mean seatbelt LAWS do. Social norms may be sufficient to induce responsible drivers to buckle up without coercion, while irresponsible individuals flout the law anyway.

Paternalism breeds more paternalism. At one time it was a joke to suggest that before long the government would be outlawing fatty foods, but who's laughing now? If failing to buckle up marginally decreases the likelihood of surviving the next year, what about Sunday driving? What about unnecessary trips to the mall? What about driving from Pittsburgh to Chicago to visit family instead of flying? There you are increasing the risk both to yourself and others (by increasing traffic). Shall we have government second-guessing us every time we get in the car? What about the campers who get caught in snowstorms, the hikers lost in the woods, rock climbers who fall, and in each case impose on the efforts of law enforcement and rescue personnel as well as harming themselves through unnecessary activities? What about downhill skiing? What about motorcycle riding, with or without a helmet?

By the way, people can be charged for emergency room use. If your insurance company won't pay because you didn't buckle up, that's a non-paternalistic inducement. If you don't meet your financial obligation to pay for services made necessary by your failure to take reasonable precautions to avoid that emergency room trip, you could have your driver's license suspended until you do. All non-paternalistic.

But if we can't draw the line at requiring seatbelts, I don't see where to draw it. You don't have to be very libertarian to place a high priority on making you own choices and taking your own risks.
1.14.2008 12:28pm
frankcross (mail):
You're entitled to your own opinions but not your own facts. The multiple regressions have ample controls for other factors, you're just throwing stuff up without familiarizing yourself with the research. And it is associated with seatbelt LAWS, because that is what is studied. The introduction and effect of the LAWS, which promoted the greater USE.

Now, you can have an opinion that it is better not to save these lives (I think it's about a 10% reduction from seatbelt laws) in order to preserve free choice. But you can't pretend that the laws didn't save lives. Do the research, don't make up arguments
1.14.2008 12:40pm
J. F. Thomas (mail):
you could have your driver's license suspended until you do.

In libertarianland, where all roads are private, what possible business would the government have in issuing driver's licenses. The whole country would be like Illinois, where driver's licenses would be issued based on ability to pay (but unlike Illinois, people--especially the Governor--wouldn't go to jail for this novel, market-driven concept), because obviously the more you can afford, the better driver you are.
1.14.2008 1:00pm
some sense:
The problem with externalities is that there is no end to them once you get started. Is there anything that anyone does that can truly be said to not produce any "externalities"?

The notion that motorcylists without helmets, when injured, become a burden to society could easily be replaced with "motorcyclists, when injured...". We could drastically cut the number of ER visits simply by banning motorcycles completely. Why don't we do that?

We could drastically cut the rate of heart disease in this country by banning the sale of the following:

Bacon, ground beef less than 90%lean, lard, butter, eggs, whole milk, pastries, pies, cakes, ice cream, sausage,
donuts, cream, potato chips, corn chips.

After all, no one needs any of those things, right?
1.14.2008 1:08pm
Stacy (mail) (www):
Getting back to the externality argument, I think one can be a libertarian and still have a coherent answer to such things. I also think that (in my experience anyway) most actual libertarians don't, but that's a different issue. The coherent answer is that the real world is not, and won't be, a perfect theoretical market. Lack of information, primitive technology for delivering a product or service (see cable TV) etc. create large and small imperfections (market failures) that can only be addressed by some sort of collective action.

This is what a lot of libertarians either don't get, or don't want to deal with because it mucks up their simple arguments. To take the cable TV example, how exactly would one propose to offer robust competition in that market? The cable company owns the physical infrastructure -- and should, since they built it. Do you force them to allow others to transmit over their wires? That doesn't scream property rights to me. Maybe you deregulate cable TV in a similar fashion to the power grid, where the monopoly company merely owns the wires, and must sell access to any broadcaster willing to buy it. But then there's still a monopoly involved. Or, of course, you could have multiple cable companies building multiple physical networks (if they can get real estate owners to agree to all those trenches)

Anyway, you get the point. There's almost always room for improvement, but not everything can be rationally privatized, and there is a legitimate (limited) role for a representative government to regulate those markets where the "reality on the ground" produces a suboptimal outcome.
1.14.2008 1:11pm
SenatorX (mail):
Well, libertarians don't have a good answer to how poverty is going to be dealt with.

Not exactly true. Libertarians in general believe that you can have freedom or equality and believe freedom is better. We don't believe there is any just coercive wealth redistribution. There are many libertarian arguments for increasing the quality of life for everyone as well as providing "safety nets" for unlucky citizens. The real argument is on actual method of implementing safety nets with incentives for the citizens to move up and off the welfare.
1.14.2008 1:35pm
Mr. Liberal:
Stacy strikes me as a reasonable person.

We can all agree on limited government, even while disagreeing on the details.

Pretty much all liberals I know of do want limits on government power. The limits they like are very different from libertarian limits, which are simply a function of a skewed logic based on bizarre starting assumptions, are excessively ideological and extremely impractical.
1.14.2008 1:36pm
Larry1 (mail):

J.F. Thomas,

I assume you were referring to the University of Chicago when you wrote the following:


Really, it's all you need to know about libertarianism that the University that is renowned as the hotbed of libertarian thought in this country is a public institution, yet they apparently are incapable of appreciating the irony in the situation.



If so, you should know that the University of Chicago is, "A private, nondenominational, coeducational institution of higher learning and research ..."

http://www.uchicago.edu/

But if it's any help to your arguments, it was founded by John D. Rockefeller, the evil, money-grubbing, monopolist ... (I'm guessing you can probably take it from there, but if you need some help, consult anything Ida Tarbell ever wrote)
1.14.2008 1:41pm
Kent G. Budge (mail) (www):
The truth is that every human activity has externalities. In some cases these are slight, though I begrudge even the precious oxygen some Internet trolls suck up. In other cases they are extreme, as when a drunk driver hits another car head on and kills a young family.

So unless one is willing to discard liberty entirely, it is not sufficient to say "identifiable externality, ergo, license for unlimited state regulation." But, likewise, unless one is willing to discard every other consideration than liberty, it is not sufficient to say "world will not immediately end, ergo, license for unlimited personal behavior."

In other words, little is gained by drinking the ideological Kool-Aid at any extreme of the political world. There will always be tradeoffs, and someone's ox will always be gored. The best we can to is to approach the minimum possible level of goring, hopefully along a path where the goring is spread equitably. (Insert predictable puns on Gore here.)

I think the present balance is too illiberal (in the classical sense) in economic and regulatory matters, but perhaps a touch too liberal regarding cultural mores. To pick a Google-friendly example, I haven't yet come up with a way that Britney Spears could have been shut down before the present train wreck, or at least a way that wouldn't constitute a cure worse than the disease, but I have no doubts a culture that sustains her celebrity status is diseased. And a diseased culture does pose externalities, even if they are less tangible than becoming a drunk driver's hood ornament.
1.14.2008 1:50pm
Mr. Liberal:
Larry1,

I am pretty sure J.F. Thomas was referring to George Mason University.
1.14.2008 2:06pm
Dco W (mail):
frankcross, you're not entitled to make up what I said. I did not offer made-up facts. I said such regressions are irrelevant. What you are talking about is a small reduction in an already tiny probability that on any day or in any year my death will be caused by failing to buckle up. That's my choice.

To J. F. Thomas: I'm talking incrementally, from approximately where we are. Of course the situation is different if roads are private. For the time being, I'm willing to focus on getting rid of some of the more presumptuous intrusions and holding the line against more.
1.14.2008 2:06pm
Mr. Liberal:

So unless one is willing to discard liberty entirely, it is not sufficient to say "identifiable externality, ergo, license for unlimited state regulation."


Actually, we do not need libertarianism or any other such skewed ideology to limit the power of the state.

All we need is democracy.

What is to prevent regulation from becoming to extreme and burdensome? Answer: Democracy.

Ultimately, we the People are not subject to any taxes or regulations that we are unwilling to collectively consent to, either through action or inaction.
1.14.2008 2:10pm
Dco W (mail):
(from Kent G. Budge) "a diseased culture does pose externalities"

But I suspect you would concur in my skepticism about the likelihood of our political class effectively diagnosing and applying therapy for a diseased culture.
1.14.2008 2:12pm
Mr. Liberal:

But I suspect you would concur in my skepticism about the likelihood of our political class effectively diagnosing and applying therapy for a diseased culture.


Are you saying there is nothing the government can do to influence culture for the better?

That is obviously false.

Just as obviously, it is true that the government cannot cure all cultural ills.

How should we decide what government does or does not? Through the democratic process, of course.
1.14.2008 2:19pm
Dco W (mail):
(from Mr. Liberal) "All we need is democracy."

Hitler was elected, as I recall. But anyway, I take it you're willing to erase the Bill of Rights, then? Who needs it? Government is constrained by democracy.


"collectively consent to, either through action or inaction."

Am I the only one to whom that sounds like one hellova can of worms?
1.14.2008 2:20pm
RowerinVa (mail):
Good post, Ilya, but you missed a key issue. The main argument for seat belt laws that holds up to scrutiny, from libertarians or anybody else, is keeping the driver in control of the car. A tiny fender bender is enough to jostle an unbelted driver out of contact with the steering wheel and brake pedal, at which point the car becomes a two-ton unguided missile. Worse, the jostled driver's flailing attempts to get back into position, or merely to brace himself, tend to involve grabbing the steering wheel with predictable results. And worse still, an unbelted passenger becomes a missile in the car, likely to injure another person or knock out the driver (as describes Gov. Corzine's recent accident.) Seatbelt laws are justified because they prevent people from losing control during minor accidents and skids, and running into other drivers, pedestrians, and property. The cost-of-care argument is a red herring.
1.14.2008 2:21pm
Oren:
If you don't have the money in your blood soaked wallet at the time of the accident, there are plenty of pretty simple solutions (installment plans, credit cards, wage garnishment if need be).


By the way, people can be charged for emergency room use. If your insurance company won't pay because you didn't buckle up, that's a non-paternalistic inducement. If you don't meet your financial obligation to pay for services made necessary by your failure to take reasonable precautions to avoid that emergency room trip, you could have your driver's license suspended until you do.


I don't know what fantasy world you guys are living in but in this world, the vast majority of the poor are completely judgment-proof with respect to the average cost of an E.R. trauma visit which can easily be hundreds of thousands of dollars. Let's be extra-generous and say $100k (it wasn't a bad accident) and let's further assume that the injured was in the bottom half of the income scale (median US income $24k). Given that interest is accruing on his $100k debt at a rate of 5% (somebody made a mistake and typed '5' instead of '15' or some other absurd rate) it's quite clear he will never pay off this debt. Hospitals don't even bother not because they don't want the money but because you can't squeeze blood from a turnip.
1.14.2008 2:26pm
Dco W (mail):
"Are you saying there is nothing the government can do to influence culture for the better?"

As a logical possibility? No. Almost anything is possible. Monkeys at guitars could come up with Clapton. Do I favor political meddling for the purpose of "improving" culture? No.
1.14.2008 2:26pm
J. F. Thomas (mail):
I am pretty sure J.F. Thomas was referring to George Mason University.

Indeed I was. It is rather presumptious to call the University of Chicago, even its economics department, libertarian.
1.14.2008 2:32pm
Dco W (mail):
"the vast majority of the poor are completely judgment-proof with respect to the average cost of an E.R. trauma visit which can easily be hundreds of thousands of dollars."

The it would behoove them to get insurance, or not drive. Come to think of it, you can't drive without insurance anyway, can you? If you think the premiums are too high for people less well-off than you, then by all means contribute to a charity fund to help defray their cost. There was a time when poor people were treated charitably, but government intervention changed all that. These days, it's "show me the plastic."
1.14.2008 2:32pm
J. F. Thomas (mail):
There was a time when poor people were treated charitably, but government intervention changed all that.

And when exactly was that time?
1.14.2008 3:00pm
J. F. Thomas (mail):
The it would behoove them to get insurance, or not drive. Come to think of it, you can't drive without insurance anyway, can you?

I mean really, how is this going to work? If someone comes in unconcious and doesn't have proof of insurance on them, do they get put aside until someone confirms that they have the financial wherewithall to pay for care? Is that how emergency care works in your libertarian paradise? Does each step of care require a call to the insurance company to see if there is enough coverage left on the policy to cover the procedure? Do they yank the plug when the coverage limit is exceeded? How about someone with a high deductible plan? Does the hospital require cash on the barrel before a patient is admitted with arterial bleeding: "no tornoquit until he coughes up that $5000 deductible".
1.14.2008 3:06pm
Doc W (mail):
[I'll fill in briefly for "Dco W", since we agree on all points]

"And when exactly was that time?"

Before the massive government intervention in the provision of medical care. Sorry, I'm not a history book.

At any rate, here's what we're down to. Everyone can be force to buckle up because of the marginal increment in medical costs run up by those who don't, and don't have insurance, and can't pay up. There is no end to that logic. Anyone who drives, say, 10% more miles than necessary increases his or her risk of injury by 10%. People who like to drive cross-county to see the sights are incurring, as a group, increased medical costs, and if they can't pay they are imposing on others. Camping, rock climbing, skiing, eating fatty foods, riding horses. And recent government moves on fatty foods indicate clearly that the logic will be followed up.

It's got to be possible for individuals to make their own choices on risk and responsibility.
1.14.2008 3:21pm
J. F. Thomas (mail):
Before the massive government intervention in the provision of medical care.

Well of course there have been government run and subsidized "charity" hospitals in this country for well over a hundred years (e.g., Bellvue and Charity in New Orleans). And of course technology has made the cost of medical care that much more expensive that delivering medical care strictly on a charity basis (and placing the burden completely on charitable institutions and the medical profession) is completely impracticable.
1.14.2008 3:35pm
David M. Nieporent (www):
There is another group that was willing to let people die in order to satisfy strange ideological fixations. They were called communists.
Communists did not "let people die." They killed them. Big difference.


Or, let people decide who they should help and how much with their own money. You are assuming that no one (yourself included) will help the helmetless motorcycle wreck in the absence of government coercion. I don't know you, so I'll have to assume your low opinion of yourself is justified; but please don't project your lack of charity onto the rest of us, ok?

I don't believe that greedy libertarians should be able to get away without contributing anything to the care of people who are injured.
What if "greedy [sic -- that word doesn't mean what you think it means] libertarians" think that a child starving in the Sudan is a more worthy recipient of his money than some guy who was so reckless that he didn't wear a helmet?
1.14.2008 3:40pm
J. F. Thomas (mail):
Communists did not "let people die." They killed them. Big difference.

Considering there will be no worker safety laws, apparently no medical care for the poor (or vaccination programs), sewer systems will be operated only for those who bother to pay for the privilege, the distinction between letting someone die and actually killing them is a very fine one. After all, the millions of dead attributed to the Communists mainly died through extreme neglect, overwork, or engineered crises. Letting someone die on the side of the road because they can't afford a ambulance ride to the hospital is pretty much the same as letting people starve to death because they are insufficiently committed to collectivization.
1.14.2008 3:50pm
Mr. Liberal:

Communists did not "let people die." They killed them. Big difference.


Really? Explain that to the dead person.

Doing nothing as individual is run over by a train, where you knew of the danger and could easily have prevented the accident, but were too busy sipping your tea, is just as evil as murder.

Its not a big difference.

Libertarians who would passively do nothing while other die on a massive scale, (admittedly, a minority of libertarians) are just as evil as the worst mass murderers.

In fact, the only explanation for such behavior is sociopathy.

And, in fact, sociopathy is strongly associated with murder. It is not that far from indifference towards others to killing them for amusement. If you do not care about others, why not kill them for amusement, just as long as you can get away with it? That is the logic of a sociopath.

Most communists would not agree with and were powerless to stop the mass killing perpetuated by a few sociopaths in leadership positions. Their adherence to communism is based on confusion concerning its likely consequences. Likewise, most libertarians have probably adopted the ideology out of a similar confusion. But the more sophisticated libertarians, those that have adopted libertarianism because it, of all political philosophies, best tolerates their indifference and exploitation of others, are pure evil.
1.14.2008 3:51pm
c.gray (mail):

Before the massive government intervention in the provision of medical care. Sorry, I'm not a history book.


If you don't know the history, how do you know your claims about the past are true?

The reality is that almost all government expenditure for health care (excluding that for its employees) is for the elderly and the chronically ill. These people are uninsurable, because massive expenditure on their behalf is completely predictable. And as a class they lack the resources to pay out of pocket for more than a small fraction of their care.

But they can vote, and so can their relatives.

There are sound reasons every industrial democracy spends massive amounts on health care as a matter of state policy.
1.14.2008 3:51pm
Mr. Liberal:
Here is a thought experiment.

If you were a sociopath, what would be your preferred political philosophy?

Well, you might like communism or any system of dictatorship, as long as you had the power. If you were able to use, torture, and murder people without consequence, that would be ideal.

But, what if you are not in a position of power? What then would be your favored political philosophy?

Either anarchy or libertarianism, of course. These both minimize accountability for individuals who use and abuse others in economically desperate situations.

Which would be among your least preferred political philosophies? Both true conservativism and liberalism, because both will hold you more accountable when you use and abuse others.

Sociopaths interested in political philosophy would naturally gravitate towards libertarianism. Those lacking in empathy for others, but not reaching the level of sociopathy would naturally gravitate towards libertarianism.
1.14.2008 3:57pm
Doc W (mail):
"I mean really, how is this going to work? If someone comes in unconcious and doesn't have proof of insurance on them, do they get put aside until someone confirms that they have the financial wherewithall to pay for care?"

The same logic applies to all sorts of activities for which medical costs could be reduced or eliminated by banning the activity. Skiing, hang gliding, camping, hiking in the woods, rock climbing, eating fatty foods, Sunday driving, driving without a seatbelt. Some people feel better without the seatbelt. Some get their kicks hanging by a rope. So the real question is, how does it work for you? Where do you get off presuming to decide, or having the politicians you vote for decide, whose individual preferences are to be subsidized? If you won't bite the bullet and force non-risky behavior on all, then you don't have any place to stand from which to criticize my position that people ought to choose for themselves.


"The reality is that almost all government expenditure for health care (excluding that for its employees) is for the elderly and the chronically ill. These people are uninsurable, because massive expenditure on their behalf is completely predictable. And as a class they lack the resources to pay out of pocket for more than a small fraction of their care."

Well that brings up another whole issue, doesn't it? If you get insurance when young and maintain it, it will be there to cover expenses. If you fall through the cracks, there is charity. If you are concerned about people falling through the cracks, contribute to charity. If the size and expense of government is massively reduced, you'll have more to give. When it comes to monumental expenditures for the elderly, made possible by government largesse, what that boils down to in so many cases is prolonging the lives of failing bodies by a few pain-wracked, dignity-free months to the tune of hundreds of thousands of dollars. And what's responsible for that is the notion that if it is technically feasible to do something medically, no matter what the cost, and if one person out there can actually afford it, then everyone must have it and everybody else must pay for it.
1.14.2008 4:25pm
Oren:


"the vast majority of the poor are completely judgment-proof with respect to the average cost of an E.R. trauma visit which can easily be hundreds of thousands of dollars."

The it would behoove them to get insurance, or not drive. Come to think of it, you can't drive without insurance anyway, can you?


A poor man has no incentive to get health insurance because it's free to him anyway! It's not worth the hospital's legal and administrative costs to squeeze what measly cash they have. Even if they could, he'd just declare bankruptcy. The man just cannot possibly pay and, insofar as the hospital is required by law to provide him with services that he can't pay for, they have to eat the costs.
1.14.2008 5:02pm
Wayne Jarvis:

I don't know what fantasy world you guys are living in but in this world, the vast majority of the poor are completely judgment-proof with respect to the average cost of an E.R. trauma visit which can easily be hundreds of thousands of dollars. Let's be extra-generous and say $100k (it wasn't a bad accident) and let's further assume that the injured was in the bottom half of the income scale (median US income $24k). Given that interest is accruing on his $100k debt at a rate of 5% (somebody made a mistake and typed '5' instead of '15' or some other absurd rate) it's quite clear he will never pay off this debt. Hospitals don't even bother not because they don't want the money but because you can't squeeze blood from a turnip.


All fair points. However, you assume that someone in the both 1/4 today, will still be in the bottom 1/4 in 10, 20, 30 years. I'm pretty sure that this is a mistaken assumption. Granted, there is a segment that are poor and will be poor their entire lives, but I'm pretty sure that is the exception, rather than the rule. (I'm sure someone can quickly tick off the statistics that support this point.) But yes, certain folks will be judgment proof, but interest rates can take this into account.

The other issue that I would take with your analysis is that is presumes that the cost of treatment would remain the same even after you take out the subsidies. In other words, one component of the price that you pay for care is the amount treatment other people are receiving and not paying for. This is a typical justification for why it costs $5 for a couple asprin at the hospital. However, if everyone is paying for the amount they recieve, the costs will go down somewhat (although I will admit I have no idea how much).
1.14.2008 5:11pm
Malvolio:
A lot of libertarian position arguments have that sort of college kid who's never had to deal with the real world flavor to them.
When I was in college, I was vaguely conservative.

Out in the real world, I saw the waste and pain and outright carnage caused by the "realistic" solution proposed by people like Jake and "Mr. Liberal" and learned that freedom does work and their precious, compassionate, caring, helpful government simply does not.

There, got that off my chest.
1.14.2008 5:39pm
David M. Nieporent (www):
A lot of libertarian position arguments have that sort of college kid who's never had to deal with the real world flavor to them.
That's true. Lots more liberal arguments do, though. Like the notion that wanting to keep what you earn is "selfish," or the notion that thinking that the government won't do a good job at helping people is "greedy."
1.14.2008 6:44pm
Oren:
All fair points. However, you assume that someone in the both 1/4 today, will still be in the bottom 1/4 in 10, 20, 30 years. I'm pretty sure that this is a mistaken assumption. Granted, there is a segment that are poor and will be poor their entire lives, but I'm pretty sure that is the exception, rather than the rule.
Considering that the debt will double every 10 years, our theoretical victim is going to have to rise pretty damn fast to be able to pay it. Remember, I'm assuming that our victim is able to finance at 5% - a rate that most home-buyers would be lucky to get! Use a more realistic number like 13% and the debt doubles in less than 6 years. Compound interest is indeed the most powerful force in the universe.
But yes, certain folks will be judgment proof, but interest rates can take this into account.
Raise the interest rate and more people will default and declare bankruptcy -- more than half the bankruptcies in the US result from medical issues. Sorry, you just made the problem worse, not better.
However, if everyone is paying for the amount they recieve, the costs will go down somewhat
Still can't get blood from a turnip.
1.14.2008 9:00pm
Fub:
Mr. Liberal wrote at 1.14.2008 3:57pm:
Here is a thought experiment.

If you were a sociopath, what would be your preferred political philosophy?

Well, you might like communism or any system of dictatorship, as long as you had the power. If you were able to use, torture, and murder people without consequence, that would be ideal.

But, what if you are not in a position of power? What then would be your favored political philosophy?
Assuming arguendo that I was a reasonably intelligent sociopath with a plan for maximizing my opportunities to torment people, I would favor a government and a polity which had two features:

1. Lots of laws regulating citizens' most intimate and private lives and health, and the political climate in which to make more of them; and

2. Lots of bureaucratic and police agencies for accomplishing that regulation, and the political climate in which to create them.

I would then join a police agency, or a bureaucracy. I would work my way into particular positions in the organization. I might be be enforcing regulations directly. I might be applying regulations and recommending actions to my superiors.

I might be the clerk behind the window who sends applicants off on wild goose chases, or to the back of the line because they didn't have a form filled out precisely perfectly.

I might be the inspector who knows exactly how to lie or exaggerate to put an establishment out of business or shut down some homeowner's budget remodeling just for fun.

I might be the healthcare bureaucrat who knows how to justify denying an application to fund a livesaving or life enhancing procedure or drug therapy.

I might be the cop who knows exactly how far he can make up facts, fabricate evidence and testilie to convict the innocent, or escalate minor infractions into felonies.

I might even try to become a judge and tilt cases before me to cause maximum injustice. I would learn the law precisely, and know exactly how far I could go in that undertaking without being removed from the bench. I would take great joy in the fact that even if my decisions were reversed by higher courts, my victims would have suffered some harm just by having to litigate an appeal. I could maximize my opportunity to cause grief and pain by picking victims carefully, and doing the most obvious and egregious injustices only to those who could not afford appeals.

The possibilities are endless.

Generally speaking, the more official paperwork that comes to one for authorization, or the more citizens one deals with and has some authority over, the more opportunity one has to negatively impact some person's life. The key is knowing the rules thoroughly, and knowing all the gotchas and catch-22s that one can apply through the rules.

If I had even more grandiose designs, I might join some legislative staff and make careful but plausible recommendations to legislators to make even worse laws with more gotchas and catch-22s.

Heck, I might even be lucky enough to become a legislator. Then I might be able to lead legislative crusades to make even more peoples' lives more difficult.

But in a society with fewer, more sensible, and less intrusive laws and regulations, and a prevailing popular political philosophy that abhorred them, I wouldn't find so much opportunity.
1.15.2008 12:14am
Wayne Jarvis:

Considering that the debt will double every 10 years, our theoretical victim is going to have to rise pretty damn fast to be able to pay it. Remember, I'm assuming that our victim is able to finance at 5% - a rate that most home-buyers would be lucky to get! Use a more realistic number like 13% and the debt doubles in less than 6 years. Compound interest is indeed the most powerful force in the universe.


You don't think the victim's salary will rise with the rate of interest? Why not?

If bankruptcy is your concern, give medical creditors ultra-super-duper priority. That at least partially addresses your concern.

You can't squeeze blood from a turnip. But reciting an old cliche isn't really a convincing argument. A stitch in time saves nine. An ounce of prevent equals a pound of cure. Don't tase me bro! Where's the beef?
1.15.2008 9:12am
Oren:
Wayne, the victim's salary will rise with the rate of interest at roughly the rate the cost of living will increase. The net result is

The argument, without the cliche, is that the bottom 50% of earners in the US do not have any discretionary spending to speak of - their paychecks go largely to necessities. Where you imagine this money to be coming from is really beyond me.
1.15.2008 4:08pm