This clearly expresses a fundamental tenet of conservative/libertarian thinking: that engaging in risky behavior with serious social costs is an entitlement. People who are injured by metal bats, or fall ill from smoking or fatty food, cost the rest of us money. We pay their emergency room bill, their Medicare bills or their Social Security disablity insurance. Only someone willing to forgo those benefits should have the right to also opt out of public health laws like those passed by the New York City Council, or pre-existing ones requiring that motorcyclists wear helmets and drivers wear seat belts. But Beston, like all conservatives, makes no serious suggestion about offering such an option in our society (much less explaining how it would be practically possible.) Instead he merely sneers at the New York City government’s efforts to lower the costs that he, like all other taxpayers, will ultimately bear (and that, should rising health costs force the government to raise taxes, Beston and City Journal would surely bray against as well).
Ah, man, you’re so close: That’s exactly why many of us object to having the public take on such responsibilities in the first place. Behold the weird alchemical powers of public subsidy: You start with a paradigm case of a self regarding act—choosing to engage in risk behaviors with your own body—which traditional liberal principles would place outside the sphere of state regulation as a core component of personal autonomy. But throw some public funds into the mix and—Abracadabra!—what had been the exercise of an individual right is transformed into the “imposition” of a cost on society. No behavior is so private that you can’t regulate or ban it, so long as you’re willing to subsidize it first!
Ben does at least seem to give a nod toward the idea that we can’t unilaterally revoke rights by suggesting people ought to have an option: Accept restrictions on risky behavior or forego public money. (Actually, you could get very much the same effect by announcing certain sorts of injuries and ailments—fractures from skiing or whatnot—just aren’t going to be covered.) That’s makes sense to me, but I doubt Ben would actually endorse the outcome. The effect is that the people who have no need to avail themselves of (say) Medicaid go on eating and drinking and smoking and playing as they please, while the poorest are heavily regimented. Come to think of it, you know what costs a lot of public money? When poor people have children. And surely only right wing loonies think having sex “is an entitlement” when it incurs “serious social costs.”
Still, at least in this scenario everyone would have a choice. It would avoid the repugnant implication that our generosity gives us the right to restrict people’s freedoms just automatically. But few people like the idea of creating this kind of caste system of rights, or of making too explicit in practice what is always transparent in the arguments for such rules: That it’s really just the poor who are the targets of paternalistic measures. So instead of enacting uncomfortably unequal restrictions that would actually make sense in light of the arguments used to justify them, we engage in the ultimate form of leveling down: We restrict everyone’s liberty, even when many or most people impose no public cost when they exercise it. The law, in its magnificent equality, forbids the rich as well as the poor from burdening the public coffers by consuming transfats, smoking, or playing baseball with metal bats.
Update: Replying to a similar critique, Ben makes the sort of response that accidentally confirms exactly how creepy his position is. On the suggestion that his own principle would endorse regulation of private sexual behavior on public health grounds, Ben essentially responds: “Well, that would be awfully impractical and hard to monitor without lots of intrusions.” This should be unsettling—it’s a little like arguing that of course we can’t carve up the homeless for spare organs, because we’d get blood on our nice new slacks. Fine, what if it wasn’t inconvenient? What if we had a pinpoint search technology that would automatically register all and only the risky behaviors we wanted to prohibit? Pace Ben, I don’t mean this as a “slippery slope” argument, in that I’m not primarily arguing that there’s grave danger of our actually going this route in the future. Rather, I’m suggesting that if you have an argument on which the only reason we’re not collectively entitled to regulate this most intimate realm in order to save a few bucks is that it would be a big hassle… there’s probably something wrong with your argument.
Ben does at least nod in the direction of suggesting that who you sleep with is more central to (most) people’s identity and autonomy than what they eat or smoke. And that’s plausible enough in general—though presumably there are people for whom that’s reversed—but it’s also precisely the kind of judgment that it would be better to avoid having to render publicly when possible. The whole point of a broad sphere of autonomy—drawn around the body, for instance—is that it allows individuals to rank the importance of these kinds of competing goods for themselves, rather than subordinating their judgment to Ben’s assessment of which exercises of liberty are sufficiently important to be due deference.
8 responses so far ↓
1 Kevin B. O'Reilly // Apr 25, 2007 at 8:30 pm
(1) There’s no guarantee that the children of poor people will wind up costing the state more than they contribute in taxes or potential innovations, so that’s the response there. Then again, smokers may cost the state less when savings in Social Security are taken into account. Perhaps smoking should be subsidized.
(2) Your opponents do not recognize a distinction between private and public costs. So even if a rich person is able to pay for the consequences of his poor choices, in their view he still makes everyone else worse off inasmuch as that capital is going to pay for health care rather than being invested in a more productive activity. By dying earlier, he deprives others of his contributions to gross domestic product and the tax base.
(3) Your opponents refuse to, or do not know how to, count the subjective value an individual derives from a pleasurable albeit risky behavior so their calculation of costs is totally one sided.
2 Brian Moore // Apr 26, 2007 at 9:41 am
We should set up a “National Healthcare” that has really strict standards. Like, if you smoke or use drugs, you’re out. If you drive a motorcycle, skydive, or don’t use seatbelts, you’re out. If you eat 10 Big Macs, adios. Don’t show up at the gym? Bye! Once we were done, I think we’d have a lot of very low-cost people on the plan. 🙂
Also, you can pre-emptively opt out and be freed from those restrictions. We could legalize drugs, and convert the entire drug war into a National Healthcare Deprivation punishment.
“Then again, smokers may cost the state less when savings in Social Security are taken into account. Perhaps smoking should be subsidized.”
The problem with smoking and other drugs (from society’s standpoint) is not that they’re dangerous, it’s that they aren’t dangerous enough. Why are we demanding that tobacco companies make less unhealthy cigarettes? We should be dumping more rat poison in! Permanently “opt-out” those evil, evil smokers!
On a non-joking note, you are completely right. The more that the government handles healthcare, the more the government must restrict the rights of those who use that healthcare, in order to keep costs down. I don’t see any other way around it, and I think that most people would find the argument for that regulation compelling, even though the idea of controlling people’s lives on that level is horrifying to me.
3 ed // Apr 26, 2007 at 2:02 pm
Your argument makes sense in theory, but I’m not sure that it’s true in practice. The US doesn’t have any real national healthcare, and yet has far more draconian drug and alcohol laws than, say, Canada or France. The public smoking bans are also a lot more popular here than in Europe, land of socialized medicine. Hell, the Germans even let you drive as fast as you please on certain roads (though, to be fair, they are quite strict about following the limits that do exist).
I could be crafty and suggest that this was due to the fact that the American health care system is incredibly inefficient compared to those in other nations, thus making the “imposed costs” of “bad” behaviour much larger. Instead I’ll just point out that maybe these laws you hate are more a function of cultural norms (and the American proclivity for puritanism) than any sort of linkage with government subsidy, regardless of how they are justified.
4 asg // Apr 27, 2007 at 8:56 am
The US doesn’t have any real national healthcare
Other than the 70% of total health care spending that is done by the government (mostly through Medicare), you mean?
5 ed // Apr 27, 2007 at 10:57 am
Please cite. That doesn’t sound correct.
6 Michael B Sullivan // Apr 27, 2007 at 4:18 pm
The thing is, the whole “it’ll cost us money, so we should be able to regulate it” thing is an excuse. Nobody actually believes it, they just invoke it when it happens to line up with some kind of regulation that they favor to begin with.
Hence, liberals invoke the public health argument with respect to smoking, trans fats, and seatbelts, but not to poor kids having children, or forcing a non-vegan diet on people.
This is also why Europeans don’t go for the same arguments: it’s an essential part of the French national identity to drink wine and eat awesome-if-not-particularly-healthy food, and so there’s no existing large base of people agitating for the ban of wine and awesome food, so they don’t seize on this excuse of an argument.
Similarly, in the US, there’s no large popular base that’s opposed to poor people having children, so you probably won’t see the argument Julian outlines above.
But you know what there is a constituency for in this country? Oppressing gays. And it’s only a matter of time before the public health argument gets trotted out as a rationale for teaching kids that homosexuality is wrong and shameful (er, make that “disease prone”), or whatever, on the grounds that being a gay male is strongly correlated with increased risk of HIV and other STD’s. Probably the only reason this hasn’t yet become an issue is that the Right is uncomfortable with public healthcare anyhow, and doesn’t tend to seize on it as a means of advancing their agenda. But if we get to the point where everyone accepts a reality of public health, you can bet that social conservatives will use it as a club against anyone who diverges from their idea of righteous living.
7 Consumatopia // Apr 28, 2007 at 10:45 am
Nobody actually believes it, they just invoke it when it happens to line up with some kind of regulation that they favor to begin with.
No, we actually believe, you just misunderstood it. The subsidy gives us the right to regulate it, not the obligation or even suggestion that we should. We have the right to ban people from stepping on the cracks of a public sidewalk, but no reason to actually do so.
Sanchez’s point makes logical sense, but is unfortunately extremely brittle in the that once you’ve abandoned anarcho-capitalism the government has its foot in the door of the subsidy-justification for any regulation. Did you parents send you to public school? Did you drive on public streets or walk on public sidewalks this morning? Did you benefit from the public good of police protection? Kevin O’Reily’s point 2 is critical here, in that once the government starts subsidizing your productive capacities (and if you’ve spent any reasonable amount of time in America than at some point they’ve already done that) then the government has a stake in both your public and private costs for the rest of your life. The government funding for the hospital you were born in becomes the Original Sin of collectivism.
I’m not sure anyone here has made that claim. However, when Sanchez draws a broad sphere of autonomy around the body to avoid Adler’s decision of which freedoms are sufficiently important, while the sort of endeavor I would support, doesn’t really avoid that ranking of freedoms at all–it’s just another way of encoding your rankings. By making such a sphere, you’ve decided that my choice of what chemicals to put in myself outranks my neighbor’s choice of whether he’d like to live in a society that allows people to put chemicals in themselves. And, indeed, I would agree with that ranking, but the only reason we want a sphere of autonomy is because we happen to be sympathetic to ranking freedoms according to their radius from the center of the sphere of autonomy.
There’s a flipside here in that if some insurance company started denying coverage to people with homosexual partners then liberals would immediately want the company shut down, but I guess libertarians would be theoretically okay with it?
8 Michael B Sullivan // Apr 30, 2007 at 4:04 pm
Yeah, I realized about fifteen minutes after I posted that message that “They don’t actually believe it” was wrong. I should have said something more like “It’s not enough to get people interested in something.” Nobody (or no significant number of people) go around saying, “What all are the things that impact health, so that we can regulate best practices?” Rather, they get interested in regulating some behaviour and then come up with a justification (that they believe) of this form.
Consumatopia: “There’s a flipside here in that if some insurance company started denying coverage to people with homosexual partners then liberals would immediately want the company shut down, but I guess libertarians would be theoretically okay with it?”
Good question. Most libertarians generally believe that markets will punish discrimination so the government doesn’t have to (ie, if you won’t hire homosexuals or blacks or whatever, you can’t hire the most qualified people, and so your business suffers while a non-prejudiced competitor flourishes), with caveats onto that. If we accepted the premise that homosexuals actually are more expensive to insure than demographically similar heterosexuals (and there probably are at least some demographics in which this is true), then that kind of market force wouldn’t act on a discriminatory health insurance company.
So, I don’t know. It seems clear that we haven’t figured out a relatively free-market-based approach to healthcare which lines up with our moral intuition about what kind of care people deserve.