Monday, December 29, 2008

The limits of philosophy meet the realities of the melt-down

Two arguments from individuals in the blogosphere whom I respect deserve legitimate answers:

First, from Waldo (because I believe he posted it first)

Greer is a small town in a pretty prosperous part of the Upstate [South Carolina]. Yet the number of people in need is growing. The support from the private sector is decreasing as the economic pinch gets worse.

What's the free market solution? Where are those billions that went to faith-based initiatives?

Point of clarification: Waldo is, as usual, tilting at the specific windmill of the SC GOP, but the question is one that Libertarians need to answer as well.

Second, from Dana at Delaware Watch [I could pick any number of posts here, Dana, but I'm using this one as representative]:

Here's an outcome of the recession that people will enjoy who never saw a welfare program they liked

[Followed by an extensive clip of States citing budgetary shortfalls to cut Medicaid benefits; you can read it there; I'm not citing it in full because I want to get straight to Dana's own words]

The poor don't need eyeglasses and hearing aids, do they? Nor do they need hospice care when they are dying. Let them, in the words of Scrooge, get on with it (death) and decrease the surplus population. Better that they go blind and deaf and die in back alleys than that anyone be "coerced" to give up a few dollars more in tax dollars.

The unqualified liberty of the needless is the tyranny of poverty and pain for the needy.

Enter the bleeding hearts (people like me):

The Democrats, who hold majorities in the House and the Senate, are sounding sympathetic for now. They are considering close to $100 billion to increase the share of Medicaid's costs that the federal government would pay during the next two years....

$100 billion that's—what?--3 months of occupation in Iraq? Yes, I too believe in cuts--cuts in the cost of empire building.

But there are other bleeding heart ideas under consideration like this one, which I think is a great idea:

According to a Washington source who is in close contact with lawmakers, some in Congress also are beginning to entertain the idea of allowing unemployed people who have lost health benefits to sign up for Medicaid, with federal money paying the entire bill.

I can imagine the consternation the help-haters will have about that proposal. "Why is it necessary to expand Medicaid, especially now during a recession," I can hear them say. I am tempted to let them stew in their blindness, but I cannot. It is during a period of deepening recession and increasing unemployment that people need help the most. Yet the knee jerk response of the help-haters is to call for cutting back such help during times like these. They feign acting responsibly even as their reasoning is trippingly counterintuitive.

When times are tough, people need help more, not less. Duh!

Here is the dynamic that a lot of Libertarians prefer to ignore:

1) While we would argue that most of the ills that either Waldo or Dana detail are the result of Statist intervention and not free-market policies [there is little, even back in the Reagan years, that could legitimately be defined as free market in any Libertarian sense], the reality of the present day is this....

2) Many American citizens have been placed, by our Statist Democratic and GOPer friends, in immediate chronic and/or acute financial and medical jeopardy by a muddled, part-Statist, part-semi-free-market, part-Robber Baron non-system....

3) And that while, long-term, only free market solutions offer the fundamental, lasting changes which will best secure the general welfare, it is an unfortunate fact that free market solutions (especially in light of our current f**ked up situation) operate too slowly and too subtly to provide immediate relief to millions of hard-working Americans going under now, thanks to the fact that they trusted ... the Government, and have been educated that when in danger or in doubt they should ... trust the Government over themselves, even if the Government helped get them into this mess.

[Aside: here's what I mean about short-term and long-term. As I pointed out in a series of posts on health care, one of the most significant moves that could be made toward reforming health care would be to relax or eliminate government licensing regulations that prevent Physicians' Assistants and Nurse Practitioners from setting up low-cost clinics around the country, while simultaneously giving Americans tax credits for every dollar spent on health care expenses. I stand by that position, but I must also admit that it would take several years to put in place, even if Congress decided to pass it in January, and that--if you child has a fever and you have no health insurance and no money--is not going to meet your immediate need.]

Do those people who lack the money or the health insurance have a right to health care services? Being a Libertarian and an advocate of negative rights, don't think so. But unlike a lot of my fellow Libertarians I do believe that, as an American citizen and a constitutionalist, we do have a responsibility toward our fellow citizens.

Here's what I wrote nearly a year ago [on New Year's Day 2008, as a matter of fact]:

But when we get to health care or education we are in a whole different ball park, because universal access to either at public expense cannot be formulated as a negative right.

Please do not mistake me here. I am not suggesting that public education or health care are not critical important issues. With Thomas Jefferson I agree that education has to be the mainstay of a republican form of government, and with millions of other Americans I agree that the inability of tens of millions of citizens to access health care is an outrage.

But it is not a violation of anyone's rights.

Instead, items like education and health care are societal RESPONSIBILITIES, and the role of government in meeting such responsibilities to any or all American citizens is something that is (A) part of the political process; (B) necessarily changes over time; and (C) involves the consent of the governed through elected representatives to fulfill these responsibilities through programs or legislation....

[There's more, and I think the argument is strong, but since it's there, I'm not going to re-post it all here.]

The point being: the current crisis involves two parts: (A) what we do in the long-term; and (B) what we do now.

The problem is that both progressives/liberals and social/fiscal conservatives generally want to pursue only short-term solutions that are consistent with the long-term ideological agendas that they are trying to implement, which unfortunately means that (in terms of acts rather than rhetoric) they see the current crisis as the opportunity to push society down their preferred road, rather than to grapple with the political process over whether or not to place pressure dressings on the arterial bleeding while arguing over the proper surgical regime to be followed later.

In many ways, Libertarians fall into this same false dichotomy.

One Libertarian blog that has some important insights into the healthcare side of this equation is Publius Endures, which recently ran a very thoughtful (not to mention dangerous) post entitled A Libertarian Argument for (limited) Single-Payer Health Care:

Yes, you read that title correctly. Before all the hate-mail starts pouring in, let me first make the caveat that all other things being equal, I would vastly prefer a truly free market approach to health care over either outright single payer or our current employer-based approach to health care. But depending on the goal of the health care system, single-payer health care might be a vast improvement over our current system. More likely, though, the absolute ideal would be a system in which almost all elements of the system were private and individual-based and other elements of the system were public and government based, with a very clear and recognizable boundary between the two.

The full argument is wonkishly detailed, but Publius eventually makes the point that the route to free-market health care may not lead through improvements in employer-paid health care, but through a very carefully limited experiment in single-payer health care. There are a lot of devils in the details here, like the bureaucratic inertia that, once the State had acquired single-payer power it would be loathe to relinquish it. But the entire argument is one of the few examples of a Libertarian thinker taking seriously the challenge of how we live up to our responsibilities to American citizens who are struggling under the current system.

[Does Publius convince me? Not entirely, but then I am not through digesting his arguments and links. The point here, however, is that everybody has to start thinking outside his or her particular philosophical/ideological box.]

I do know that disgustingly Darwinian responses, like this one, are not the way to think about other American citizens who have been so thoroughly failed by existing government bureaucracies and public education and should not be considered representative of the Libertarian movement:

Some of us don't want anything from the government EXCEPT DEFENSE!

Don't give me any welfare, don't give me any silly-ass health programs, and don't you dare make me pay for someone elses benefits.

The only thing I want from government is protection from Terrorism and Islamic extremism, and protection of the Borders from Illegal Immigration.

Beyond that, the Federal Government has little if any legitimate role in our lives.

The Feds keeping and maintaining the Smithsonian Institute, a few National Monumnents and Parks? That's fine by me. While some radical libertarians want to privatize everything, I'm okay with a tiny bit of government beyond the Military. Even some sort of safety net for the very elderly, blind and extremely handicapped.

But welfare programs to help fat, lazy couch potatos who spend all day watching Oprah, soaps, and game shows, instead of getting a real job. No thanks.

Hand-outs through Federal Welfare Programs for the able-bodied? Just get rid of them all.

Yeah, grossly over-simplifying the situation by demonizing people in difficulties who haven't been trained to become self-reliant, or who are barred from common-sense solutions by extensive government regulations meant to buck up Statist monopolies while ignoring the bank presidents leeching $1.6 billion in bonuses for driving their whole organizations into the ground at taxpayer expense--that's the way to reach people.

I draw an analogy between the current Meltdown and the issue of Gay Marriage.

As a Libertarian I would prefer to get the State completely out of the marriage game. Make civil unions simple another form of contract that any consenting adults (pairs or groups) can freely enter, while reserving the sacrament of marriage to the churches if people are so inclined and are willing to follow ecclesiastical rules.

But--in the short term--I support forcing the government to live up to the full faith and credit clause of the Constitution and quit discriminating against people who want to get married based on sexual orientation. I hope that pursuing the short-term solution will get us all closer to my preferred long-term solution, but I am unwilling to support the societal prejudices against LBGT American citizens or to trample on the opportunity for tens of thousands of gay Americans who want the societal, legal, and regulatory recognition of their relationship that we don't prevent drug-abusers, spouse-abusers, or even serial killers from enjoying.

Thus I find myself looking at what can be done now--in a carefully limited short-term--to use Libertarian philosophy and the political process to assist millions of other American citizens going down for the second time.

No, this is not any sort of definitive answer, nor a willingness to support any old welfare plan to come down the pike.

But it is a promise to my friends like Waldo and Dana--and other Americans--that I will look at every idea with an eye toward what we can do together, rather than what we can fight about.

And if that makes me a Nazi or a Stalinist to certain people, that I can live with.


Brian Miller said...

Take a look at government priorities, too.

For example, much is being made of the "sadly necessary cuts to social spending in the light of our economic crisis."

That's happening in just about every state.

However, those states still have fleets of automobiles for employees to drive free of charge.

They still have stately, fancy mansions for governors and mayors.

They still have fancy subsidized restaurants, and expensive new buildings with rich amenities.

The towns and state are cutting back on health care payments, but they're not firing the paid poet laureate, or the city arborist.

One thing we need to ask our statist friends is a simple question:

If Libertarians are evil black-hearted villains for challenging the inefficiency of centralized government distribution of resources, what do you call politicians who cut food stamps and Medicare yet preserve their state-leased cars, stately facilities, government-provided first-class airfare and subsidized haircuts?

Steven H. Newton said...

Agreed completely--and I think those sorts of issues should automatically be on the table--I don't want a net growth of government--I want a net decrease.

I should have made that point--but at least you have.

paulie said...

Thanks for the thoughts.

Like a late stage hard drug addiction, or an advanced cancer, force-based problem solving is quite ingrained in the social host, and any attempts to extract it can be deadly to the patient. Libertarians might only look at the eventual need to cure the patient, while compassionate people may only look at the suffering this would entail (not seeing the suffering that will result if it is not done).

Compassionate libertarians should seek solutions we should all agree on, like easing and if/when possible completely removing mandatory licensing in the healing arts, decoupling medical insurance from employment, promoting (voluntarily) preventive and alternative care.

It helps to understand how we got here to see where we went wrong; Mary Ruwart addresses that well in Healing Our World (old edition available for free download online, current edition for sale).

As for the non-compassionate spending, that should not even be an issue at all.

Illegal immigration? Legalize it.
Problem solved.

Fighting terrorists? Quit stirring the hornet's nest, or at least go fight them on your own dime.

The drug war? Run up the white flag. Drugs have won a final and decisive victory.

Brian in comment one points to some of the other waste that goes hand in hand with force-based solutions to social problems, but there is far more than anyone can realistically document. What we don't see is all the good that could be done with all that money instead, by individuals and cooperatives finding private, non-mandated ways to solve social ills.

Unfortunately, the force-based war on poverty - like the regime's wars on drugs and terror - only makes the problem worse. So, certainly, we will suffer to some extent no matter what we do. Chemotherapy is painful and dangerous. A dying alcoholic will suffer if you don't give him a drink. In many cases, what is compassionate and what is not isn't immediately obvious.

Steven H. Newton said...

Metaphors have limits. The cancer/chemo-therapy metaphor has a limit for me when the "dead cells" carved away to kill the disease are American citizens.

tom said...

Here's a thought: why don't your liberal and/or progressive friends simply end the recession by having their President and their Congress end the occupation of Iraq and the illegal invasion of Afghanistan/Pakistan by ordering an immediate and orderly withdrawal of our troops. Maybe even start withdrawing our troops from the rest of the world while they're at it.

At that point, I wouldn't begrudge them a half a trillion of so for their pet social welfare projects as long as the remainder of the savings went into debt reduction and tax cuts.

They're all opposed to war, aren't they?

Steven H. Newton said...

I keep asking that, but I keep getting no answer from anybody except Dana Garrett.

paulie said...


No system will save all patients, citizen or not.

The system we have now won't, the system the people want to socilaize more won't, and my ideal system won't either.

I think my system will save more lives, even if it does not at first.

I think a more socialized system will destroy more lives.

I have reasons for thinking so - both empirical and theoretical - but to pretend that saving everyone is an option is something I think we should all, regardless of how much or how fast we want to socialize or desocialize medicine, handily reject. Otherwise, serious dialogue can not really even begin.

We all want to help as many people as possible. In some cases, it may be that more can not be saved in the short term so that more can be saved in the long term - or perhaps, we may went to help more people in the short term at the expense of moving towards better long term solutions.

In no way can I, or should we, pretend such trade-offs are easy, or that they will become easier if we put them off.

paulie said...

By the way, feel free to use the alcohol addiction metaphor if you find it less distasteful than the cancer one.

A drunk will certainly feel pain if denied booze, but is serving a late stage alcoholic more alcohol truly compassionate?