Ron Paul recently received a lot of criticism for arguing that tax money should not be used to save a sick young man who had decided not to buy health insurance. Robin Hanson raised a very good point in response to his critics:
But a great many ill, collapsed, etc. folks in the world are largely left to die, at least if curing them costs anything like a US hospital stay. Ezra argues above for “decent” nationalcare, not global care. And even libertarians wouldn’t leave family members to die. So everyone agrees that we heroically help some, and leave others to die. We only disagree on who falls into which category.
I’ve made similar arguments many times, so I am certainly not going to criticize Robin. Nonetheless, I do support tax funded catastrophic insurance plus mandatory HSAs at the national level. If Robin is right, how can I do so?
Let’s start with the fact that I am a utilitarian. We utilitarians believe that everyone’s well-being is of equal value, whether it be Bill Gates or a peasant farmer in Pakistan. Public policy should maximize aggregate well-being. So why don’t I favor an international health care program? Actually, I wouldn’t be opposed to the idea. But I am also a pragmatist, and for now we are dealing with national governments and voters who are very nationalistic. I believe that publicly funded health care of the sort I described with boost aggregate well-being, as compared to our current system. I hope the circle of people’s empathy will continue to shift outward, as it has for the past few centuries. If the public is eventually willing to make the following shift in health care spending, I’m all for it:
1. Stop providing publically-funded health care in non-life and death situations.
2. Use the extra money to fund higher-valued health services in poor countries.
Obviously our culture has not yet reached that degree of empathy, and it seems unlikely that it will in the near future. Until then I’ll keep advocating the Singapore/Brad DeLong solution.
I do not agree with the following argument by Robin Hanson:
Humans clearly evolved quite different mental modes for thinking about how to treat folks with our our local tribe, vs. how to treat distant strangers. Libertarians largely accept the usual ideas about how to treat both groups. Where they disagree is who counts as a stranger.
Libertarians limit “my tribe” to close family and small chosen communities, much as did our forager ancestors, who were free to change bands at any time. Farmer culture taught farmers to think of distant strangers as “my tribe”, as long as “our elites” said so, or if “we” fought wars together. And nation-states have worked hard over the last few centuries to transfer this feeling to nations. Libertarians mostly just don’t accept this. And though I’m not strictly libertarian, on this I agree – it is far from obvious that nations must be our tribes.
Now people usually try to be nicer to their tribe than to distant strangers. From this one might conclude that libertarians, who see more folks as strangers, are not as nice people. But not only are folks who see their tribe as smaller usually nicer to such insiders, libertarians also tend to be more accepting of mutually beneficial interactions with strangers.
I think the world is a better place if we work to make the “tribe” as large as possible. Mutually beneficial transactions are great, but only get you so far. There are many areas of life where unselfish altruism is required to make institutions work effectively, most notably in governance. If you have a political entity of 5 million people who for deep historical reasons developed a culture of mutual respect, say Denmark, you will end up with more effective governance (and more market-oriented too!) than a political entity of 5 million people who for deep historical reasons lack trust outside the immediate family, such as Sicily. Indeed even entities of 5 million people who lack a deep historical tradition of trust, but who have worked very hard in recent decades to develop a culture of national solidarity, such as Singapore, will do better than low trust societies.
Self-interest isn’t enough. If I followed self-interest I would not vote, and I would not blog on important public policy issues. If I was family-oriented I would spend more time with my daughter.
I don’t doubt that some of the distrust of strangers is hard-wired into us. But that’s no reason to be defeatist. If we’ve learned anything from the last 200 years of cultural evolution it’s that technological advances in the narrative arts have gradually made many of the “others” seem much less strange, and thus we’ve gradually increased the size of the circle of races, religions, and lifestyle groups that count as “us.” There is no reason this process can’t continue until we have a single global tribe by the year 2300.
PS. Although I favor a global tribe, I also believe governance should be increasing decentralized, except where that is not feasible (say global warming policy.)
PPS. I should clarify that I’m not predicting that bigotry will completely vanish, as there will continue to be differences between people. Rather I am arguing that we will become a single tribe for public policy purposes. For example, there is still racial prejudice in America, but all races now qualify for programs like Social Security and Medicare.