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What are the underlying roots of the health care debate?
from a Facebook note by Lewis Woods
Wednesday, September 23, 2009 at 12:40pm
Below is an incomplete list of what I think are some of the most important underlying roots of the debate of health care between those who advocate increasing government involvement and those who advocate decreasing (or eliminating) government involvement. I am assuming equally good intentions on all sides so as to focus on matters of principle and fact. In other words, I’m seeking an answer to the question of why good, caring people would disagree. I’ve tried to phrase things in as neutral a way as possible but have no doubt failed on a number of counts.I would be curious to hear if there are other important ones you would add.

Here goes:

I think the issues can be meaningfully summarized under three major headings and one minor one: debates regarding the nature of government, the nature of markets, and the nature of justice are the major ones; debates regarding human nature and our capacity for freedom/responsibility in the face of risk and uncertainty is the minor one.

I. Debates regarding the nature government:

What is government? Is government of the people, by the people, and for the people; the people in “administrative mode;” or, a legitimated monopoly on the use of coercive force?

The extent to which government is thought to posses the three requisites of all successful action: adequate knowledge, proper incentives, and ability, and the extent to which these are thought to be sustainable over the long run.

The extent to which government is thought to be susceptible to being captured by wealthy special interests. Thus, a program may start off serving those in need but end up serving the wealthier. How frequently does this occur? Are there any systematic safeguards that can reduce or eliminate such occurrences?

II. Debates regarding the nature of markets:

Questions regarding the extent to which economic inequality has socially beneficial effects.

Different understandings of the regulative role of competition.

In what ways do markets foster human welfare, in what ways do they hinder it? Do markets handle some kinds of goods better than others?

The nature of profit and wealth. For example, the difference between accounting and economic profit, and, in the words of Adam Smith, the nature and causes of wealth.

The effects of taxation in the long and short runs. The difference between taxing productive activities vs. taxing unproductive or harmful activities–e.g., taxing wages vs. taxing natural resource depletion or pollution.

The concept of consumer sovereignty: is it an adequate characterization of the ends market activity serves?

III. Debates regarding the nature of justice:

The question of whether health care is a right to which all are entitled or a good that, like any other, comes at a cost and becomes more affordable as society develops economically.

Different understandings of the relationship between property rights and human rights generally.

Differences over the extent to which good ends (like universal health care) justify the use of governmental means (like taxation and regulation). Differences over the extent to which ends are considered to justify means, or at least trump them in discussions. Utilitarianism vs. natural rights vs. democratic procedures.

The extent to which wealth is thought to be a phenomenon to which the categories of desert or fairness apply. For example, one could argue that fairness simply doesn’t apply to height. Some people are taller than others and that’s that. Is wealth like height or not?

The relationship between rights and nation-states. If something is a human right then it is something we are each entitled to without regard to nationality. Perhaps, then, USers are entitled only to an equal share of global health care expenditures rather than an equal share of US health care expenditures.

IV. Debates regarding human nature

How capable are human beings of making free decisions in a world of ubiquitous advertising? How much freedom can we achieve in a “consumer” culture?

Different conceptions of individual human responsibility and capability. In particular, how capable are we of handling uncertainty and risk that is remote in time or space, given our evolutionary past?

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