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Health care Free-for-All

These health care town hall meetings and concomitant protests are kind of getting me down. On one hand, the Democrats are presenting a plan that is bound to cause vastly more harm than good, and expensively to boot. On the other hand, these mindless Republican protesters are using uncivil tactics and silly arguments, doing long-term damage to the level of political discourse in the U.S., in favor of what I consider the correct short-term position. How are you readers dealing with it?

Yeah, I couldn't resist a comment on the Twitter outage

In case you hadn't heard, Twitter went out recently, leaving millions of self-absorbed, clueless brats to realize how worthless their lives are. Among people I know in real life, the more interest a person has in Twitter, the less interesting that person is. What could have been a really badass innovation has turned out to be pretty much of a dud, if you ask me.

Krugman relates a funny

I'll hand it to Krugman, this was funny:

There was a telling incident at a town hall held by Representative Gene Green, D-Tex. An activist turned to his fellow attendees and asked if they “oppose any form of socialized or government-run health care.” Nearly all did. Then Representative Green asked how many of those present were on Medicare. Almost half raised their hands.

Via Clusterstock

Incentive vs. Coercion

Publius at Obsidian Wings outlines his argument against allowing kidney sales. It's one just about every libertarian has encountered, and been utterly bewildered by, before:

Here's an example. Let's say Wal-Mart decides to start offering people $5,000 per finger. (Let's assume scientists have found a chemical in finger bones that helps break unions). Under the liberal view, everyone is "free" to take that offer or to decline it.

But this "freedom" isn't all it's cracked up to be. From an opportunity cost perspective, Wal-Mart's offer exerts more force on someone with a salary of $25,000, than it does on someone who makes $100,000. The former is essentially throwing away 20% of their yearly salary, while the latter is throwing away 5%. Both individuals are "free" - but the lower income makes the offer harder to refuse for the $25K person. It exerts more force on that person. To say, then, that these two people are both "free" misses an important difference between them.

The problem with this argument is twofold: First, it relies on a deeply flawed conception of what coercion is. If Wal-Mart were to go around making people poor and then offering to buy their fingers for $5,000 apiece, that would be coercive. But Wal-Mart doesn't make people poor*. They'd be poor with or without Wal-Mart and its funds-for-fingers offer.

So to say that Wal-Mart's hypothetical offer exerts more "force" on the poor is true only in a very broad sense of the word "force"—i.e., one that includes force of persuasion. The poor aren't having their options limited by Wal-Mart; they're having their options limited by being poor. By offering to buy their fingers, Wal-Mart expands their options.

Which leads to the second problem with this argument: It can be accurately summarized as follows:

Premise: It's terrible that some people are so poor that they might decide that selling a kidney is their best option.

Conclusion: Therefore we must make sure that they don't have that option.

The premise is tenable, but the conclusion—that we should make the bad situation the poor are in even worse by cutting off what they consider to be their best option—is absurd. A somewhat less insane conclusion to draw from the premise is that we should find some way to raise the standard of living of the poor so that selling a kidney becomes a less attractive option**.

The fact that we have not done this yet*** is not a legitimate reason to support a ban on kidney sales. The two issues are entirely independent of one another. If the poor are to remain at their current standard of living, they're made better off by being given the option to sell their kidneys. If we do find some way to mitigate poverty further than we already have, the poor are still made better off by being given that option. And it's very unlikely that legalizing kidney sales will prevent further attempts at poverty mitigation.

Really, there's only one tenable argument against legalizing kidney sales, and that is that the poor are, by virtue of their lower intelligence, simply not competent to decide whether or not to sell a kidney. While I certainly do acknowledge that the poor are, on average, quite a bit less intelligent than the middle and upper classes, I'm just not comfortable with that level of paternalism except in truly pathological cases. And I don't think there are many leftists who want to go down the road of deciding what rights should be denied to people with low IQs. Nevertheless, I will grant that this argument is at least logically coherent.

It's worth noting that this refutation applies to all arguments that take the form of "It's coercive to offer the poor money to do X."

Via Ampersand.

*Yes, I'm aware that many leftists believe that Wal-Mart does just this, but they're too far gone to bother with.

**Actually, since most people put a very high value on not dying, this would most likely just result in an increase in the market price of kidneys, and the kidneys would still come from disproportionately from the poorest among us. But I'm assuming that there's some absolute standard of living high enough that most left-wing opponents of kidney sales would drop this particular objection.

***In fact, we have a truly excellent poverty mitigation program which has increased the poor's standard of living severalfold in the last century, and several others which have increased it moderately beyond that. (I am of course referring to capitalism and to various government welfare programs, respectively.) What I mean is that we haven't mitigated poverty enough for people to stop making this argument.

Loss of health care freedoms

As I said below, Americans are finding out that actual health care reform won't be easy, and there will be the same kind of backlash that I vividly remember from 1993. Shawn Tully writes the kind of article we are going to see more and more of:

The Senate bill requires that Americans buying through the exchanges -- and as we've seen, that will soon be most Americans -- must get their care through something called "medical home." Medical home is similar to an HMO. You're assigned a primary care doctor, and the doctor controls your access to specialists. The primary care physicians will decide which services, like MRIs and other diagnostic scans, are best for you, and will decide when you really need to see a cardiologists or orthopedists.

Under the proposals, the gatekeepers would theoretically guide patients to tests and treatments that have proved most cost-effective. The danger is that doctors will be financially rewarded for denying care, as were HMO physicians more than a decade ago.

That's right-- to control costs, you actually have to spend less money. And if the government is the rationer, by definition Americans will have fewer choices.

Free advice to anyone looking to quash health care reform: Recite the above two paragraphs in as many settings and media as possible over and over again. Nothing else could be more powerful.

Is there any reason why I shouldn't wish a slow, painful and agonizing death to everyone involved with

I don't know anything about it except that it appears on my screen without permission and f*cks up several times a month and randomly blocks access to real blogs.

Regards, Don

Free torture

David Theroux links to Harvey Silverglate's opposition to prosecutions for the CIA torturers.

This caught my eye:

... A CIA agent, operating in good faith, could readily consider such DOJ advice to be a binding legal opinion that he could safely follow. And in our legal system, based on an ancient Anglo-Saxon moral and legal tenet incorporated into our own criminal codes, a wrongdoer may be punished only if he knowingly and intentionally committed an act that he believed to be illegal. Given the facts and circumstances - the nation had just withstood the worst terrorist attack in its history and was being led by a president who suddenly declared a full-scale "war on terror" - it is inconceivable that any criminal jury in any American jurisdiction could, would, or even should agree unanimously (which is what it takes to convict) that an agent, acting in accord with DOJ legal advice, is guilty beyond a reasonable doubt (another prerequisite for conviction). These are legal realities often missed by those outside the practice of trial law.

I don't know exactly what training the CIA gives its personnel, but I'm sure they must cover the rules about what is permitted and what is forbidden. With that in mind, it's a flimsy defense to hide behind the DOJ. These operatives are trained professionals. To say that a specialist in interrogations operates in good faith when the DOJ all of a sudden allows him to do something he'd previously been unable to do is almost laughable. What if the DOJ were to declare some form of torture legal that even the most bloodthirsty Republican couldn't abide? The Nuremberg defense just wouldn't hold water in that case.

Either things are legal because the DOJ says they are, or agents need to take some individual responsibility.

National Health Care and Innovation

Megan McArdle has a very long, very good post about why she opposes national health care. In a nutshell, she thinks it would have a deleterious effect on innovation. I agree with her, but here's a simpler "proof" of why I think she's correct: How many times does Obama (or any other supporter for that matter) mention improvements in innovation as a motivation for health care reform?

Politicians, generally speaking, will promise that any particular program will deliver a cornucopia of riches if there is any remotely plausible rationale. So if they fail to mention a potential benefit, it's either because (1) there's no good argument for it, or (2) they think the public doesn't care.

(2) strikes me as possible, but pretty unlikely. Although a depressing number of comments on McArdle's post take an extraordinarily blase attitude towards the importance of new medicine, I still think most Americans see the potential benefits of innovation. Think back to the embryonic stem cell debates. How many times did politicians trump them as the cure for virtually any disease you can think of? At least in that context, the public seemed to care a great deal about curing Parkinson's.

So I think we're left with (1). I think people can, and do, make reasonable arguments about why national health care would be cost saving, and more short-run efficient (I believe those arguments are wrong, but not self-evidently stupid). But the arguments that it wouldn't harm innovation mostly amount to some handwaving about the NIH and the evils of pharma advertising.

Don't believe me? As of right now, there are 165 largely hostile comments on McArdle's post. I did a word search for "innovation", after having trudged through the entire thread. Only one pro-nationalized care poster used the word trying to defend national health care, and it was basically "what about the NIH"? That is not an argument.

If the left thought national health care was pro-innovation, for sure you'd be hearing about it, but you're not. What does that tell you?