Wednesday, September 14, 2011

I Think It's A Little More Complicated Than That

Update: Roderick Long also has a good take on this. Unfortunately, his three-step answer is no more suited to the context of a contemporary debate than the objections I outlined below. I beginning to think that libertarians should respond with "You got fifteen minutes?" when they get these kinds of question.

(via Digby) I'm in agreement that people who laugh at the thought of other people dying a probably assholes. That said, the question directed to Ron Paul at the last GOP debate is harder to answer than my friends on the left make it out to be.

Consider that this was not the case of an unemployed individual (such as Kyle Willis) dying of some simple malady because they couldn't afford insurance. Rather, the hypothetical proposed by Wolf Blitzer involved a healthy individual who could afford, but chose not to buy, health insurance. While his specific question focused on healthcare at its heart it's really a question of when society should intervene to save people from themselves.

The position which seems to be implicit in criticisms of the audience's behavior is that of course we should pay for the gentleman. As Greg Laden says he's in that position because he "made a mistake in not getting proper insurance coverage"; it's unconscionable that someone someone should die on account of such an easily-remedied mistake.

I'm sympathetic to this view; it speaks well of our species as a whole that we generally try to keep our fellows from dying. Where I disagree with Greg (and probably the bulk of humanity) is in the use of the word "mistake" to qualify the gentleman's actions. "Mistake", at least as it is used here in the context of a discussion of moral dessert, seems to imply a misunderstanding or lack of knowledge that leads the actor in question to draw an erroneous conclusion. In such a situation its easy to give the actor a mulligan when it comes to the consequences of eir actions, especially when the actor is acting in good faith and/or did eir best to become appropriately knowledgeable. If an actor's actions lead to a consequence which could not have reasonably been foreseen there's a decent (though not airtight) case to be made that they have some sort of claim of aid from their fellows.

In the hypothetical currently under discussion, however, this sense of "mistake" is totally absent. There's no suggestion that the actor in question had bad information of failed to form an accurate picture of the consequences of his actions1. He simply rolled the dice and lost, which makes his moral claim to assistance highly suspect.

We can, as a society, still choose to help the gentleman out of his predicament, but to do so opens up a big can of worms. If you do it for this gentleman you must do it for others in the same situation as well (on what ground can you discriminate?), at which point you've got a classic example of the free rider problem on your hands2. Free riding, apart from being a morally dubious practice, has a lot of corrosive, knock-on effects if left unchecked.

There's also the question of personal autonomy; to rescue this gentleman is to deny that he's a competent steward of his own life. Once we've rendered this judgement he effectively becomes a ward of the state, at which point we may be morally obliged to intervene in other aspects of his life as well. It would take far more space and time than I have here to fully explore all the ramifications of this intervention, so instead I'll just offer one stark example which springs immediately to mind: his kids. If we've determined that he's not capable of making decisions for himself, what does that say about his ability to look after children? It seems to me that, if we're being consistent, we're going to have to assume some portion of his parental responsibilities as well.

You may say that I'm being unduly alarmist and that all these problems can be solved by providing him with health insurance whether he likes it or not. But recall what I said in the beginning that Blitzer's question was only nominally about healthcare. What it's really about is how far we trust individuals to make decisions for themselves. If it's not healthcare then it's something else: smoking, drinking too much, eating transfats, driving without a seatbelt. We're uncomfortable letting people experience the consequences of their actions when we deem those consequences to be too severe. Instead we instead limit their choices and deny them their full personhood, a move which is designed primarily to relieve our own discomfort. Thank you, but no.

As an aside I feel a little bit bad for Ron Paul. Sure, he gave a inane response, but there was no way in hell he could provide a nuanced answer in the context of a GOP debate (try explaining "supererogatory act" to a Tea Partier).

1 My wife, an ER doc, suggests that people are uniquely bad at assessing risk to themselves in the context of medical decision making. This may be true, and is certainly relevant to the larger discussion if it is, but isn't part of the factual background implicit in Blitzer's question.
2 Yes yes, I know you could require everyone to buy insurance ahead of time; again, not part of Blitzer's hypothetical.


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