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America and health care

In the light of the recent passage by the U.S. House of Represenatives of the Senate’s version of healthcare reform and the ensuing wailing, gnashing of teeth and smearing of soot in the hair by opponents of said reform, let me give my view – as an outsider – on the matter:

It’s a question of morality.

It astounds me — and, frankly, every other non-American USA-watcher in the developed world — that the richest nation on earth, whose very constitution proclaims the pursuit of life, liberty and happiness to be it’s highest ideals, whose citizenry so loudly profess to live by Christian virtues, would not guarantee that some form of basic, minimum healthcare be available to all of its citizens independently of their ability to pay.  It utterly astounds me.  If I were American, it would disgust me that this had not happened 50 years ago.

If my income and my wealth is above average for my society, I have an ethical duty to subsidise the health care of those who are, for whatever reason, at the lower end of the spectrum.  Yes, there are issues of free riders and of personal responsibility, but they simply do not matter when answering the basic question.  The government of a country, acting on behalf of that country’s people, has a moral imperative to provide a minimum level of care to all of its citizens.

I am not saying this as a screaming socialist.  I freaking hate socialism.  I love the market (when it’s allowed to function properly with full transparancy).  I support (at least partially, and possibly fully) privitised social security.  I like the idea of small government.  I rage against the nanny-state in Australia and in the UK.  I worry about encouraging dependency and a sence of entitlement in those people assisted by the government.  But those concerns take a back seat on this issue.

So, yes, the second question (a two-for) is to ask what the minimum level should be and how to pay for it.  But first question should have been a no-brainer.

If all the country can afford is a polio shot and a packet of aspirin, then that’s what they should provide (hopefully a charity or two might help out, too).  But if the country is the richest in the history of the planet, they should be able to stump up for a bit more.

And, yes, for the next criticism, this particular reform by the U.S. Congress is nominally promising more than it will reallly provide when it comes to the fiscal deficit.  Yes, again, given America’s political structure, U.S. government spending won’t be truely corrected until there is a real crisis approaching (as opposed to the make-believe crises being proclaimed by people opposed to the bailouts and stimulus package(s)).

I don’t care.  The child of an unemployed, drug-taking high-school dropout should not be deprived of basic access to a doctor just because we’re angry at their parents.  Nor should their parents, come to that.

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Evil? No. Amoral? Hopefully, yes.

The NY Times looks at economists and the ‘yuck’ factor here.

You can kill a horse to make pet food in California, but not to feed a person. You can hoist a woman over your shoulder while running a 253-meter obstacle course in the Wife-Carrying World Championship in Finland, but you can’t hold a dwarf-tossing contest in France. You can donate a kidney to prevent a death and be hailed as a hero, but if you take any money for your life-saving offer in the United States, you’ll be jailed.

…

Paul Bloom, a professor of psychology at Yale … conducted a two-year study to try to get at why people consider athletes who take steroids to be cheating, but not those who take vitamins or use personal trainers … The only change that caused the interviewed subjects to alter their objections to steroids was when they were told that everyone else thought it was all right. “People have moral intuitions,” Mr. Bloom said. When it comes to accepting or changing the status quo in these situations, he said, they tended to “defer to experts or the community.”

Often introducing money into the exchange – putting it into the marketplace – is what people find repugnant. Mr. Bloom asserted that money is a relatively new invention in human existence and therefore “unnatural.”

Economists are asking the wrong question, Mr. Bloom said[.] They assume that “everything is subject to market pricing unless proven otherwise.”

“The problem is not that economists are unreasonable people, it’s that they’re evil people,” he said. “They work in a different moral universe. The burden of proof is on someone who wants to include” a transaction in the marketplace.

I disagree.  Economists are not immoral (violating moral principals), they simply seek to be amoral (not involving questions of right or wrong; without moral quality; neither moral nor immoral).

There is, or ideally is, a permanent distinction in economics between positive statements (statements of fact, shorn of moral interpretation; a statement of what is) and normative statements (moral judgements; a statement of what ought to be).  The distinction didn’t originate in economics.  We’ve borrowed it from the philosophy department (that economics, like all branches of study, first grew out of).  David Hume was using the idea back in 1739, for example.

It’s an enormously powerful technique.  It allows us, for example, to observe that there are trade-offs to be balanced in creating optimal tax policy, or that there is a statistically significant correlation between increased rates of abortion and decreased crime rates 20 years later, or that the decision to be a prostitute may be a marginal one instead of a discreet one.  These are statements of what is; they are positive statements and can be debated as such.  But once a positive statement is agreed upon, it then informs the normative debate.

This is an awkward thing for many non-economists to grasp, because for most of us, our beliefs about facts and beliefs about morals are closely intertwined and even interdependent.  None of which is to say that we always can separate the positive from the normative, especially in studying the economics of (government) policy.  But even in these cases, attempting to make the separation and acknowledging where any given statement contains an element of the other makes for better, more informed debate.