Bryan Caplan  

Debate Reactions?

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I had a blast at the Separation of Health and State Debate.  If you didn't attend, video will be posted in the near future.  If you did attend, I'd like to hear your reactions - and the best questions that weren't asked.  Who knows, maybe David Balan will join in the comments, too...

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COMMENTS (15 to date)
Garrett Harmon writes:

Professor Caplan,

You did a fantastic job debating. I thought you were engaging and persuasive. I think David did have several good points as well. Specifically, I feel like you sort of sidestepped the issue of what to do about people that require healthcare through no fault of their own. I know that personal responsibility plays a big role, but I didn't get a clear idea of what you thought should happen to people who were born with disabilities.

To be honest, many of the students' questions were long winded and poorly worded. I suggest that in future debates you require students to write down a question with no more than two sentences on a piece of paper. This will help them collect their thoughts. Some of the students just wouldn't stop talking.

Peter Twieg writes:

I was going to challenge you guys to make some solid predictions/bets on the effects of Obamacare, but David brought that up on his own during the questioning. This should be standard procedure for all of your debates!

Somewhat-tangentially, my dream Caplan 2011 debate would see you go up against John Nye on something. Just my vote.

Josh K writes:

My thoughts are along the lines of Garrett Harmon's. It seemed to me like the crux of the debate was whether or not we, as wealthy able bodied people, have any moral obligation to those who are less fortunate than ourselves. Do you think we have a duty to the deserving poor? Why or why not?

I also agree with Garrett Harmon about the student questions. That format should be adjusted.

Garrett Harmon writes:

To be fair, Josh, I think Prof Caplan made a good argument that there wasn't a general case to be made for helping the poor. I was wondering specifically about those born with health defects. He stated that infants obviously shouldn't be held personally responsible, but he also never came out and explicitly said that the government has a moral right to provide for those cases.

Zac Gochenour writes:

I wasn't there unfortunately, but in response to the "should the government provide" question, it probably should be mentioned that the government must first steal to then provide. Also note that even if helping the poor by stealing from the rich was morally acceptable, there are better ways to do it than a multi billion dollar subsidy program for adverse selection.

William Bruntrager writes:

Balan argued that if everyone had exactly the same health care demand, it would be reasonable to expect government to pay for health care for the poor. Then, since the only difference in the real world is that health care demand is subject to random disturbance, government should pay for people who are "born sick."

Sure, if you assume away even the possibility of inefficient overproduction of health care, it's much easier to make the case for government involvement.

I thought someone should have asked Balan whether it is important that the demand for health care, like the demand for everything else, is not perfectly inelastic.

Also, it wasn't clear to me what Balan was defending. I would have liked to hear him say yes, we should abolish licensing, the FDA, and the de facto insurance cartel, but there will still be a role for government at that point, and talk about what that would be.

Eli writes:

I had two related questions for David.

First, what framework of morality are you working with? You said a lot of things were immoral as if it was self-evident. For a lot of us, morality is not self-evident, and we would like to know where you are coming from. Also, we can't make fun of your beliefs until we know what you believe. ;-)

Second, there was very little discussion of opportunity cost. Government involvement in health care tends to be expensive, and a lot of other good things could be accomplished with those expenditures. For instance, instead of spending money to keep your sick, irresponsible uncle alive, we could induce people to create perhaps 10 new humans, most of which would be healthy and some of which would be responsible. Would that not be a better world? If not, is no better use of the funds conceivable?

Nathan Goldschlag writes:

I very much enjoyed the debate.

I had one lingering issue though. I asked a question to you Bryan, and I do not think I had articulated my point or question well. I had asked about what social safety net you may support, if any, and how you feel about the roll of altruism.

What I was really getting at was whether or not you believe in ANY involuntary contribution via the use of force to support the destitute. If not, do you believe that your view is in any way dependent upon altruism filling the gap, and that many of the destitute will in the end be taken care of by the voluntary contributions of the community?

Do you subscribe to the idea that the welfare state crowds out private charity in a large way?

Brandon Minster writes:

I enjoyed the debate. I think David did a great job in front of a less-than sympathetic audience. My only suggestion for future debates would be to work out the microphone situation better. They might as well have not been there at all.

Telnar writes:

I think most people in America (and probably even most people in the room) share David's moral intuition that we have some obligation to help those who are sufficiently deserving and sufficiently in need (although there would be more disagreement over whether government is a good vehicle for that assistance). That seemed like a well chosen starting point.

What I don't think was equally effective was the linkage between the desire to help an unspecified group of very poor people (I'll skip over the question of whether it's at all reasonable to include any significant number of Americans in that group) and the desire to provide that help in the form of health care.

Conceding and excluding extreme cases like vaccination against infectious disease, the empirical record of government at providing health care in a cost effective way is relatively poor. One reason for this is that government provided health care almost always narrows the range of available choices compared to what one would see in an unregulated market.

The range in prices and qualities of available television sets is vastly wider than the range in prices and qualities of available medical services. This leads publicly provided health care to have a high minimum cost in the vast majority of countries. The exact minimum cost varies by country, and it may be that the voters in a country like the UK are more open to using government policy to reduce health care availability than US voters are (whether because Americans are richer, have different moral intuitions, or have a constitutional system which creates different political incentives for elected officials).

If you believe my argument that increases in government involvement in health care will in practice (and here I think that I can get away with empirical evidence even though the resolution is theoretical, since the public choice question of how governments behave is a big part of the decision of whether to use government), then having government heavily involved in health care (as opposed to providing cash to the poorest which can be used for health care, or perhaps even Robin Hanson's suggestion of "health stamps" analogous to food stamps which can be used to buy health care in an unregulated market) poses a serious problem for those of us with moral intuitions which suggest non-zero levels of per capita support for the very poor which are significantly lower than those which actually occur in countries where the government is heavily involved in health care, since the lower price and quality services needed to provide more limited health care support will be much less likely to exist as an indirect result of significant government involvement.

If I were going to phrase this as a question, it would be "David, do you expect that the range of available prices and qualities for health care will be likely to be compressed as a result of government involvement, and do you see that as a good thing?"

Overall, I thought the debate was very good and it benefited from the degree to which both debaters were operating in a similar framework if with different values.

Brian writes:

Considering 160 years ago California was sovereign territory of Mexico and the U.S. took it in a war. There is no difference between that and E Jerusalem other than the time period is less with Israeli. I do think the historical claims from a modern proprety right stand point are silly though.

As far as the article's Historical and Archeology claims, it is a bunch of ignorant hogwash. True the Egyptians records are not strong but there are a few passing references to the Israelites. The Siloam inscription for one shows that the Jews had authority over the city in the 8th century.

Brian writes:

I thought that David did a weak job of making his case. For instance, he said that he was overjoyed with the passage of ObamaCare, but I don't remember him saying one thing he actually thought it would do that was beneficial. Also, he disregards most of the unintended consequences of government involvement in health care. Basically, he waved his hands and said that the deserving poor deserve free medicine and thats that.

Here are a couple of unanswered questions that I would pose.

1. Most individuals with HIV/AIDS have gotten their condition because of irresponsible behavior. I believe that antiviral drugs that sustain these individual's lives are wonderful advances, but are these individuals entitled to these drugs subsidized by more responsbile individuals? Doesn't it set up a moral hazard problem.

2. David is apparently comfortable with individual mandates to health insurance even though health care has a weak correlation to health. Why not mandate that all individuals join a fitness club instead? This would probably be a much cheaper alternative and would probably be more effective at promoting health.

3. Finally, most government-provided health care goes to the elderly and not the poor. David didn't address this Caplan point at all.

Swimmy writes:

David held his own pretty well. His moral intuition was fairly appealing. He made some major mistakes, though. His first rebuttal to Bryan maintained that high rates for sick people are the major problem for government to solve. But during the Q&A, he hinted that high prices were due to adverse selection. These views are not very well compatible. He did a poor job defending his health care paternalism relative to to a cash option to sick people. Of course, this wasn't a debate about paternalism, but he seemed perfectly willing to concede that much medicine was wasteful, and that medical error kills a huge number of people, yet refused to admit that health care policy should be less paternalistic because of these facts. He said that the government can do things to relieve medical error. But this ignores the fact that the government often protects hospitals from publishing mortality statistics, thereby encouraging medical error! Furthermore, medical licensing makes the firing of negligent doctors much more expensive than it otherwise would be. And if Robin Hanson is right about the root cause of this problem (people don't WANT to know mortality rates because medicine is about signaling), then democratic politics will do nothing to alleviate the problem. (I didn't press him on this point as it wasn't my debate, but I think it's a major problem for his position.) Finally, he was a little too big on emphasizing what was and was not politically "practical," undercutting several of the things he said he would like to do--means testing, cutoff points, funding for certain types of research, etc.

Bryan made a couple of tactical errors. He took on a list of standard insurance market failures and showed that the government was the source of many of them. But he never countered a few of David's other premises: the need for non-profit research into non-patentable medicine, positive externalities from a more-healthy labor force (a point Caplan has made on this blog to combat Greg Clark), and I think there might have been a couple of others. Bryan also made two claims that require substantially more evidence than he provided in the debate. One was, "Give the government an inch and it takes a mile." The evidence he used was the progression of government intervention in the U.S. since its small beginnings with vaccinations. But this doesn't imply a necessary progression--the American public gave the government a mile. In Singapore, it appears the public has given the government a half-mile, and it does rather well. The second was that the principle difference in immigration policy between today and earlier periods in American history is the existence of the welfare state. Public opinion has changed a lot since then, and I'm not convinced the only major obstacle to immigration is welfare.

David J. Balan writes:

Hey folks,

Thanks for the comments. I'll post some replies over the weekend.


PrometheeFeu writes:

I would like to point out that there is a libertarian argument for government provision of healthcare. And that is the imperative to provide security. I think that if you agree that we should not let someone break into your house and shoot you in your sleep even if you "chose" to live in a seedy neighborhood, it makes sense that we shouldn't let you die simply because you caught some disease. There is little to no practical difference as to the implication for your security to let you get shot, starve or die in some other way you did not seek out.

Furthermore, I would like to point out that people do not choose to be born rich or poor. And while there is always the possibility to raise your lot in life or lower it significantly, there is substantial statistical evidence that people who are born poor will be poor their entire life. As such, speaking of their personal responsibility in the fact that they are poor and therefore cannot afford health insurance or healthcare is a bit far fetched.

Now mind you, I am not saying that your position is one that is entirely unsound, but I think that we live in a gray world where the principles of freedom you believe in and which I share do not inevitably lead to the conclusion which you espouse.

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