Consequentialism, Libertarianism

The Libertarian Three-Step Program

Wolf Blitzer: You’re a physician, Ron Paul, so you’re a doctor. You know something about this subject. Let me ask you this hypothetical question.

A healthy 30-year-old young man has a good job, makes a good living, but decides: “You know what? I’m not going to spend $200 or $300 a month for health insurance because I’m healthy, I don’t need it.” But something terrible happens, all of a sudden he needs it. Who’s going to pay if he goes into a coma, for example? Who pays for that?

This is the kind of question that libertarians usually give stupid answers to. Their first impulse is to stress that no one has the right to force other people to pay her medical bills – which is true enough, but a weird place to start. This answer in effect treats the free market as the present system minus welfare, and so takes for granted that the problem described is likely in a free market. It also casts the sick person as a threat to others’ liberty rather than as a person who can be better helped by libertarian methods than by statist ones. If someone is looking to smear libertarians as people who want to let sick people die, this hands them the opportunity on a platter. (Of course it doesn’t help if your alleged supporters are actually yelling in the background that the patient should die.)

Most libertarians’ second impulse is to mention charity. And their third impulse, if they ever get around to it, is to mention the point they should have led with – that the high cost of health care is a product of state regulation.

In the last Republican debate (transcript here), Ron Paul went through the three stages in depressingly predictable order. First, demonising the victim:

Ron Paul: Well, in a society that you accept welfarism and socialism, he expects the government to take care of him. … But what he should do is whatever he wants to do, and assume responsibility for himself. My advice to him would have a major medical policy, but not be forced …. That’s what freedom is all about, taking your own risks.

Next, he finds his way to charity (though with a bit of stage one still mixed in):

Ron Paul: I practiced medicine before we had Medicaid, in the early 1960s, when I got out of medical school. I practiced at Santa Rosa Hospital in San Antonio, and the churches took care of them. We never turned anybody away from the hospitals.
… And we’ve given up on this whole concept that we might take care of ourselves and assume responsibility for ourselves. Our neighbors, our friends, our churches would do it.

And only then, finally, does he get around to talking about the structural problems caused by corporatist regulations. Now to his credit, he does actually get to stage three, where many libertarians would not. But leaving it to the end forces him to rush through it with no pause for explanation:

Ron Paul: This whole idea, that’s the reason the cost is so high. 

The cost is so high because they dump it on the government. It becomes a bureaucracy; it becomes special interests. It kowtows to the insurance companies and the drug companies, and then on top of that, you have the inflation. The inflation devalues the dollar; we have lack of competition. There’s no competition in medicine. Everybody is protected by licensing. And we should actually legalize alternative health care, allow people to practice what they want.

But when you lead with stage one, that’s what people will remember; adding stage three as an afterthought will leave far less trace in people’s thoughts.

The right way to answer a question like Blitzer’s is to proceed in precisely the opposite order. Start by asking what causes people like the hypothetical patient to be in the plight they’re in. In other words, lead with stage three. Why didn’t the patient buy insurance? Because the price was too high. Why is it so high? Talk about the specific ways in which corporatist policies drive up medical costs (and disempower the poor in other ways too).

Then, if you still have time, proceed to stage two. If someone doesn’t have insurance and needs care, what’s the most efficient way to get it to them? Talk about how charity and mutual aid are more efficient than government welfare, and how we therefore need to shift the venue of assistance from the latter to the former.

And then you can finish by pointing out that peaceful, voluntary solutions are not only pragmatically but morally superior to coercive ones.

I’m not saying that one should generally stress consequentialist over deontological considerations; it depends on the issue. But this is one of the issues where starting with the deontological issue is overwhelmingly likely to be heard as Scrooge-like, and that perception will colour and even obscure whatever you go on to say after that – which is, predictably, exactly what has happened in the aftermath of Paul’s answer in the debate.

This impulse to start with stage one is a strategic and rhetorical error on libertarians’ part; but I don’t think it’s solely that. I think it’s a symptom of incomplete emergence from a right-libertarian paradigm. The first impulse is to approach the issue as though our current system were a free market or close to it; and the left-libertarian point that it is no such thing is added as an afterthought because it is an afterthought. The problem is with the vision itself, not just with a strategy for conveying it.

I don’t mean this as a rant against Ron Paul. As I said, the fact that he does advert to anti-corporatist considerations at all is a point in his favour. (I have other problems with Paul, but sufficit malitia diei sua.) But his recent answer on medical care was a highly visible instance of a widespread libertarian problem.

Published on:
Author: Roderick Long
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  • Anonymous

    In fairness to Paul, an interviewer whose first question starts out “You’re a physician… so you’re a doctor” isn’t exactly Mensa material either.

    • I think it was a conversational-segue “so,” not an inferential “so.”

    • Anonymous

      It’s not a contest. Wolf Blitzer isn’t running for president. And most people in the USA will ask far dumber questions than that.

    • Puzzled

      A physician is a type of doctor. Thus, it makes sense that being a physician implies being a doctor.

  • Kyle Walker

    I agree he answered in the wrong order, but research on the serial position effect shows that people are most likely to remember things that come at the beginning and at the end.

    Description of SPE here:

    Given that this is the case, it might be better to answer: 1.) costs 2.) coercion 3.) charity.

    • Yes, but when one is giving brief answers in a debate one can’t count on getting to the third point, so one should frontload the important stuff.  (The same applies in job interviews, or any venue where the likelihood of getting interrupted is high.)  If one has a fair bit of time and can count on not being interrupted, then yes, there’s a case for moving an important point to the end.

  • Elizabeth Bernard

    I think what is most pertinent here is what is obvious in EVERY appearance that Paul makes where he is pressed for time:  He is NOT good at talking points, in fact, he is SO bad at it that it is surprising he has any success at all.  I don’t place any weight on the order of his answers.  I am just grateful he gets the answer out at all.

  • Hyena

    You lead with what Paul said because it is not an empirical claim. Unless you have a reason to believe that no one would be unable to afford any form of medical care absent government regulation, then you must admit that the premature death of many people is to you an acceptable outcome. There is no escaping this conclusion.

    • Agreed.  Sometimes bad things happen. We can still argument that under our preferred setup there would be fewer bad things and/or those things would be less bad.

      • Hyena

        Yes, but now you’ve given up the principle and are negotiating the price.

        • All else is posturing.

    • The only premature death is that caused by malicious intent or gross negligence of another human being. Health care creates the postmature death of those who acquire illness naturally or statistically. Natural death, even before reaching the average  “life-expectancy” is an acceptable outcome. And I’m a doctor.

      • Hyena

        I’m so glad that my ancestors did not agree with you. I quite like living in a technological society wherein we’ve inherently decided (why else invent) that these outcomes are unacceptable.

        I do hope that you one day either see the light or remove yourself to some place where you can live with and as the beasts.

      • Anonymous

        You are just playing with words, not meaning. By premature, most people mean “medically preventable with modern technology at a reasonable price and by non-heroic means.” That does not flow off the tongue quite as easily, though. 

        Also, even if you were trying to offer something other than clever word play, your point remains dubious. Are you saying non-gross negligence cannot cause premature death?  

    • Nathan Stocker

      Right. And unless there’s nothing, absolutely nothing, that you think shouldn’t be done in pursuit of preventing as many “premature deaths” as possible, you also must admit that such deaths are acceptable to you.

      • Hyena

        They are unacceptable to me and they should all be prevented lest the prevention results in lives which are worth less than they would otherwise be to those who live them (i.e., others may not starve so that you might live, no keeping people alive if they would prefer death to the suffering the method causes, etc.).

        Anything less than this makes me wonder about your moral footing.

        • Nathan Stocker

          Just pointing out that unless you accept full-out, anything goes consequentialism, you also are negotiating the price.

          I’m not on about “should all be prevented”, but which *means* are considered fair-game in pursuit of that end.

          For the record, I’m not down with any ends that make fine and dandy with human suffering and death, but I’m also not down with means that make mere means of persons, either. And I don’t let the first consideration elide the second.

          • Hyena

            If you accept balls-out consequentialism, you are always negotiating on price. That’s kind of what defines the systems.

            I think you’d be hard-pressed to find any moral system which made “mere means” of persons. With any of them, I could always make a Bayesian move to eliminate the objection.

          • Nathan Stocker

            Yes, just like you could make an Orwellian move to make “coercion” into “cooperation”.

            BTW, I’m with you on organic governments. Just, if you think that characterizes the modern state, not so much.

            I’m also with you on what’s out of bounds for death prevention, but my sense is that I’d add on a few more to the list that — from where I’m meaning — I’d regard as regarding people as mere means, while you’d identify differently. I’ guessing I wouldn’t go as far as you would in all the directions you would, and I gather I regard many more things as outside my (or anyone’s!) bailiwick than would you. (My sense is also that you even pre-condemned me for even pointing out that there is no such thing as a trade-off-less choice or action when you were writing exactly as if there was, so I figure I’ll give you more sweets, here.)

          • Hyena

            Well, the Orwellian move woulf be invalid, merely redefining. The Bayesian move treats the system as an insurance function from which you have incidentally failed to benefit (just as if you never have a fire, you “don’t benefit” from fire insurance).

            I don’t think, and never have thought, that the “mere means” statement usefully picked out a concept. I would argue that value maximization requires agency, since it’s eudaimonic agents we seem most squarely concerned with. So anything which undermines that agency risks destroying value, the question is whether people realize more and more valuable freedom under some system.

          • Nathan Stocker

            The concept I take it to pick out *is* (in this context) disregarding
            others’ agency. Perhaps that’s just me. I mean it, I dunno – I’m just

          • Hyena

            Usually it means that you don’t benefit; IIRC, this is how Kant uses the term. Killing you for food is the ultimate “as a means merely”. The problem, as with most things like that, is it can be passed through filters to make it disappear.

          • Nathan Stocker

            BTW, and a day late, and of no import or utility anyway, I’m sure: this first paragraph here seems to display a basic communication breakdown (or disagreement). [Partly for the same reason your bullet-biting projection was off-target. I wasn’t trying to see if you’d bite the bullet, since I don’t think anyone’s really that silly. (Some are that monstrous, but y’no.) It wasn’t an attack, though you responded as if it was. I said my initial comment precisely because you’re *not* supposed to be that silly (or monstrous). Of course, you weren’t: you did indicate that yes, indeed, there were some things you’d rule out-of-bounds, even in pursuit of the least premature deaths. And glad to hear it, though I had no doubt.]

            To me, balls-out consequentialism means “For *that* end, what *shouldn’t* be done?!!” It’s exactly *not* negotiating on price because it ignores the price of the goal entirely. It’s a price/morality-no-object stance.

  • Tobias Franke

    While you are explaining this to the world, you should also be ready for the most common counterarguments:
    1) Why is healthcare more expensive in an ideal socialized system then in an ideal free market. Current situation is, that healthcare is cheaper in more socialized systems ( like Germany) and more expensive in more market based systems ( like the us ). Why would it be wrong to extrapolate here?

    2) Why is charity morally superior to safety nets? Psychological studies show that a reliable safety net is better for the mental wellbeing, and the risktaking needed for a mobile society. While an unreliable charity supports a static and caste based society, even if the average payout is higher. 

    3) Why is private charity more effective then government based ones. Studies about aid for Africa  show that government aid is more effective in helping people then private aid organizations. This is commonly attributed to the religious missionary attitude of private aid groups. Why can this not be generalized to all charity?

    • GaffiGubbi

      1. “Less socialistic” doesn’t mean “more market-based”. Regulations, licensing fees, employer-based insurance, patents etc. raise costs tremendously, and while many social democratic states have similar things in place, they are able to counteract that with price controls, subsidized drugs and premiums, resource pooling and other things. Reason Magazine editor Matt Welch and mutualist writer Kevin Carson, among others, have made the point that socialized medicine isn’t a terrible idea compared to the corporatist mess in USA, which lacks all the good things about free markets but also lacks the “socialized” part. That’s not a point against free markets.

      2. I would agree that a stable state welfare net is in many ways preferable to unreliable charity, but those aren’t the only two options. Mutual aid organizations can provide the stability of a state welfare net without the coercion, and they have in fact existed long before the welfare state came about.

      3. Umm… because not all private charity is religious? Your question makes no sense – does an organization like Doctors Without Borders have a religious agenda and attitude, and if not, why would you paint it with the same brush as ineffective bible-thumpers? I’d also like to see some of the studies you’ve read, because my understanding of government aid is that much of it goes straight to the hands of dictators and bureaucrats. Maybe that’s inaccurate right-wing propaganda, and there may be many instances of successful government aid, so I’d be happy to be proven wrong.

      Besides, international charity and local charity are two different things. The former has a joint objective of providing a living standard for poor third world citizens plus helping boost economic growth (the effectiveness of which is dubious), the latter is meant as a last resort for first world people in need.

      • Hyena

        “Mutual aid organizations” are what governments actually are when they arise organically.

        • By “organically”, I assume you mean “without coercion”. If so, I doubt most people here would consider that a “government”.

          • Hyena

            Yes, that’s exactly what happens and most people would recognize it as a government. It busies itself with the business of human welfare; when and where it existed, that mostly meant settling disputes, harvest pitch-ins, fire watch rotations and irrigation planning.

          • Tobias Franke

            So alliances in EVE are not governments. Even as they call them selfs communist nations, declare collective ownership of most goods, collect taxes and conduct wars?
            Just because they have less coercive ability over their members then a house owner has over his renters?

      • Tobias Franke

        1) But it, and your point too, is a point against all real changes suggested in the name of libertarianism. At least all I have ever seen.
        2) If both worked equally well I also would prefer free systems. But historical reliable ( which usually means able to blackmail the populace when things go bad
          (generally indirectly through the government)) systems have usually abused their power to assume all negative aspects of a government. 
        3) This leaves you with the problem that free charity is still less efficient. Unless you want to forbid religion, like the Andrew Ryan model. And even then it might turn out that to be caused by an incompatibility of free markets with a service like charity.

      • Much of the high cost of US health care is a creation of the health care industry which the federal government allowed to happen.  Prescription laws were passed in 1938 because these laws benefitted doctors.  Gave them higher incomes than what they had before because with these laws, people had to pay the doctor to write a prescription for something that beforehand they only had to pay the actual of.  One very obvious example of this is heart worm pills for dogs now require a prescription.  The only one who benefits from this is the “vet”.  Added money in their pocket.  The economic term for this is “rent seeking”.  That is you have to get “permission” (which you have to pay for) in order to do something.  Rent seeking is something governments have been doing for a long time.  However organized groups of individuals now can do the same thing.  It is an economic benefit to the to the “rent seeker”, and is a net loss to everyone else.  Health care without government involvement would be much cheaper.  No just with prescription laws, but with everything else relating to health care.  The major difference between the US system and the systems used in the rest of the developed world is that their governments act on behalf of their people, while the US government is more the “tool” of the organized well off. 

        • Anonymous

          When you compare the two systems, health insurance was invented in the US to secure the provider (a hospital) of revenue via contracts with employers/companies (bigger companies had better deals), while in Europe health insurance was started to secure an individual for unexpected costs .  

    • 1) “Cheapness” of healthcare is a function of how much you allow people to consume. Just comparing dollars (or euros) spent does not mean anything. If you mandated a limit of only one doctors visit per person per year in the U.S. regardless of ailment, you would make our system “cheaper,” too.

      2) I’m not being snarky here, but my 8-year-old son knows why charity is morally superior to safety nets. I asked him these questions:
      Q1:  “If I have some extra money, and I give it to people who use it to feed the hungry, is that a good or bad thing?”
        His answer: “That’s a good thing.”
      Q2: “If a man points a gun at me and says, ‘Give me your extra money, I’m going to give it to people who use it to feed the hungry!’ is that a good or bad thing?”
        His answer: “That’s a bad thing.”

      I tried very hard to convince my son — that the same money was going to the same people to do the same thing, and that the man with the gun wasn’t going to keep it, he wanted to help those hungry people. It didn’t matter. “It’s mean to take people’s money with a gun.” And make no mistake — taxes ARE taking with a gun.  It may not be tomorrow or next year.. but if you don’t pay your taxes, eventually, there will be guns pointed at you.

      Also — I completely disagree that a reliable safety net is better for the risk-taking needed for a mobile society. I defy you to name one single entrepreneur who ever said, “It’s okay if this investment fails, I can always go on welfare.”

      3) Because people spend their own money better than they spend other people’s money. The money that is in a charity is theirs. It was given to them with the understanding that it will be used well, and if they don’t use it well, the donors will stop giving. Government has no concerns about ever losing its funding. It can always charge more in taxes (backed by guns) so there is never any incentive to be effective.

      • Anonymous

        If I have the choice in giving to charity, suppose you give 10% of income and I give 0%?  Since “the shopper is always right,” how can you criticize my lack of contribution?

      • Anonymous

        This robbing at gun point metaphor is always trotted out by libertarians but it is never accurate. The government is democratically elected, and the robber is not. This means that the government has validity even when you do not agree with it. So ask your 8 year old son this: “if a duly and constitutionally elected body of government pass a constitutionally valid law, but you disagree with it, do you still have to comply?”

        •  Just what doesn’t election validate?

          • Anonymous

            Not sure I understand the question, but obviously actions forbidden by the constitution are not valid even if they are the result of democratic decisionmaking. 

          • “actions forbidden by the constitution”…as defined by who?

          • Anonymous

            I suggest you take a basic government course and then come back to this conversation. I am not going to give you Civics 101 in this forum. 

          • I was seeing if you realized that within your formulation the ones responsible for interpreting the boundaries of government action are government agents — which poses a dilemma for constitution-as-limit.

            If you assert in some way in response to that “well, the REAL determinants are US”, then you’re either assigning democratic legitimacy to anything an elected government does, constitution be damned, or you’re opening the door to civil disobedience in response to abuse regardless of if the democratically-elected government says what they’re doing doesn’t count as abuse. 

            If legitimacy still attaches, then constitutions mean squat.  If it doesn’t, then the real limit is what the public is willing to literally fight over, and no further.

        • This robbing at gun point metaphor is always trotted out by libertarians
          but it is never accurate. The government is democratically elected, and
          the robber is not.

          Well, great: they haven’t got your consent; but they have got majority support.

          So before you just had a robber; and now the robber has a posse.

          This means that the government has validity even when you do not agree with it.

          That conclusion does not follow from the premises that you’ve listed. You will at least need an auxiliary premise that democratic elections are sufficient confer legitimacy on the use of legal force. But of course there’s no reason why a libertarian need believe that that’s true. Most libertarians believe that there are at least some limits on what any government can legitimately force you to do, no matter how popular that government or that policy may be.

          So ask your 8 year old son this: “if a duly and constitutionally elected
          body of government pass a constitutionally valid law, but you disagree
          with it, do you still have to comply?”

          Good Lord. If I had an 8 year old son, I’d hope that I would have brought him up better than to think that constitutions or majority votes ought to be treated as a veto on your conscience. As a notable Baptist minister once pointed out, “One may well ask: ‘How can you advocate breaking some laws and obeying
          others?’ The answer lies in the fact that there are two types of laws:
          just and unjust. I would be the first to advocate obeying just laws. One
          has not only a legal but a moral responsibility to obey just laws.
          Conversely, one has a moral responsibility to disobey unjust laws. I
          would agree with St. Augustine that ‘an unjust law is no law at all.'”

      • Tobias Franke

        1)  Its not about cheapness its about effectiveness. While measures of effectivity are disputed, there has never been one which was not correlated to socializedness.

        2a) So if I agree that you can monopolize some land it is good. But if you enforce your exclusiveness of use, on your land, with a gun you become evil. So I can just come and camp on your lawn. Few libertarians would say that. Respect.
        2b) I would say taxes existed before guns. But I know many American libertarians would disagree and say that rents payed to a king who owns all the land are perfectly just and moral.
        2c) “It’s okay if this investment fails, I can always go on welfare.” no they won’t say this. But when psychologists look at their behavior they find that most secretly think this.
        Or would like to think so instead of thinking: “My Parents are rich, so I can invest riskily and later pretend I got rich myself” or “The current safety net is too weak, I have to bear with my employer abusing his near monopoly”.
        But it is true that risk aversion behavior is a subject where many people say the opposite of what they do.

        3) So the studies that show the opposite of what you assumed, not only show that the free market is unsuitable for charities, but also disprove the effectivity of the free marked in general… I would never have went that far.

        • Anonymous

          I would say taxes existed before guns.

          Before the invention of guns it was taking money with a sword.

          But I know many American libertarians would disagree and say that rents payed to a king who owns all the land are perfectly just and moral.

          If he really owns the land, yes. But the thing is that actual kings throughout history did *not* own their land. Not in the libertarian sense of owning.

          • Tobias Franke

            Could you explain this libertarian sense of owning?
            In its most common use it just seems to mean “owned by libertarians”, which does not necessarily exclude said king.

            Abstract property ownership is always given by the government, it allows one person to monopolize the use of said property, by using force on people who try to use said property without their permission.
            Without government backed property, others are only morally prevented from preventing your use. Then property is what you can defend. Until you band together with others and become a government

          • Anonymous

            Could you explain this libertarian sense of owning?

            There are basically two ways of becoming an (legitimate) owner:
             – original appropriation
             – voluntary transfer of (legitimate) title, either as a gift or through trade.

            In its most common use it just seems to mean “owned by libertarians”, which does not necessarily exclude said king.

            Where’s that coming from?

            Abstract property ownership is always given by the government

            I don’t know what you mean by “abstract ownership” and I don’t know what you mean by “given” in this context.

            Without government backed property, others are only morally prevented from preventing your use. Then property is what you can defend. Until you band together with others and become a government

            Really? Is a drugs gang which protect it’s stash and money a government?

          • Tobias Franke

            Said King has as much right as anyone else to pretend to be in legitimate succession to the original creator of the land ( title ).
            Especially if there was no acknowledged system of ownership titles before said kingdom was founded.
            In fact can you name any piece of property ( especially abstract property ) which is legitimately owned according to your decision.

            Abstract Property is the exclusively modern concept of property. Either of abstract objects like land or ideas. Or monopolistic concepts of property, where property ownership means prohibiting the use of said property by other persons, instead of only preventing others from preventing the owners use.

            These concepts of abstract property have no moral justification and are relatively modern constructs. Especially the idea of a title to a property. A title can not exist without a legal system/government defining its form.

            A Gang becomes a government once it claims the right to manage (give) property titles (without resorting to the rules of transfer or creation of ownership deriving from a different government).
            It would also become a government by claiming moral legitimacy of it’s rule system. Or by claiming a monopoly on the use of force.
            I might accept a requirement of all 3 factors to become a true government.

          • Anonymous

            Said King has as much right as anyone else to pretend to be in legitimate succession to the original creator of the land ( title ).
            Especially if there was no acknowledged system of ownership titles before said kingdom was founded.

            Where there people living on the land at the time the kingdom was founded?

            It’s still not very clear to me what you mean with abstract property, but I’ll tell you my view on property. First of all, in my opinion ideas cannot be owned. Land on the other hand can be owned. How exclusive this is depends on the use of the land. People are not allowed to enter someone else’s house or garden without permission. But if it’s a pasture, people have a right to pass over it as long as they don’t disturb the livestock.

            A Gang becomes a government once it claims the right to manage (give) property titles (without resorting to the rules of transfer or creation of ownership deriving from a different government).It would also become a government by claiming moral legitimacy of it’s rule system. Or by claiming a monopoly on the use of force.I might accept a requirement of all 3 factors to become a true government.

            So simply banding together to protect property does not a government make…


          • Georgian Tutuianu

            In the context you are describing the only legitimate way the King can create title to the land and have it mean anything to anyone is if the people who were using the land before the King gave direct consent to the idea of abstract property. Just because a piece of paper says the King owns the whole universe does not make it true. 

            By government I think you mean association of people making up the state willing to use  possibly legitimate force to pursue their goals or enforce their potential titles. 

            I don’t think the gang as previously described would be a government or a state. I think they are simply a collection of people willing to use force to defend their property. 

      • Anonymous

        You can find comparisations of different systems. Try and get to learn about it in stead of these assumptions and ridiculous self-serving metaphors.

    • Anonymous

      Classic. This article was all about the fact that the US doesn’t have a free market system. So your first counter-argument is not on point. A zillion US regulations favor corporate medicine & stomp out smaller competitors, allowing corporate prices to rise. That’s just one reason why the US has expensive medicine. There are other regulatory causes for high prices, too, and few of them show people the respect for their choices that are the hallmark of a market-based system.

      Charity is better than stolen / taxed money, because charity doesn’t empower the political class, which causes them to become totally corrupt and declare the next war.

      Lastly, peaceful alternatives, like charity and respect for a competititve market (as long as there’s not force or fraud), promote an overall notion of civilization and what it means to have respect for others.

      Hopefully, one day you’ll stop using terms like “safety net” to cover up the fact that the kind of power necessary to force everyone into a universal medical collective is not only uncivilized, but has corrupted the political class, and is therefore responsible for all of the big-government scams that you probably hate, like aggressive wars, and bigoted laws that promote alcohol over marijuana.

  • Beyond the criticisms outlined in the post (which I think are spot-on), I’d add another one: The responses made by Ron Paul and others reinforce the impression many people have that the costs of putting libertarianism in practice would primarily be borne by (typical) individuals, while the benefits would primarily accrue to corporations and those (less-typical) individuals who are major shareholders in them.

    So in reversing the sequence and first emphasizing the role of government regulation in distorting the health care market and raising health care costs, you could also talk about the responsibility that needs to be placed on the health care industry and those who invest in it, including in particular the responsibility of finding ways to make a living that don’t depend on laws and regulations that discriminate against providers of generic medications, that prohibit nurse practictioners from providing routine medical services not requiring an MD degree, and so on–basically all the ways that health care providers and other industry players leverage government to rig the system in their favor.

    • TigerMike74

      “the impression many people have that the costs of putting libertarianism in practice”
      Exactly, my intuition is that after the great libertarian medical deregulation of 2015 , the regulations that restrict the powerful will be gone, but somehow the regulations that “health care providers and other industry players leverage government to rig the system in their favor” will have miraculously survived.
      And the libertarian theorists will walk around looking confused muttering, “if only they had followed our plan correctly.”

      • GaffiGubbi

        That’s certainly possible, and the vast majority of deregulation that’s passed in DC always seems to have big money behind it. Although it’s true that many regulations, subsidies and tax increases tend to benefit the rich, it’s also true that there are regulations that the rich don’t like very much. Therefore I don’t blame liberals for having the impression that deregulation = big business wet dream. This miscommunication needs to be taken seriously by libertarians, and aligning with “business-friendly” conservatives and the Chamber of Commerce is the last thing they should do, even if they are ostensibly against the socialist boogeyman.

      • Anonymous

        ‘There is another theory which states that this has already happened.’ -Douglas Adam

  • Anonymous

    Excellent advice, Roderick.

  • I would add two additional blunders he makes. The first is to dig in and defend an extreme libertarian position when I don’t think that’s the turf he really cares about. He could have said that no, he wouldn’t let someone like that die, but that doesn’t mean we should have a large entitlement program that pays for myriad routine (i.e. not life-or-death) expenses for the middle class.The second additional blunder is not to point out that Wolf’s question is not a very helpful one in trying to decide what legal regime we want to live under. (In truth, I find it a bit sanctimonious.) We “let people die” all the time. We let them die when we subscribe to Netflix, although the same amount of money could alleviate malnourishment in the third world. (Peter Singer is good on this point.) Wolf Blitzer let people die when he bought a nice suit. The current health care regime lets people die when they are uninsured and can’t afford expensive procedures. Any alternative single-payer system that proposes to spend less than an infinite amount on a particular case will also let people die. A more constructive question is, what kind of rules will let the fewest people die while also maximizing resources for other things that we like (education; comfortable homes)?

  • The audience members cheering for the death of a hypothetical man highlights one of the main problems with the right-libertarian alliance: the “right” part of the alliance finds libertarian solutions appealing because of their rage against “parasites,” “freeloaders” and people outside of their tribal affiliations.  If the market is used as a sword against those we dislike, it will never be seen as beneficial to society as a whole.

    The BHL project takes a stab at this problem, but until the personal rage dies down, libertarianism is doomed to be the political province of academics and the sort of people who always have someone else to blame (usually the politically and economically powerless) for the state of the country. 

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  • It seems to me that trying to explain, in 15 seconds or less, how the current mixed private-socialized medical system causes these catastrophically rising prices, is an impossible task.  It could only be brought up as a statement which would have to be taken, by the audience, on faith, and then perhaps researched by them at a later time.

    I once plugged my nose and read George Reisman’s lengthy piece, I believe entitled ‘the real right to medical care versus socialized medicine’ and while I definitely did not agree with it completely, I have to say that of anything I have ever read, it did the best job of making me understand the technical economics of how prices rise in our system.  No way could those ideas/explanations have been made very succinctly, within the format of a debate.  At least not by Ron Paul…and it pains me to say anything in criticism of someone who stands up in public and makes arguments in front of millions of people the response to which would humiliate most people into silence within the circle of a small group of their friends.

    One of the most important thoughts in the entire Reisman essay was made at the outset, quoted here:
    “I will have a great deal to say in criticism of the Clinton administration’s proposal later on. Here I want to stress that I do not believe that the most important or fundamental objective that must be accomplished in connection with the Clinton plan is to explain why it should be rejected. It certainly should be rejected. But the mere rejection of the administration’s proposal will serve only to maintain the status quo. The status quo with respect to medical care does not deserve to be preserved. It does bear the earmarks of financial lunacy. It does call for reform – for radical reform. The question is, what kind of radical reform?”

  • Jim

    I would have first pointed out that if the theoretical guy survived and cam out of the coma within say 10 years  he could be handed a bill that he could amortize over time.  

  • Steven Horwitz

    This is indeed excellent advice from the esteemed Prof. Long.

  • The real problem is that libertarianism isn’t communicable in sound bites. We believe in a complex world, and that requires complex explanations more often than not. Democrats and (the rest of the) Republicans believe in a simple world with simple solutions. Those are conducive to sound bites. We are stuck with that problem. Nevertheless, I think Paul did well, even if I do have to agree that the order was wrong. I also agree with Kyle Walker’s order. We remember first and last best. He at least ended with the most important point first.

    • Anonymous

      There are as many simpletons on the libertarian side as any other

    • Anonymous

      We are the ONLY industrialized country to NOT have a national healthcare plan ,putting the costs onto business.So how do we compete ?…In your “complex world…..

      • Please learn what the words “complex” and “complexity” mean, then we can talk.

        • Anonymous

          It was a legit question. Do you have a legit answer?

          • Anonymous

            It’s a confusing question. Ignoring the presupposition that being like other industrialized nations is the superior thing to do, it remains difficult to answer a question that might as well be asking “How do we live?”

            I think some background must be set and some terms defined before the question is answered.

  • Anonymous

    ” his recent answer on medical care was a highly visible instance of a widespread libertarian problem”

    I agree that if his first thoughts were genuinely libertarian he’d answer the way you suggest.  Instead I suspect he answered in exactly the order he, and his cheering section, think about this, leaving the actual libertarian answer as almost an afterthought once he got his real feelings out of the way:

    a) I don’t care who they are, I’d rather see them die than feel obliged to lift a finger to help them.
    b) If we can sucker churches into helping, they may be soft-hearted and stupid but whatever, I’m not obliged to waste my money on churches either. (See his mentor Ayn Rand’s opinion of churches and voluntary charities in general.)
    c) Oh, and “to be sure,” blah, blah, corporatist price controls, blah, blah, blah.


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  • Anonymous

    As a doctor Paul knows better.ALL hospitals used to be NOT FOR PROFIT!!THATS why costs have exploded.And where are those “community ” and “charities ” NOW when we need them?The same place they were during the Irish famine and Victorian England.In his IMAGINATIO­N!!”           

    So where is all that “charity” ?We  have the largest uninsured population of all the industrialized countries so why have they stepped up?Because they DONT thats why.Unlike “libertarians ” I live in the REAL World not some fantasyland where everyone plays fair and does the right thing.

    Republicans  cheer onWAR.They cheer onTORTURE.They cheer onEXECUTIO­N.They cheer on leaving a person toDIE.If thats the party of “life”….­…..oh right ..only if your NOT BORN YET!!”           

    So where was that disgust` by the candidates when IT HAPPENED??They cheered Perry executing people too.Also WARS and TORTURE.At what point do you say the PARTY is DISGUSTING­?What does it take?Eatin­g abeatingHU­MANHEART?”           
    Yes and it is up to LEADERS to correct their FOLLOWEI;.­FYI..Paul is the best they have and he is a follower of the supremeSoc­iopathicCU­LT of Ayn Rand.She would gleefully say “let them die”If any civilizati­on is to survive, it is the morality of altruism that men have to reject.Ayn Rand”     

    What do you think that means eh?      

    • Tobias Franke

      Well, it means that one of the points of appeal of libertarianism is, that some of its opponents babble around like crazy drunks.

      • Anonymous

         Ayn Rand’s First Love and Mentor Was A Sadistic Serial Killer Who
        Dismembered Little Girls

        What did Rand admire so much about Hickman? His sociopathic
        qualities: “Other people do not exist for him, and he does not see why they
        should,” she wrote, gushing that Hickman had “no regard whatsoever for all that
        society holds sacred, and with a consciousness all his own. He has the true,
        innate psychology of a Superman. He can never realize and feel ‘other
        people.’”This echoes almost word for word Rand’s later description of her character
        Howard Roark, the hero of her novel The Fountainhead: “He was born
        without the ability to consider others.”

  • Blitzer’s insistence on conflating “society” with “government program, funded by theft instead of open hearted charity” … that’s the real crime here. he set up Ron Paul with a ‘when did you stop beating your wife?” scenario … Ron might have responded with his 3 points in reverse order,  but failed to do so. sad, but under the gun, perhaps was inevitable.

  • Anonymous

    Superb advice.  

    I agree about the complexity of communicating the third point, but I typically approach it by beginning with the general claim, “In a properly structured system of free enterprise, goods and services that benefit humanity constantly become lower cost, higher quality, and more widely available – typically dramatically so.  Whenever we do not see such phenomena taking place, we are not actually seeing a properly structured free enterprise system.”  This approach then leads to unpacking the notion of what a “properly structured system of free enterprise” is, but at least it immediately puts forth the hypothesis that under some set of conditions free enterprise always leads to faster better cheaper.  The intellectually curious, non-partisan mind then begins to wonder about what those conditions might be.

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  • Anonymous

    Church’s will never pick up the tab.  That is pure fallacy.  They never did. Saying they did is a lie.  

    Why do people buy this crap?

    • Anonymous

      I know this to be false. A church in my town does pay for some of its indigent parishioner’s medical expenses. This church, then, picked up a portion of the tab (for some people, all of their tab).

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  • This is all wrong.

    The correct answer is that everyone will receive SOME TYPE of care.  Don’t budge from that.

    Then that like ALL things, different types of care have different prices, and different types of care, have different outcomes.  This makes it a menu of services issue.

    We balance risk based on cost everyday, we cannot spend unlimited amounts of money, but we can deregulate the market to make things even riskier / less expensive.  This increases the menu.

    THEN you say, those poeple wil insurance will OBVIOUSLY receive BETTER care.

    This is the real issue with Obamacare – the 70% of the haves DO NOT WANT the bottom 30% to consume resources that the 70% would get for themselves.

  • Damien S.

    “that the high cost of health care is a product of state regulation”

    Does this pass empirical examination?  Taiwan had a mixed system 10-15 years ago, before deciding it sucked, looking carefully all over the world, and creating Medicare-for-all single payer.  Did they have state regulations analogous to our own driving up cost?

    Mexico and India are destinations for medical tourism because they’re cheap compared to US incomes.  (Especially higher US income.)  Are they cheap compared to Mexican and Indian income?  Chile and Thailand and all of Europe and Japan have public or regulated health care and insurance; why?

    The UK and some other countries go past state regulation of medicine or insurance to actual state-run (mostly) health care.  They’re also a lot cheaper than the US. Why?

    Canada, UK, and US have all about the same number of doctors per capita; other European countries have considerably more.  We might blame the AMA and limited medical schools for our numbers, but what’s going on elsewhere?

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  • Anonymous

    It’s rather astonishing how _every single_ one of those points can be wrong.

    Firstly, yes, in the hypothetical question, that guy ‘choose’ to not get insurance. However, in the actual real world, plenty of people who do not have insurance are not ‘choosing’ to not have insurance. They cannot afford it, or it’s even possible that insurance companies will not sell to them. (And will continue to not sell to them until 2014 thanks to idiotic compromises.)

    Second, to skip ahead, as Damien S. said…just
    saying ‘Government regulation makes health care costs high’ does not
    make it true. The level of government regulation appears to have
    absolutely no effect on health care costs when doing comparisons worldwide.

    And last, to skip back, if charities can fix this…where are they? What, _exactly_, is stopping charities from stepping in and providing medical treatment?

    Well, nothing…there are, in fact, a lot of such charities. A void exists, and charities have stepped in. Tiny, overworked one run out of basements of food pantries, that operate one day a week and have a two month wait to get in. (Waits, of course, are only bad when they are ‘socialized’ waits. I guess it’s fine when it’s at the free clinic.)

    And the big, traveling charities that show up and are _blanketed_ with people. They show up in a city, hundreds of thousands of people show up for care, and end up getting turned away. (Getting turned away from medical care, of course, is fine when you’re poor or uninsured. It’s horrible when you’d have the money to pay for it but the medical professionals think you don’t need it.)

    There is literally nothing stopping such charities form existing, no magical barriers to them. Charitable donations are still, as far as I know, even tax deductible. And we need about a _hundred_ time as many currently exist.

    _ALL_charitable giving in the US, added together, totals $300 billion a year. Let’s pretend all charitable giving went towards those medical bills.

    Let’s also pretend that only 20% of the population had trouble with medical bills. It’s actually 50%, but let’s pretend that we’d only need to pay the equivalent of the total cost of 20% of them. Some we’d be paying 100%, but some only 10%. This is incredibly lowball, but let’s just go with 20%.

    Dividing $300 billion by the population gives us $1000 each, and dividing that by 20% gives us $5000.

    Now, of course, the people can’t get insurance and have trouble paying their bills probably have _more_ than the average medical costs, but let’s pretend that, hypothetically, they pay exactly average.

    Average per capita spending on health care in the US in 2008? $8,327.

    Crap, we’re an entire 1/3rd short of being able to cover people even under our utterly insane, impossibly-best-case scenario.

    So what’s the theory here? Saying ‘charity’ is not a fucking answer. Things don’t just magically arrive out of thin air because someone says ‘charity could provide it’. If all current charitable donations in the entire country went into paying medical bills, we _still_ wouldn’t have enough.

    Hell, we don’t even have enough _homeless shelters_ in this country, and those are much cheaper than medical care to set up and operate.

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  • Anonymous

    Beautiful advice.

    I find most such arguments are based in the “extreme 1%” of cases at the detriment of the middle 90%.  Another good example is public school where out such fear-based hypotheticals (Johnny doesn’t have enough to get an education!) we subject the other 90% of Johnnys to mundate sub-par education.

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  • Long merely evades the hypothetical as long as he can. The question was about what happens if health insurance costs more than an individual is willing to pay.  RP answered straight up.

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  • AlgernonSidney

    Mutual aid might be more efficient than “government welfare,” but I’m not about to ask my neighbor to take out my appendix.

    • . . . The “mutual aid” societies are intended to help you pay for the appendix to get taken out. Not to help you out with direct service provision. (At least, that’s certainly how self-described mutual aid societies and friendly societies operated when they were relatively common, in the late 19th/early 20th century — as a form of grassroots, consumer-owned insurance.) For that matter, the welfare office doesn’t cut out your appendix either; they give you money which you pay to the doctor who does the cutting.

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