Bryan Caplan  

What Do We Owe the Deserving Sick?

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Friday's Rant... Gary Becker Interview...
The main recurring question in the comments on the Separation of Health and State Debate: What do we owe the deserving sick?

Garett Harmon writes:
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.
Josh K asks:
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?
Like David Balan (much to my surprise), I think that the distinction between the deserving and undeserving poor is important.  Forcing people to help the undeserving poor seems clearly wrong to me.  Forcing people to help the deserving poor is a harder case.

In the end, though, my attack on what I call the Family Analogy undermines any legally enforceable obligation to help strangers, regardless of how deserving they are.  If it should be legally permissible to turn your back on the parents who gave you life, then it should be legally permissible to turn your back on complete strangers, however awful and undeserved their plight.  It might be wrong to refuse to help, but you're within your rights to do so.

Another way of thinking about it: If someone is sick and/or indigent due to their own irresponsible behavior, it's fair to turn them down with, "I'm sorry you're in trouble, but it's really your own fault."  If someone is sick and/or indigent despite exemplary behavior, it's fair to turn them down with, "It's terrible that you're in trouble through no fault of your own.  But you're not in trouble through any fault of mine, either."

Nathan Goldschlag asks:
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?

Few moral principles can be known with complete certainty.  Whatever you think about involuntary charity, however, it's got to be less justified as voluntary charity becomes more abundant.  Using coercion when there's no other way to get the job done is less objectionable than using coercion when there are other ways to get the job done.

Nathan adds:

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

I do, but I've got to admit that private charity hasn't done much to eliminate dire poverty in the Third World - and I can't blame the largely non-existent international welfare state for the problem.  Private charity is a realistic substitute for our welfare state, but not a realistic solution for global poverty.


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COMMENTS (21 to date)
AC writes:

I think your analogy makes sense, but from a practical policy point of view, the vast majority of people simply don't accept that the coercive nature of taxes is a bad thing in itself (of course, that doesn't make an argument for it).

Kurbla writes:

Bryan: If it should be legally permissible to turn your back on the parents who gave you life, then it should be legally permissible to turn your back on complete strangers, however awful and undeserved their plight.

If you pay for all members of the society, then your parents are included. So, with public health system, it is not allowed to you to turn your back to your parents. And what if your parents are left in some other country? I think they have the right to apply for citizenship, don't they? It appears everything is solved.

And why you are forced to pay for complete strangers? Here it goes: not you, but society as whole decided it - as whole - will help all its members. Society made this decision due to some combination of moral and utilitarian reasons. You didn't liked that decision, but you was outvoted.

Of course, your next question is "why I have to be member of that society? Why I'm forced to obey? I do not want to be member of such group!" The answer is - you do not have to be. But in that case, you must leave the territory owned by society. (We usually say "state", but state is not essential here, because in small groups, one can be expelled from group and its territory even without state.) It is actually that same Rothbard's cinema owner argument.

Nathan Smith writes:

The argument that we have an obligation to help the less fortunate, even at the cost of using coercion to take resources from unwilling, wealthy people would have some force if it were applied globally. I would probably lean against *international* socialism, but I'd recognize some moral force on the other side.

However, setting up a worldwide social safety net-- *national* socialism-- is not feasible.

I don't understand how anyone could think that there's an obligation to help needy AMERICANS, even at the cost of coercion, when foreigners are much worse off. Suppose I have $1,000 to spare and plan to donate it to charity to buy 1,000 bednets to sav 1,000 Mozambican children from death by malaria. The IRS comes along and says: "Sorry, we're taking that to keep a senior on Medicare alive for another year." How can this be anything but evil?

International socialism is a beautiful dream. National socialism is a cynical rationalization for abuse of the power of the vote.

Lekowitz writes:

Kurbla,

Isn't the logical conclusion of your second paragraph that 50% + 1 members of a society can do anything to the 50% - 1 members?

Also, if you include all humanity in society they haven't all decided on this outcome. If you don't, then what principle do you use to distinguish between one society and another: national boundaries, religious, ethnic, or racial divisions?

Finally, to your third paragraph. If every other society on Earth is sufficiently evil, I wouldn't want to move away from the relatively less evil society, but that doesn't justify what it does to me.

PrometheeFeu writes:

Again, I think that the analysis is not complete until you have dealt with the issue of the right to security. What is the difference between paying a police officer to prevent a killer from breaking into your house and killing you and paying a doctor to prevent a disease from entering your body and killing you?

In the first case, I think nobody in their right mind would argue that you should have just purchased a gun. But in the second case, there is an argument which is made that you should have purchase health insurance. Why the difference?

N. writes:

This is how libertarians get the reputation for having cold hearts. Bryan's argument may be moral, it may be rational, it may be true and correct, but from a signalling perspective it is cruel, full stop, and for that reason alone it isn't going to win any friends -- you know, friends, the groups of people who make up communities, societies and nations that propose and attempt to implement and enforce this kind of legislation.

Bryan may be right, but from a practical and political perspective (that is, from a human perspective), it just doesn't matter. At all.

RL writes:

I think the argument for those born with undeserved illnesses (which, BTW, is a small minority of illnesses) must be similar to those born with other morally undeserved conditions. As I commented on an earlier post, some are born destined to be quite short. This has been measured in many economic papers as having a very detrimental effect on one's earning potential and mating potential. Yet no one is calling for government programs to pay for human growth hormone injections to save these people, something easily done if we chose to. Similarly, no one is calling for government payment for plastic surgery for ugly people, whose undeserved condition also negatively impacts both their earnings and lovelives.

jstaples writes:

PrometheeFeu,

Your analogy just doesn't hold up to scrutiny.

Despite all the recent talk of "preventative healthcare", there really isn't much a doctor can do that is preventive in nature. I can talk to my patients about managing their health until I am blue in the face, but in the end they go home and do whatever they want.

We don't need doctors to come to our homes and tell us to turn off the TV and go outside. We don't need doctors to tell us not to eat at McDonalds everyday. Apart from vaccinations, what exactly are doctors capable of preventing?

If your argument really is that it is the government's job to prevent disease, what you should be in favor of is government provided personal trainers and federally subsidized dietitian/chefs for every family.

Your analogy is an argument for the nanny state, not for socialized medicine.

Loof writes:

The family analogy fails by confusing positive law and natural law. While responsibility to parents has remained in natural law, the origin of legal responsibility for children in positive law is Roman. The family father had to accept a child and give it a legal name or it was exposed to the elements. It was his legal right to expose “it”: an object to be tossed aside without human rights in natural law that parents had. To civilized people this was barbaric and the law was reversed. Incongruously, the reversion with a family analogy makes “the undeservedly sick” objects without human rights.

In discussing this issue in India, some people still excuse away human rights and justify not helping others. To them it’s karma. No such thing as “undeservedly sick”. Sick people deserve to be sick, poor people poor, etc. due to negative behavior in past lives.

"What do we owe the sick?" is a moral question, and completely legitimate when it is a discussion among free men to voluntarily address that need.

Whatever the conclusion about that morality, it is immoral to pull out a gun and take resources from others to give to the poor, taking a good bit for oneself along the way.

It doesn't matter that there are 100 men backing up the gunman, or that they voted for the gunman, or that the 100 threw $5 into the pot while they take $100 from the one "able to pay".

It becomes ludicrous when the $100 is distributed not only to the needy, but to anyone who can contribute a vote to keep the gunman in business, with some spoils distributed to the crowd.

It is insane when the policy of "charity by gun" leads to a generally poorer society, so that people are worse off in general than if the charitable coercion were not operating at all, and worse off by a multiple of the forced charity collected.

The only justification for taking from "the rich" is that the rich got their resources in an illegal way, essentially by stealing. There is no explanation for taking only 50% of the ill-gotten gains, rather than all of them, and not putting the thief into prison.

In commiseration, if you watch goverment at work, it is easy to think that all wealth does come from cheating, scheming, and special favors.

The final laugh is that the crowd in support of the gunman would drop their "humanitarian" support in an instant, if they realized that they were all paying for that support in lower pay and fewer opportunities, or if they were also forced to contribute as little as 10% of their income to help the sick.

Kurbla writes:

Lekowitz:

Isn't the logical conclusion of your second paragraph that 50% + 1 members of a society can do anything to the 50% - 1 members?

Yes, if there is the right to exit. If there is the right for exit, it shouldn't be the problem.

One might say that leaving territory causes lot of discomfort. It does - but issue is any land property, not collective or state property specifically. If my landlord start requiring something odd - I have exactly the same problem.

Also, if you include all humanity in society they haven't all decided on this outcome. If you don't, then what principle do you use to distinguish between one society and another: national boundaries, religious, ethnic, or racial divisions?

This moment, the citizens of USA make collective decisions. Why exactly that group - and not some other? Only answer I see is: the freedom of association. At this moment, this is how people want. Citizens of USA can decide to allow other people - to join in the process of making collective decisions. As EU does. Or, they can decide to split on two or more groups - like citizens of Russia and Ukraine did.

If every other society on Earth is sufficiently evil, I wouldn't want to move away from the relatively less evil society, but that doesn't justify what it does to me.

I might agree with you. But, that is the problem with property in general, not with collective or state property in particular. The same critical is valid if the world is divided between landlords, instead of societies. If every other landlord on Earth is sufficiently evil, I wouldn't want to move away from the relatively less evil landlord, but that doesn't justify what it does to me.

roversaurus writes:

Certainly we owe the deserving poor.

God commanded us to help the poor. This is a Christian nation and we should encode that moral structure into our laws.

Josh Weil writes:

@roversaurus

Who owes whom what? What is poor, and does your definition change over time? What proof do you have of God's existence? Why should we legislate your version of morality?

Steve Roth writes:

Bryan, I think this confutes the issue of individual rights and deserts with the question of utilitarianism and efficiency (Hansonianism).

If government redistribution does a better job than charity of creating a prosperous society with widespread well-being, it is reasonable for society to choose that system (via voting), and enforce it on all--including those who would prefer to benefit from that system without contributing their (full) share.

On your previous:

If it seems unrealistic to rely on donations to provide for the poor, consider: Back in the era of established churches, wouldn't it have seemed equally unrealistic to rely on donations to provide for religion?"

Centralized, hierarchical religious institutions, and the human tendency to support such institutions, show all signs of being emergent properties of a system that has us (humans) as its components. (Perhaps due to our innate predilections for group-ness and pattern-matching/meaning-finding--but in any case.)

This is not true for large-scale charity. The historical evidence seems to suggest quite the contrary: run the system, and what results is highly concentrated hierarchies of money and power.

Some of us would argue that the only way to counter that system's "innate" emergent properties is to create group compacts running counter to that system's (and many individuals') innate properties--for the good of everyone, rich and poor alike.

This will inevitably allow some (many) "undeserving" people to cheat and leech off the system (others). But (especially as cheaters will always be with us--cf. Wall Street), it's worth it.

Jeremy, Alabama writes:

I strongly agree that "moral obligation" is irrelevant compared to whether we have a "legal obligation", where somebody sticks a gun in my face and takes my stuff. If we were only helping the truly poor/sick, either charity or taxes would work just fine, but once the machinery of coercion is in place, governments do not know when to stop themselves.

The realistic solution for global poverty is a) for them to fix their own governments and b) for our own government to get out of the way of them exporting to us.

Allan Walstad writes:

Kurbla: "Society?" Who dat?

PrometheeFeu: "What is the difference between paying a police officer to prevent a killer from breaking into your house and killing you and paying a doctor to prevent a disease from entering your body and killing you?" .... First of all, the police don't generally prevent killers from entering houses and killing people. They investigate murders and other crimes, apprehend criminals, and make it possible for them to be prosecuted and punished. If you really, really want to defend yourself from a home-invading killer, then you need a gun, you need to keep it loaded and readily accessible, and you need to practice and know how to use it. A better example for you might be national defense. The main point is that police, courts, and national defense safeguard the framework of individual liberty within which we can all pursue our individual purposes through our own efforts allocated according to our own priorities. Our liberty against aggression stands or falls together in a way that our medical care certainly does not--unless we were talking about, say, the spread of a highly contagious disease.

N.: "This is how libertarians get the reputation for having cold hearts." .... We have cold hearts because we oppose robbery and coercion, because we recognize the long-term superiority of free markets in making people better off by&large, because we want individuals who are concerned about others to have the maximum opportunity to allocate their own time and money to helping them? Nonsense. The problem is, once you allow in principle for people to be robbed to pay others' living expenses, there is simply no place down the slippery slope to dig in your heels. Eventually you get to where everyone's income and property are treated as a commons to be plundered by majority vote.

Kurbla: "This moment, the citizens of USA make collective decisions." .... So why don't they have the enforceable obligation to make a collective decision to send 50% of their wealth to aid the indigent in other countries?

Kurbla: "...freedom of association." Huh? How does freedom of association translate into my being robbed and coerced by politicians? That is the very antithesis of freedom of association.

Kurbla writes:

Allan:

Society, in this context - group of people who interact and enforce rules of interaction. In large societies, such rules are enforced mostly (but not exclusively) through special organization - the state. But essentially, it works on the same way without state. Small, primitive societies directly enforce their rules, and even today, citizens will on their own prevent some forms of crime, without calling police.

This moment, the citizens of USA make collective decisions." .... So why don't they have the enforceable obligation to make a collective decision to send 50% of their wealth to aid the indigent in other countries?

Because they own the territory you live on and not vice versa. If I want to live in your house, I have to accept your conditions. If I do not like these conditions, I can leave. If you do not like tax or draft or whatever your society enforces on you, you can leave their territory.

Of course, one can deny such ownership over territory. How is that they own the territory and not me? And guess what, you're right - but the problem is that same arguments can be applied against private property as well. So, it is criticism of any property, not state or collective property specifically.


Kurbla: "...freedom of association." Huh? How does freedom of association translate into my being robbed and coerced by politicians? That is the very antithesis of freedom of association.

First, politicians are not important here. The citizens are - you live in state, and not in anarchy because great majority of citizens want state and not anarchy, and they vote and support adequate politicians.

Second, you have your freedom of association. You do not like this particular society that enforces tax over you? Fine, just leave the group, and leave its territory. You have no good place to leave? I understand, but hey - if you are my landlord and I do not like your conditions - is it your responsibility to find the better place for me?


Allan Walstad writes:

Kurbla: Suffice to say that I think you are hopelessly confused, but it's rather late in this thread and will take too much time out of my workday to argue through all the points. It is individuals who think and act. If we say that society does this or that, it is only shorthand for the longer way of saying that certain things happen as the result of decisions and actions by many individuals operating under various constraints including power that they or others wield. What your posts boil down to is that there is power in numbers and as a general principle you approve of others in sufficient number using that power to rob and coerce individuals such as myself. No sale.

Kurbla writes:

What your posts boil down to is that there is power in numbers and as a general principle you approve of others in sufficient number using that power to rob and coerce individuals such as myself.

No, that is not my position.

but it's rather late in this thread and will take too much time out of my workday to argue through all the points.

No problem.

Alfred Centauri writes:

Steve Roth wrote: "If government redistribution does a better job than charity of creating a prosperous society with widespread well-being, it is reasonable for society to choose that system (via voting), and enforce it on all--including those who would prefer to benefit from that system without contributing their (full) share."

If slavery does a better job of creating a prosperous society with widespread well-being, is it reasonable to choose that system?

If a single unfortunate child must be kept in perpetual filth, darkness and misery in order for everyone else to live a prosperous happy life, is it reasonable to choose that system?

http://en.wikipedia.org/wiki/The_Ones_Who_Walk_Away_from_Omelas

*Reason* informs us every man is an end in himself, not a means to the ends of others.

DB writes:

Personally, I do not think the government should be allowed to take our money to pay for what and who they deem to be “deserving,” and of course, the definition of deserving will always vary from person to person. I think that people who are suffering due to circumstances that were out of their control should be helped, but by people who want to help them. Forced charity is not charity at all, and it infringes upon the personal freedom of the people who are having their money taken from them. If a person wants to give their money to a cause that they deem is good or justified, then they should have the right to do that, just as a person who believes that a cause is not justified should have the right to withhold their money and support. One point to be made for this case is that if people were not required to give money to so many different causes that are not of their choosing, then they would have more money to give to causes that they feel are deserving. It is just simple economics.

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