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March 2010 posts

Health Care and Conscription (con’t)

Jonathan B. Wight

A few days ago we carried out an active debate about whether requiring someone to buy health insurance from private companies was a “new” event in American history.  It turns out it is not.

From Brad DeLong comes this extract from Second Congress, May 8, 1792.  The act provides federal standards for a militia and forces every free male to purchase various items from private sellers.  These purchases would not have been cheap back in 1792: 

Second Congress, Session I, The Militia Act of 1792

An ACT more effectually to provide for the National Defence, by establishing an Uniform Militia throughout the United States.:

1.                  Be it enacted by the Senate and House of Representatives of the United States of America, in Congress assembled, That each and every free able-bodied white male citizen of the respective States, resident therein, who is or shall be of age of eighteen years, and under the age of forty-five years (except as is herein after excepted) shall severally and respectively be enrolled in the militia.... That every citizen, so enrolled and notified, shall, within six months thereafter, provide himself with a good musket or firelock, a sufficient bayonet and belt, two spare flints, and a knapsack, a pouch, with a box therein, to contain not less than twenty four cartridges, suited to the bore of his musket or firelock, each cartridge to contain a proper quantity of powder and ball; or with a good rifle, knapsack, shot-pouch, and powder-horn, twenty balls suited to the bore of his rifle, and a quarter of a pound of powder; and shall appear so armed, accoutred and provided, when called out to exercise or into service...


Money Enough

Jonathan B. Wight

Economic mores can take on a life of their own, leading to the unthinking acceptance of ways of life that can be destructive.  One such custom is to consume, consume, consume.  One’s life can become defined by one’s spending, and the grasping for income to pay for it all.  Adam Smith wrote extensively about this issue in The Theory of Moral Sentiments (see the passages about the poor man’s son).  The economy sets us up for failure because we can’t all be number one, yet we strive onward thinking that the next toy, the next car, the next promotion will bring happiness and success.  People step on this treadmill and can’t get off. 

Religious-minded authors continue to write about the subject.  Doug Hicks, a delightful colleague and co-teacher of an ethics and economics class with me, recently came out with his own book addressing this issue:    

Douglas A. Hicks, Money Enough: Everyday Practices for Living Faithfully in the Global Economy (Jossey-Bass 2010).

This is a thoughtful book that addresses the conflicts and contradictions of modern economic life. How does one create community and place? Most importantly, how does one create meaning in our lives?  Money fills a void, and increases the external resources available to satisfy cravings. But deeper longings and drives remain. For example, Adam Smith noted that the instinct for commerce does not arise initially from the desire to get wealthy, but from the desire to converse (Lectures on Jurisprudence 1982, p. 493)! 

Hicks majored in economics as an undergraduate and went on to get an MDiv and PhD in Religion.  Amartya Sen was his second dissertation reader.  Hick’s work is thus informed by the capabilities approach and its ethical framework. Money Enough is a friendly read, for those seeking some gentle nudging (not of the paternalistic kind!) toward a balanced life of greater meaning and purpose.  Here are chapter titles that give you a hint for the journey:

Ch 1: Surviving

Ch 2: Valuing

Ch 3: Discerning Desires

Ch 4: Providing

Ch 5: Laboring

Ch 6: Recreating

Ch 7: Expanding the Community

Ch 8: Doing Justice

Ch 9: Sharing

The book takes the form of a personal narrative, rather than an academic tome. The problem in any economic system remains determining what the goal ought to be. This book beautifully demonstrates that this can and ought to be a deeply personal decision, guided by faith and practical wisdom. 

Health Care versus the Civil Rights Act

Jonathan B. Wight

Frank Rich in today’s NY Times makes an interesting analogy:

To find a prototype for the overheated reaction to the health care bill, you have to look a year before Medicare, to the Civil Rights Act of 1964....  The apocalyptic predictions then, like those about health care now, were all framed in constitutional pieties, of course. Barry Goldwater, running for president in ’64, drew on the counsel of two young legal allies, William Rehnquist and Robert Bork, to characterize the bill as a “threat to the very essence of our basic system” and a “usurpation” of states’ rights that “would force you to admit drunks, a known murderer or an insane person into your place of business.”

Richard Russell, the segregationist Democratic senator from Georgia, said the bill “would destroy the free enterprise system.” David Lawrence, a widely syndicated conservative columnist, bemoaned the establishment of “a federal dictatorship.” Meanwhile, three civil rights workers were murdered in Philadelphia, Miss.

Jonathan’s query for readers: 

The Civil Rights Act could be criticized on libertarian grounds: The Act deprives me of my own liberty to run my business exactly as I like.  If I run a restaurant, the act forces me to serve people I previously may have barred based on race.  The act forces upon me certain minimal standards of behavior as a basis for citizenship.  It is thus coercive.  Yet most Americans today support the Civil Rights Act as a necessary delineation of African American rights—implying that others do have positive duties toward fellow citizens.

For those following the previous post on health care and conscription, does this analogy to the Civil Rights Act work?  Why or why not?


Health Care and Conscription

Jonathan B. Wight

I posed the query below to Bart Hinkle, a gifted editorial writer for the Richmond Times Dispatch, who enjoys the foray into ethics and economics.

Query to Bart:  The Constitution says Congress shall have the power “To raise and support Armies” – and does not specifically say how to do it.    The draft is constitutionally legal, even though it is a form of slavery.  How is the “conscription” to buy health insurance different from the “conscription” to serve in the army?   

BART:  I don't think it is any different. Conscription for any purpose has always struck me as an egregious invasion of individual liberty.

In fact, military conscription was the cover the Supreme Court used to justify many WWII-era economic regulations. In a decision on rent controls, William O. Douglas wrote that

 A nation which can demand the lives of its men and women in the waging of . . . war is under no constitutional necessity of providing a system of price control on the domestic front which will assure each landlord a ‘fair return’ on his property.

Likewise, the high court ruled that Washington could renegotiate wartime contracts to eliminate “excess profits” because “in total war it is necessary that a civilian make sacrifices of his property and profits with at least the same fortitude as that with which a drafted soldier makes his traditional sacrifices of comfort, security, and life itself.”

JONATHAN:  Thanks, Bart.  That’s very helpful.  It would imply (to me) that Virginia Attorney General Cuccinelli’s lawsuit against forced health insurance is rather frivolous (although you point out in a separate email that it all depends on the judicial landscape when the suit comes up).

Oliver Wendall Holmes wrote that “Taxes are the price we pay for civilization.”  Being forced to buy health insurance is equivalent to paying a tax—with the proceeds used to buy insurance.  While no one likes to pay taxes, the U.S. is not anywhere near the high marginal tax rates we were in previous decades (does anyone remember the 1970s?).  Hence, I don’t think the destruction of liberty is at hand.   I could be wrong.... 

Rights for Robots?

Jonathan B. Wight

"If machines can and do become conscious, will we take their feelings into account?"

If you're worried about this(!), Peter Singer and occasional co-authors tackle these and other fascinating questions in “The Ethics of Life” on The Project Syndicate website.

We know that mirror-neurons in the brain may be a key part of autonomous sympathetic responses.  If so, designing robots that are cute, that smile, and so on, will cause humans to react more sympathetically.  An experiment shows that simply putting smiley faces on an energy bill will make consumers conserve more energy!  (Thanks to Sandra Peart for calling this to my attention.)

I’m sure Mark will enjoy hearing that people can be so easily manipulated…  :) (not!)  Onward to the robotic age.

The Indignity of the Health Care Bill (A Reply to Wight)

Mark D. White

You beat me to it, Jonathan--I was going to wait until the president signed the bill, but since you said your piece, I will too.

Universal health care coverage is a laudable goal--or, to be precise, universal access to coverage is laudable, since health care insurance should always be voluntary, with individuals bearing the risks of noncoverage. But this bill attempts to achieve this goal in the absolutely worst way imaginable (short of complete state control, which is a long-run inevitability), sacrifricing not only voluntariness but autonomy and choice, responsibility, patient- and physician-directed care, and technological and procedural innovation--all of which would be provided by a more market-oriented system than we currently have, not the bureaucratic behemoth this bill creates.

With all due respect, Jonathan, utilitarianism is what got us into this mess, for two main reasons. First, the overwhelming emphasis on costs: saving money at any cost to choice, dignity, and health outcomes. Of course, markets are also driven in part by costs, but in markets individuals can always choose to bear higher costs if they choose and are able--this choice is made for them by some distant bureaucrat working on a spreadsheet. Second is the fact that utilitarianism neglects the process by which outcomes are arrived at--in case, most relevantly, the aspect of autonomous choice. Without the proper checks and balances, utilitarianism breeds social engineering, endorsing control over personal decisions by bureaucrats and regulators who "know better" what should be done (as was my main point in our paternalism debates), and removing more and more control over personal decisions for individuals themselves--and what decisions are more personal than those regarding the health of you or your loved ones?

Regarding rights serving utility, such rights are no rights at all. For rights to be meaningful, they must trump utility or welfare in at least some nontrivial cases. Without rights, we are all pawns in the hands of the powerful, even if those in power will elected democratically (hence, Mill's warning about the tyranny of the majority). And the cynical, instrumental use of rights language to drive a utilitarian agenda which neglects true rights based on dignity is a travesty.

Universal access to health coverage could have been achieved at (actually) lower costs, and keeping with the principles of choice, autonomy, and dignity, if the many state-created barriers and distortions in the health care market had been reversed: removing or restructuring the tax exemption on health care benefits that created employer-based health coverage (which ties people to inferior jobs for fear of losing their benefits), loosening the restrictions on interstate purchases of health coverage, and reforming medical malpractice law to make sure both patients and the doctors they rely upon are protected.

But as it is, under the current proposal the government will inevitably ration medical resources through price controls, introducing more distortions into the "market" for health care. Less talented young people will go into the medical field, and less resources will be devoted to R&D for new medicines and technologies. Financial burdens for patients will be transformed into time costs, and bureaucrats will play a growing role in determining who gets what treatment and when--all in the interests of controlling costs, taking into account lives, health, and choice only in terms of their imputed monetary value.

In short, the health care system did need fixing, but the answer was less government, not more--and certainly not this much more.

Health Care Reform Passes!

Jonathan B. Wight

I’m a supporter of health care reform, largely for utilitarian reasons. Expanding access to health insurance will (in theory) lead to greater prevention, and more kids will be covered in the womb and in infancy—when critical brain development happens. That is a good thing for promoting long run economic growth, and will be cost effective. The net benefits of spending on social services in a child's infancy likely far exceed that at any other age (think of the cost of incarceration).

In addition, current health spending is disproportionately geared to administrative expenses—to identify and avoid clients with pending health needs.  How many people stay in their miserable jobs simply because they would lose insurance if they left? With reforms that prevent denial based on pre-existing conditions, many people may reallocate their labor to pursue entrepreneurial dreams.

Part of making all this work is that everyone will be required to acquire health insurance, and subsidies will be provided for those unable to pay full freight. The Attorney General of Virginia is planning to sue the federal government on this point, claiming that no citizen has previously ever been forced buy a product.  But is that true?  Since the 1930s every working American has been forced to “buy” retirement benefits in Social Security.  Everyone who drives a car is forced to buy head restraints and air bags.  So, this argument doesn’t cut it for me. 

However, there is a troubling point for me: Nancy Pelosi and President Obama have argued for health care based on it being a “right” and not a privilege.  What do you readers think about that?  A negative right (forbidding others from harming me) is much easier to argue than a positive right (forcing others to give me a benefit).  Interestingly, the Geneva Convention on Prisoners of War entails both: no torture is allowed, and reasonable health care must be provided. 

I like Bentham’s observation that rights theory is “nonsense on stilts.”  Still, rights theory is a useful platform for motivating political reforms. In other words, rights theory can be helpful in a utilitarian way.

Symposium on Sen's philosophy at Erasmus

Mark D. White

Erasmus University in Rotterdam is hosting Amartya Sen for a public lecture and symposum on June 30 (lecture) and July 1 (symposium).

Lecture: "On Global Justice"


Ann Cudd (University of Kansas, USA):
Commitment and Explanation: Sen’s Philosophy of Social Science

Mozaffar Qizilbash (York University, UK, and Lahore University of Management Sciences, Pakistan):
Amartya Sen’s Criticisms of Utilitarianism

Henry S. Richardson (Georgetown University Washington, USA):
Mapping out Improvements in Justice Comparing vs. Aiming

Ingrid Robeyns (Erasmus University Rotterdam, the Netherlands):
Equality of Root Capability

Amartya Sen (Harvard University, USA): Discussion

New book: The Thief of Time: Philosophical Essays on Procrastination

Mark D. White

WARNING: Indulgent self-promotion ahead! You've been warned...

TOT My latest book, The Thief of Time: Philosophical Essays on Procrastination, edited with Chrisoula Andreou for Oxford University Press, is now available. Working on this book with Chrisoula and the rest of the contributors was a truly wonderful experience, including a terrific meeting of the minds at a workshop hosted by the CUNY Graduate Center in July 2008.

From the book's description:

When we fail to achieve our goals, procrastination is often the culprit. But how exactly is procrastination to be understood? It has been described as imprudent, irrational, inconsistent, and even immoral, but there has been no sustained philosophical debate concerning the topic.

This edited volume starts in on the task of integrating the problem of procrastination into philosophical inquiry. The focus is on exploring procrastination in relation to agency, rationality, and ethics-topics that philosophy is well-suited to address. Theoretically and empirically informed analyses are developed and applied with the aim of shedding light on a vexing practical problem that generates a great deal of frustration, regret, and harm. Some of the key questions that are addressed include the following: How can we analyze procrastination in a way that does justice to both its voluntary and its self-defeating dimensions? What kind of practical failing is procrastination? Is it a form of weakness of will? Is it the product of fragmented agency? Is it a vice? Given the nature of procrastination, what are the most promising coping strategies?

The contributors (in table-of-contents order) are George Ainslie, Don Ross, Sarah Stroud, Duncan MacIntosh, Jon Elster, Olav Gjelsvik, Christine Tappolet, Sergio Tenenbaum, Elijah Millgram, Jennifer Baker, Frank Wieber and Peter Gollwitzer, Chrisoula Andreou, Mark D. White, Joseph Heath and Joel Anderson, and Manuel Utset.

Books That Influenced Me

Jonathan B. Wight

Nice selections, Mark.  Here are some of mine.

1.  Herman Hesse, Demian: The Story of Emil Sinclair's Youth.  This is a coming of age novel and is spell binding reading, particularly for me as a teenager.  The young protagonist struggles between the world of light (good) and dark (evil).  He questions the basis of moral society and the origins of moral norms.  There are no simple answers but some finely nuanced insights.

2. Ayn Rand, The Fountainhead.  This is another great novel for a young person.  I’ll never think about the world in the same way after discovering the creative life of an individualistic architect.  While it is a powerful revelation, I don’t think the book holds up well either as good literature or good philosophy.  Rand’s objectivism and “greed is good” runs into problems.  For one thing, none of her individualistic heroic characters turns to be greedy!  They are self interested, but always have high ideals and would never use others to get their own way.  It remains on my list of favorites.

3.  The Bible, particularly the New Testament.  What I sopped up as a teenager were the pronouncements on economic justice. Throw the money-changers out of the temple!  When Jesus is confronted with the question of whether it is lawful for a Jew to pay taxes to a Roman king, he responds with that wonderful line, “Render unto Caesar the things of Caesar...”  Jesus’ ingenuity and cleverness were easy to admire: after all, don’t teenagers spend most their time trying to outwit their parents?  The Bible is a profound text because it cannot be read literally. 

4. Thomas Merton, Seeds of Contemplation.  Merton lived a riotous life of debauchery in the U.S. and Europe for about thirty years.  He woke up one day and decided to become a Trappist monk, taking a vow of poverty and silence (for details, see his spectacular autobiography, The Seven Storey Mountain).  He lived and worked the rest of his life at Gethsemani monastery in Kentucky.  Seeds of Contemplation is a compilation of insights into the interior life.  He talks about the ideological “hats” a monk tries on, and about finding your own voice.  I spent a silent retreat weekend at Gethsemani in the early 1980s. 

5.  Adam Smith, The Theory of Moral Sentiments.  I came to TMS mid way in my career and quite by accident.  I was in a Borders bookstore trolling the economics aisle when my eye fell upon this plain paperback Liberty Fund edition.  For $7.50 it was a deal, and I thought it would make a nice bookend with Wealth of Nations.  I got home around 10 pm and thought I would open the book as a prelude to falling asleep.  (What better sedative is there than reading moral philosophy?)  Instead, I was transfixed by the language, the intensity, and the ideas.  It’s been a wonderful ride since. There’s something new to learn every time you open it. 

6. Nicholas Georgescu-Roegen, The Entropy Law and the Economic Process.  Georgescu-Roegen was a Romanian economist of astounding brilliance, temper, ego, and rant.  This book is a seminal critique of the methodology of neoclassical economics. 

7.  James Agee, A Death in the Family.  This is an autobiographic account of the death of Agee’s father when he was six.  It is the most hauntingly beautiful book I have ever read.  

8.  George MacDonald Fraser, Flashman.  This novel didn’t really “influence” me; rather it pleased the hell out of me.  I’ve never laughed so hard.  The protagonist—an outrageous rouge—happens along to play pivotal roles at the major events of the 19th century, in Afghanistan, Crimea, India and other British colonial outposts as well as the United States.  Somehow this traitorous, cowardly scoundrel always ends up on top of things. There are 11 books in the Flashman series.  Try the first and go happily on from there. 

9.  Mark Twain, Huckleberry Finn.  Who can say enough about this spectacular novel?  So I won’t say anything....

10.  There are too many good last picks: Deirdre McCloskey’s, Crossing: A Memoir; John Howard Griffin’s, Black Like Me; The Autobiography of Malcolm X; Ken Kesey’s, Sometimes a Great Notion; Arnold J. Toynbee, A Study of History, Vol. 1, and many more.  I can’t choose!

Next up (to Mark): What are your most influential movies?