Recently there was some excitement when Ron Paul told Wolf Blitzer a view that everyone who knows Ron Paul knew he had, and that every Ron Paul fan knew a lot of other people disagreed with. Specifically, Paul resisted the idea that an uninsured 30 year old who was dying ought to get any sort of public support. This view isn't exactly a news flash, of course.
Robin Hanson responded in this way:
"But a great many ill, collapsed, etc. folks in the world are largely left to die, at least if curing them costs anything like a US hospital stay. Ezra argues above for “decent” national care, not global care. And even libertarians wouldn’t leave family members to die. So everyone agrees that we heroically help some, and leave others to die. We only disagree on who falls into which category."
And Arnold Kling said much the same thing:
"What most non-libertarians favor is some form of collectivist policy at a national level. National socialism, to coin a phrase. People are naturally collectivist at the level of family and others in their immediate vicinity. And that's fine. But to libertarians, national socialism is a mistake. The way to behave ethically with distant strangers is to trade honestly with them and don't steal their stuff. There is no reason to treat distant strangers that live within one political boundary differently from distant strangers that live inside another boundary."
These both seem quite wrong and to ignore what seems to me to be the major point. The allegation is that non-libertarians are nationalists, and that they want to divide people up by national borders - that those within a border are in the "tribe" and those outside aren't. Libertarians, it is argued, are tribal creatures too (we all are) they just have a more reasonable tribe - the immediate family.
However, if you asked the average non-libertarian and Ron Paul a different question - whether public funds should be used to help fight AIDS in Africa or other relief efforts - you'll likely get the same difference in response. So despite the effort to smear non-libertarians as "national socialists", it's not clear to me this holds water in describing the difference in preferences.
Economists talk about demand for goods and services (of which medical care is an example) as "ability and willingness to pay". It's worth sorting through exactly which of these two constrains Ron Paul from suggesting we provide free health care to the world and which constrains the average non-libertarian from providing free health care to the world.
There are a lot of things on our plate. Clearly we can't provide high quality health care to several billion people without cutting into other priorities. There's also the collective action problem - that paying for other countries' health care is less sustainable of an arrangement if it's a free lunch for them. For these two reasons, a lot of public health spending does get spent at the national or sub-national level. The constraint here, though, is clearly the ability to pay. Our dollar doesn't go nearly as far, and dollars are less available, when we start providing health care globally. But there's just as clearly a willingness to pay for global public health for most people. As we've gotten richer there has been more of a sense that we ought to put public funds towards these sorts of efforts. Certainly because we all think people should take a certain amount of personal responsibility, our willingness to pay for health care globally isn't infinite, but the major constraint seems to be ability to pay. As we get wealthier and our public budget constraint expands, most non-libertarians want to pay for more health care at the local, national, and global level.
Is this true of Ron Paul? I think it's safe to say "no". Whereas ability to pay is the biggest thing standing between the average non-libertarian and providing public health care globally, willingness to pay is the biggest thing standing between Ron Paul and this goal.
This seems obvious to me. Everyone knew this, right? His position may be controversial, but the fact that he holds this position doesn't seem controversial.
In light of that fact it seems wrong for Robin Hanson and Arnold Kling to say libertarian critics see that nation-state as the relevant "tribe".
The difference is in whether libertarians are willing to pay for certain goods publicly and whether non-libertarians are willing to pay for certain goods publicly. It shouldn't be a newsflash that Ron Paul distinguishes himself by his unwillingness - not by his transcendence of nationalism. Most non-libertarians are willing to pay for some sort of public health care. How extensive the actualization of that willingness is is going to depend on a lot of institutional, budget and resource constraints (ability to pay), and the nature of those constraints is inevitably going to lead to a lot of national-level policies. Extrapolating from that "ability to pay" issue that somehow non-libertarians see the nation as a tribe seems very wrong to me.
Libertarians regularly express an unwillingness to pay for certain things through government. This is not a news flash. Only the most illiberal non-libertarians express the view that we should treat people who live in our nation-state tribally. So I'm not sure why Hanson and Kling come to the conclusion that they do, except that perhaps they find the libertarian position hard to defend. I don't know - but I do know I'm no national socialist and no non-libertarians I know are either.
The problem is that all the problems you cite about providing quality medical services on a global level are applicable on a national level, and hence you come back to the exact same position as many opponents of state-funded medical care.
ReplyDeleteIndeed, have many people also not pointed out that medical services in tiny Austria is a whole different issue from medical services in giant 300 million+ people United States?
Well, at least you and the libertarians come back to the same ground - you feel that a plan is essentially unsustainable at a particular level, but you disagree about what level that is.
Prateek - there are some libertarians who think that public health care is impractical, and on that point I would be closer to them (I just think either it is somewhat more practical than they suggest, or I think the impracticality is worth it for getting more equity).
ReplyDeleteOn the margin I may agree with some libertarians. I'm not a fan of single payer and there's a lot of things about health reform that I've said on here I don't like and one of those things is that I've said several times that the larger a plan you get, the less manageable and the less nimble and experimental it is.
But I don't think Ron Paul is of this ilk. If any level of government could run health care splendidly and efficiently, I still get the impression Ron Paul wouldn't go for it.
We should stop making these excuses like "non-libertarians are nationalists" which don't hold up well and instead just point to the difference that Ron Paul himself is happy to acknowledge: he doesn't want government to be involved in the provision of health care.
It's such a readily embraced position of his (and many other libertarians) that I'm not sure why it's so hard for people to say.
But to be clear - if we could expend the same resources for a sustainable public provision of health care to the world as we could nationally, I would be supportive of some public action on that front. My support is "ability to pay" constrained in that sense. Many, many non-libertarians would agree. You get some whining about foreign aid, but generally people like things like the Peace Corps, mosquito nets, aid to Haiti, AIDS funding, etc. Generally these are seen as worthwhile things by non-libertarians.
ReplyDeleteRon Paul wouldn't support these things even if "ability to pay" wasn't the constraint that it is, and that's the point. He's open about this too, so I don't see the big obstacle to telling it like it is - I don't see why we have to accuse other people of being national socialists. This isn't a view Ron Paul tries to conceal.
Hi Daniel, ist it somehow possible to send a personal message to you without using the comments on this blog? I cannot find an email address or something.
ReplyDeleteNon libertarians favour strong nation states with their own 'collectivist' policies as anything else would entail a great degree of centralised authority, something libertarians object to elsewhere.
ReplyDeleteDani Rodrik has also demonstrated that strong nation states are good for the global economy.
Daniel Kuehn,
ReplyDeleteForeign aid tends to lead to dead aid and it tends to simply be swallowed up by whoever runs the country receiving the aid and their apparently is no way around that short of simply ignoring those local rulers, which is a totally different can of worms - that is, do we really want to create a bureaucracy in a foreign nation to distribute this money, food, etc.?
As for nationalism and health care provision, hmm, much of the anti-immigration stance (which cuts across partisan lines) is directly predicated on protecting entitlements like medicare from immigrants (particularly of the "illegal" variety). Paul's approach is a bit different, but it is itself concerned with immigrants getting healthcare, etc. provided by the state. Thus, I'm sort of surprised Daniel that you didn't get into Ron Paul's own thoughts on immigrants, etc.: http://en.wikipedia.org/wiki/Political_positions_of_Ron_Paul#Borders_and_immigration
Anyway, the whole argument seems silly to me on far more basic grounds - if you believe in the nation state as it has developed since roughly the 16th century* (which almost everyone does - indeed, it is almost viewed as "natural" anymore) then you are for some level of "national socialism" as Kling describes the term (I think he uses it wrongly, but whatever). So you don't even have to get to the whole discussion of medical care.
*You could say it started with Aquinas, but whatever.
Anonymous,
ReplyDeleteLibertarians favor strong nation-states too, they simply disagree about the specifics (it isn't an in difference in degree vs. difference in kind).
Really, it is a very small sub-set people (coming from an ideologically diverse mix) which doesn't believe in a strong nation-state. It shows how successful the notion of a nation state has been since early modern era kicked off the intellectual, preconditions for its arrival.
I agree that the nationalism thing is irrelevant to this discussion.
ReplyDeleteLibertarians (or at least ones of the free-market variety) want health care to be treated like any other good and not supplied or subsidized by the state.
Of course this raises the ethical issue of what happens to those who can't afford access to healthcare.
The typical libertarian/free market answer would be that anyone who wants to can donate to healthcare charities (or help out family members or neighbors in need) and they can choose whether they want to donate to local or global causes.
Any model where people are forced against their will to pay for others health-care (which is how many libertarians see the tax system) is not only unfair but actually leads to more expensive and less efficient health care being provided (due to the issues of overuse and bureaucracy typical seen in state-sponsored systems including the current US system)
So in the long term the free market approach is not only fairer but actually increases the supply and reduces the cost) so that fewer people will choose (or have no alternative but to forego) medical cover or treatment.
Dan, I am sure that you know this, but I figured I'd mention it just in case. Not all libertarians are Austro-libertarians, and even fewer are anarcho-capitalists. In my personal opinion, Ron Paul (like myself) is a Rothbardian (aka anarcho-capitalist). However, he is also practical and understands that the world probably is not yet ready for a stateless society, that changes to contemporary political structures do not happen very quickly, and thus he takes a constitutionalist or minarchist approach.
ReplyDeleteObviously, I cannot speak for the man, but that is my view.
With regard to that particular exchange in the debate I would say that he was combining aspects of constitutionalism, libertarianism and Austrianism. As I am sure that you know, he believes that the unhampered free market could provide better care and efficiency than either the quasi-governmental system that we have now, or the full governmental system that was really at the heart of the question. Also, I think that he was hailing to individualism, as well as the heart of libertarianism, the principles of non-aggression and private property.
Sure, from a purely economic viewpoint, you could say that it is a contrast between willingness and ability to pay, but I think that ignores what is behind the so called "unwillingness".
That Ron Paul desires a stateless society is a joke. Why does he reference everything in regards to the constitution if this is the case? Why does he have a whole page devoted to securing the borders on his campaign website? Also if I hear a libertarian say unhampered free market again I think I'm going to go wild. Who enforced the contracts? Who decides whats property?
ReplyDeleteIf libertarians don't want anyone telling them what to do, they can go live by themselves in the wilderness Thoreau style. If they do want to live in a society, than they should quit pretending that all they want is not to be bothered. They should say clearly that what they really want is someone else to provide protection for what they own regardless of how they came to own it, and to have no other responsibilities to the other individuals who make their well being in that society possible.
ReplyDeleteAnonymous,
ReplyDeleteFairly clearly Ron Paul doesn't desire a stateless society.
"Also if I hear a libertarian say unhampered free market again I think I'm going to go wild."
Generally it goes without saying that there are certain caveats and axioms that a statement like that are based on.
"They should say clearly that what they really want is someone else to provide protection for what they own regardless of how they came to own it..."
Libertarians do not condone force or fraud, so the whole "regardless" line doesn't make any sense.
"...and to have no other responsibilities to the other individuals who make their well being in that society possible."
This is I think based on the assumption that responsibilities can only be exercised through the state.
Anonymous,
ReplyDeleteNow, if you want to meet some folks who do argue for a stateless society, see here: http://c4ss.org/
Or heck, add them to your RSS feed.
Jaffi Joe -
ReplyDeleteThis is a good point and I was working this out with Prateek earlier. "Libertarian" is a fluid concept, and there are "libertarians on the margin" like myself, Greg Mankiw comes to mind, and others who are clearly not relevant to this discussion. In talking about the provision of health care by the state it seems to me one need not be an anarcho-capitalist, a Rothbardian, or an Austrian to offer a "libertarian" opposition. He may have had Austrianism in mind personally, but nothing in his response was at all contingent on that. But I still agree with your point.
Now, I'm not sure this is completely true: "Sure, from a purely economic viewpoint, you could say that it is a contrast between willingness and ability to pay, but I think that ignores what is behind the so called "unwillingness"."
I never said "oh Ron Paul just doesn't like poor people", and everyone knows I've never made that sort of accusation before of libertarians. I didn't go into details of what was behind the "unwillingness", but I did say this is clearly a position grounded in his libertarianism - presumably, as you say, in his reading of the Constitution, economics, etc. Sure we could talk more about why given the opportunity to he still wouldn't do this. But I think my point was still an important one to make to do away with the non-sequitors and absurdities that Kling and Hanson were bringing up about the tribalism of non-libertarians. Does he have his reasons for being unwilling? Sure. I've never painted Ron Paul as a monster on here. But the difference is in the willingness to provide these services throught the state. The difference is not in the willingness to provide these services in the market (most American non-libertarians still like having a market for health care), and the difference is not due to some sort of brooding nationalism by non-libertarians.
I think my assessment was a lot fairer and a lot more accurate than what was offered by Hansen and Kling. I'm only restating precisely what libertarians have always (for the most part) said: "we don't want health care to be provided through the state"
The more the state controls healthcare and your choices about healthcare the more things like this happen: http://dailycaller.com/2011/09/20/desperate-couple-slams-govt-for-hideous-quick-sand-of-health-care-restrictions/
ReplyDeleteNow you could argue that in a completely private market, sure, they may not be able to do X or Y or Z due to costs, however, they would be permitted to at least advertise their case and seek charitable or other avenues for funding such. In the case where the government is making the decision, however, they can't even do that because the government has to determine whether they even able to donate stem cells for this procedure. This is a basic point Hayek makes in _The Road To Serfdom_ a number of times - how do you want these decisions made - through the government or thru the marketplace? Framing it as, well, simply do we want the government paying for healthcare, ignores this question - and in the run up to the vote about ObamaCare it isn't surprising that Democrats did their level best ignore that question. Not surprisingly Ron Paul's full statement on the matter has also been ignored - as I recall he makes this very point in his answer to the question.