Thoughts on Libertarianism/Health Care

Jeez, this post ended up being longer than expected.

There’s another intuition that at least libertarians have, which is that it is not as bad to have undesirable things result from an impersonal process than from an active decision. It is bad if someone’s house burns down and they couldn’t afford insurance. It’s worse if someone’s house burns down, and they were in the class of people deemed unworthy by a bureaucrat of having their house rebuilt.

I think almost all progressives have the opposite intuition. They think it’s better to try to produce an optimal result, even if that results in individual injustices (which it will—government rules are very broad brush, and will always involve error at the margins). I’m not sure how to bridge that intuitive gap.

I think that McArdle, in what is in her blog a rare moment of non-obfuscatory reflection, touches on something quite profound here: the articles of often irrational faith that motivate libertarian ideology. In this thought experiment, it’s better—or at least more fair—to the libertarian, to have one’s house burn down and to lack insurance than to have government-run insurance possibly deny your claim to a collectively held insurance. This is an analogy, to her, for the current health care debate.

It’s a bad analogy: part of the problem is that private insurance carriers are in the business of denying claims even for people who have insurance. How this is worse than the government denying it, I’m not sure, especially since the private health insurance industry invests a considerable amount of its resources not in providing health care, but in securing the means to most efficiently deny it, especially to people who are most in need. The bureaucratic structures McArdle fears are already in place for many people who already have health insurance. “Death panels” are already in place: they’re just not publicly accountable, and as a result, providing high quality services conflicts with the pursuit of profit.

But the deeper issue has to do, of course, with the libertarian, and here, you can also say, conservative, faith in the unregulated—I think saying “free” is disingenuous unless you equate freedom with the lack of restraint—market. Again, the house-burning-down analogy is kinda silly when you’re talking about health care because most people don’t own houses. Increasingly, people don’t “own” a great deal more than their bodies, and those happen also to be the people who stand to benefit most from single-payer health care.

McArdle tacitly confesses here that libertarians are, in the case of health care, generally satisfied with settling for poor social outcomes so long as the government doesn’t seem to encroach on individual justices. While part of me thinks that the only truly principled response to this is “wow, what a bankrupt, selfish, and half-baked notion of justice you’ve got going there,” another part of me thinks that this statement deserves further scrutiny and less immediate judging.

McArdle’s version of libertarianism is an American one. Unlike the British tradition from John Locke on, from which it derives its authority, American libertarian philosophy, especially since Robert Nozick added to it its neoconservative inflections, does not imagine itself as rooted in a theory or practice of duty. American libertarianism generally conceives of itself as a philosophy and politics of individualism that places the rights of the individual over those of groups, and assumes that the individual fully “owns” himself (I use the gender pronoun advisedly).

Nozick, in a book that is still widely read, and was central to the post-60s resurgence of libertarianism and the neoconservative renaissance of the 80s, essentially disposed of the theory of collective responsibility that was at the core of Lockean philosophy, leaving only the individualism. Locke apparently saw little contradiction between the ideals of property, tolerance, and self-ownership that he promoted, and the “rights of conquerors,” as discussed in his Two Treatises on Government, which included the enslavement of colonized populations. Few of its present practitioners are reminded that the father of libertarian thought provided also a rationale and a justification for the slave trade in which he himself was an investor. For Locke, “individuals” were wealthy, white, Christian, British men. They held their property not only in ships and estates, but also, other human beings.

Maybe it is telling that the trade in human beings did not immediately trouble the founders of libertarianism and individual justice. For these founders of the free market in human flesh, to be denied the right to trade in African women and men—whom they did not see as “individuals” in any sense of the word—would also be to deny them their natural right to pursue property. It would impose an unjust regulation on their pursuit of property and wealth.

Understanding the degree to which the history of slavery/conquest and the history of individual rights are intimately intertwined might pause to some libertarians these days, but probably not many. Some might respond that, yeah, that’s messed up, and then say that the solution is to recognize everyone as having individual rights, rather than just some. A nice enough idea, to be sure, especially if those rights include health care, but that same history has produced a society where we do not perceive unequal outcomes as injust. If someone’s comes down with cancer and, since they don’t have insurance, they can’t get treatment, we don’t perceive it as the outcome of a fundamentally unjust system. We are so attached to the habits of individualistic perception that it seems downright natural that some are seen as the just recipients of top notch health care (because they can afford it, or because they are in a position to work for it) and others are not. If you’ve got money or the right job, you have more of an individual right to health care than if you don’t.

The lesson, then, is that, as a school of thought, libertarianism loves individual rights, but they them only as a result of the fact that they operate in a system that denies the full enjoyment of these rights to others. When McArdle says that “progressives” (those people who are running scared from the term “socialist” right now because they are too wary of the term’s connotations to consider that a little more “socialism” might actually be something good for everyone) think it’s better to try to produce an “optimal result,” she forgets that that the name for that “optimal result” is equality. Equality is only seen as injust on the individual level because in the individualism of libertarian ideology, social inequality is a necessary prerequisite. For Locke, the role of the unequal was played by the Africans and the indigenous peoples of the Americas: human beings who could not be seen as having property in the self because they were themselves property, or because they could only be seen as savages whose ways white men had no duty to tolerate. For Nozick, almost three centuries later, it was the poor and the jobless, many of whom, it should be pointed out, were the ancestors of those whom Locke did not recognize as equally human.

Any health care reform—libertarian, progressive, socialist—that does not address itself to this history seems to me bound to fail.

Notes

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