Ann Coulter’s appearance at the Berkeley was cancelled in response to threats made by anarchist groups. While some conservatives argue that concerns about security should often trump concerns about rights (such as infringing on religious liberty or privacy to “make us safer”), two conservative organizations have started a lawsuit against the university. The claim that the school is endeavoring “to restrict conservative speech” on campus. Since Berkeley is a public school, the First Amendment does apply and hence the case can make an appeal to this constitutional right. While well-paid lawyers will hash out the legal matters, this does raise an interesting moral concern.
As I have shown in numerous other essays, I hold to a view of freedom of expression that goes far beyond the limited legal protection laid out in the First Amendment. I also hold to the freedom of consumption—that people have a right to, for example, hear whatever views they wish to hear. As such, Coulter has a right to express herself and the student organizations have the right to invite her so they can listen to whatever wicked or foolish things she might elect to spew forth.
Like many classic liberals, my go-to justification of these liberties is based on J.S. Mill’s arguments. The gist is that allowing people the liberty of expression and the liberty of consumption creates more happiness than restricting these liberties. Being a fan of natural rights, I also find the idea that these rights have additional grounding beyond mere utility appealing. I do, however, admit that such rights are certainly metaphysically suspect and difficult to properly ground in reality. In short, while I think that Coulter will say nothing worth hearing, she has every right to speak before the student groups that invited her.
I should note that my view of Coulter is not based on any notion that conservative political theory lacks merit; it is based on my view that she lacks merit. Unfortunately, thoughtful conservative political theorists seem to be out of vogue. This is unfortunate; the past saw many excellent conservative thinkers and they made significant contributions to political and philosophical thought. These days, there seem to be mostly just empty pundits spewing emptiness on Fox News. Or, worse, racists and sexists purporting to represent conservative thought. Then again, perhaps abandoning the intellectual aspects of politics was a smart tactical move: the left might have its intellectuals, but the right holds the power in most states. But, back to the matter at hand.
While I do accept the rights of expression and consumption, these rights are not absolute. If the justification for rights and liberties is taken to be utilitarian, then these rights can be limited on the same grounds. As such, if the harm created by allowing the freedoms of expression and consumption would create more harm, then they can be justly limited. The stock example is, of course, the restriction on people yelling “fire” in a crowded theater when there is no fire.
If a natural rights view is accepted, the restriction of a right can be justified by appealing to other rights. In the case of speech, the right to life would warrant preventing people from yelling “fire” in a crowded theater. The challenge is, of course, working out a hierarchy of rights. However, it does seem reasonable to make the right to life a rather important right, if only because being alive is generally a necessary condition for the other rights.
If having a person speak could put that person and others in danger, then this can justify postponing a speech until proper security arrangements can be made or even cancelling it if such arrangements cannot be made. This can be done by appealing to a utilitarian justification or by arguing that the right not to be harmed trumps the rights of free expression and free consumption. This is analogous to other cases in which liberty must be weighed against safety.
This does lead to the obvious concern that free expression and free consumption could thus be thwarted simply by threatening violence; thus giving individuals and groups willing to make threats considerable powers of censorship. One limiting factor is that making such threats is a crime. Unfortunately, the internet provides so many anonymous ways of making threats that the police face considerable challenge in dealing with them.
Deciding how to respond to credible threats of violence requires weighing the rights of expression and consumption against the harms that are likely to arise. As a general principle, it seems reasonable to accept that a speech should be postponed in the face of a credible threat that cannot be addressed in time. Such a credible threat should be dealt with by law enforcement and then the speech can be made. If the threat can be addressed so that an acceptable level of public safety is possible (within the available budget), then the speech should proceed normally. This approach can be easily justified on utilitarian grounds: people are kept reasonably safe while at the same time threats are prevented from becoming an effective tool of censorship. This does require that the state take such threats seriously and take appropriate action.
There is, of course, also the moral responsibility of those who make such threats: they are wrong to do this. If they do not like, for example, Coulter’s views, they should ask a campus group to invite them to speak out against her views on campus.
The question “when was the last battle of the Civil War fought?” is a trick question; the last battle has yet to be fought. One minor skirmish took place recently in New Orleans as the city began its removal of Confederate monuments. Fortunately, this skirmish has yet to result in any injuries or deaths, although the removal of the first monument looked like a covert military operation. Using equipment with hidden company names, the removal crews wore masks and body armor while operating under both the cover of darkness and police sniper protection. These precautions were deemed necessary because of threats made against workers. In addition to being controversial, such removals are philosophically interesting.
One general argument in favor of keeping such Confederate monuments in place is the historical argument: the monuments express and are part of history and their removal is analogous to tearing pages from the history books. This argument does have considerable appeal, at least in cases in which the monuments mark an historical event and stick to the facts. However, monuments tend to be erected to bestow honors and this goes beyond mere noting of historical facts.
One example of such a monument is the Battle of Liberty Place Monument. It was erected in New Orleans in 1891 to honor the 1874 battle between the Crescent City White League and the racially integrated New Orleans Metropolitan police and state militia. The monument was modified by the city in 1932 with a plaque expressing support for white supremacy. The monument was modified again in 1993 when a new plaque was placed over the 1932 plaque, commemorating all those who died in the battle.
From a moral perspective, the problem with this sort of monument is that it does not merely present a neutral historical marker, but endorses white supremacy and praises racism. As such, to keep the memorial in place is to state that the city currently at least tolerates white supremacy and racism. If these values are still endorsed by the city, then the monument should remain as an honest expression of these immoral values. That way people will know what to expect in the city.
However, if the values are no longer endorsed by the city, then it would seem that the monument should be removed. This would express the current views of the people of the city. It could be objected that such removal would be on par with purging historical records. Obviously, the records of the event should not be purged. It is, after all, a duty of history to record what has been and this can be done without praising (or condemning) what has occurred. In contrast, to erect and preserve an honoring monument is to take a stance on the matter—to praise or condemn it.
It could be argued that the 1993 change to the monument “redeems” it from its white supremacist and racist origins and, as such, it should be left in place. This does have some appeal, part of which is that the monument expresses the history of the (allegedly) changed values. To use an analogy, a building that once served an evil purpose can be refurbished and redeemed to serve a good purpose. This, it could be argued, sends a more powerful statement than simply razing the building.
However, the fact remains that the monument was originally created to honor white supremacy and the recent modification seems to be an effort to conceal this fact. As such, the right thing to do would seem to be to remove the monument. Since the monument does have historical significance, it would be reasonable to preserve it as such—historical artifacts can be kept without endorsing any values associated with the artifact. For example, keeping artifacts that belonged to Stalin as historically significant items is not to endorse Stalinism. Keeping a monument in a place of honor, however, does imply endorsement.
The matter can become more complicated in cases involving statues of individuals. In New Orleans, there are statues of General Robert E. Lee, Confederate President Jefferson Davis and General P.G.T. Beauregard. It cannot be denied that these were exceptional men who shaped the history of the United States. It also cannot be denied they possessed personal virtues. Lee, in particular, was by all accounts a man of considerable virtue. P.G.T. Beauregard went on to advocate for civil rights and voting rights for blacks (though some might say this was due to mere political expediency).
Given their historical importance and the roles they played, it can be argued that they were worthy of statues and that these statues should remain to honor them. The easy and obvious counter is that they engaged in treason against the United States and backed the wicked practice of slavery. As such, whatever personal virtues they might have possessed, they should not be honored for their role in the Confederacy. Statues that honor people who were Confederates but who did laudable things after the Civil War should, of course, be evaluated based on the merits of those individuals. But to honor the Confederacy and its support of slavery would be a moral error.
It could also be argued that even though the true cause of the Confederacy (the right of states to allow people to own other people as slaves) is wicked, people like Lee and Beauregard earned their statues and their honor. As such, it would be unjust to remove the statues because of the political sensibilities of today. After all, as it should be pointed out, there are statues that honor the slave owners Washington and Jefferson for their honorable deeds within the context of the dishonor of slavery. If the principle of removing monuments that honored those who supported a rebellion aimed at creating an independent slave-owning nation was strictly followed, then there would need to be a rather extensive purge of American monuments. If honoring supporters of slavery and slave owners is acceptable, then perhaps the removal of the statues of the heroes of the Confederacy could be justified on the grounds of their rebellion against the United States. This would allow for a principled distinction to be made: statues of slavery supporters and slave owners can be acceptable, as long as they were not rebels against the United States. Alternative, the principle could be that statues of victorious rebel slavery supporters are acceptable, but those of losing rebel slavery supporters are not. Winning, it could be said, makes all the difference.
There is a reasonable concern that can be raised in response to my view that the red line should be drawn at the murder of civilians rather than at murdering them with chemical weapons. This is the worry that my view would abandon the red line being drawn for using chemical weapons against civilians, thus creating a situation in which there are no red lines. This would be problematic because while the murder of civilians with conventional weapons is tolerable, crossing the red line of murdering civilians with chemical weapons does at least generate a response. Since some response from the world is better than no response, it is clearly better to have some viable red line rather than one everyone will simply ignore.
The tolerance of conventional murder and opposition to chemical murder has resulted in some actions whose impact should be duly assessed, to get some picture of the value of the chemical red line.
One impact that has been touted by some former members of the Obama administration is the fact that Syria got rid of many of its chemical weapons because of pressure from the United States and the world. On the plus side, less chemical weapons entails less possible murder with chemical weapons, which is presumably a good thing. One obvious offset to this alleged good is the concern that the Syrian government simply filled up the chemical kill gap with conventional killing, thus producing roughly the same number of deaths. If this is the case, then the focus on chemical weapons did not reduce the number of deaths.
This point could be countered by arguing that being murdered with chemical weapons is worse than being murdered with conventional weapons. The usual case for this is based on the claim that chemical weapons cause more suffering than chemical weapons. The usual response to this is that death by conventional weapon can be as or even more awful that death by chemical weapon. For example, a person who slowly dies while buried under the rubble caused by conventional bombs has certainly suffered more than a person who is killed almost immediately by a chemical weapon. As such, if death by chemical weapon is roughly equal to death by conventional weapon, then the difference between the two weapons is a difference that does not make a morally relevant difference. This can be illustrated by the following analogy.
Imagine that Sam is engaged in regularly murdering people in his neighborhood with guns. Those outside the neighborhood do not like this, but do nothing beyond Tweeting and posting about how awful Sam is. Then, one day, Sam tries a new type of murder: he poisons a few people. The neighbors are outraged and, after Tweeting with righteous fury, have their best shooter take a few rifle shots at where they think Sam keeps his poison. Sam goes back to murdering with his guns and the neighbors go back to occasionally tweeting about how bad Sam is. If this at least reduced Sam’s killing rate, this action would have some merit. But, if Sam just goes on killing with his guns, the action would have no meaningful impact and would have been pointless. At least beyond making the neighbors feel righteous for a short while.
The general point of this analogy shows the problem with how the chemical red line is used. To be specific, it allows for occasional and limited action when violations take place, then the offender merely returns to conventional murder. This does not address the real concern, namely that civilians are being murdered. As such, my original point seems to stand: the chemical weapon red line appears to create a moral space in which murder is tolerated while allowing a pretense of having meaningful moral standards. While this is presumably an awful thing to consider, having some red line might be worse than having no red line—after all, the chemical weapon red line enables the wicked self-deception that we are engaged in righteous action when in fact we are not. This allows us to salve our conscience and say “at least they are not being killed with chemical weapons” while we tolerate more murder.
Some years ago, I was firing my .357 magnum at an indoor range. This powerful pistol mades a satisfying “bang” and hurled a piece of metal at lethal speeds towards the paper target. Then there was a much louder noise and I felt a “whuummmp” vibrating my ribcage. My friend Ron was firing his .44 magnum nearby, close enough for me to feel the shockwave from the weapon.
While the .44 magnum is a powerful handgun (just ask Dirty Harry), it is a mere peashooter compared to a weapon like the Carl-Gustav M3, a shoulder fired heavy infantry weapon. When fired, this weapon generates a strong shockwave that might be causing brain injuries to the operators. While a proper scientific study has not been conducted on the effects of operating such weapons, it makes sense that they could cause such injuries. After all, the shockwave from the weapon is certainly analogous to that produced by other explosions, such as the IEDs that have caused terrible injuries. While IEDs certainly inflict wounds via the shrapnel and explosive burst, their shockwaves can also inflict brain damage without otherwise leaving a mark on the target.
The United States military had been gathering data using small blast gauges worn by soldiers. However, the use of the gauges was discontinued when it was claimed they could not consistently indicate when a soldier had been close enough to an explosion to suffer a concussion or mild traumatic brain injury. These gauges did, however, provide a wealth of information—including data that showed infantry operating heavy weapons were being repeatedly exposed to potentially dangerous levels of overpressure. Because such data could be used to link such exposure to long term health issues in soldiers, it might be suspected that the Pentagon stopped collecting data to avoid having to accept fiscal responsibility for such harms. This can, obviously enough, be seen as analogous to the NFL’s approach to concussions. This leads to some clear moral concerns about monitoring the exposure of operators and the use of heavy infantry weapons.
While it might seem awful, a moral argument can be made for not gathering data on soldiers operating heavy weapons. As noted above, if it were shown that being exposed to the overpressure of such weapons can cause brain injuries, then the state could incur the expenses associated with such responsibility. Without such data, the state can maintain that there is no proof of a connection and thus avoid such expenses. From a utilitarian standpoint, if the financial savings outweighed the harms done to the soldiers, then this would be the right thing to do. However, intentionally evading responsibility for harm does seem morally problematic, at best. It can also be countered that the benefits of being aware of the damage being done outweigh the benefits of an intentional ignorance. One obvious benefit is that such data could help mitigate or eliminate such damage and this seems morally superior to the intentional evasion by willful ignorance.
While there do seem to be steps that could be taken to minimize the damage done to troops operating heavy weapons (assuming there is such damage), it is likely that such damage cannot be avoided altogether. That is, there will always be some risk to the operators and those near. One technological solution would be to remotely operate heavy weapons (thus allowing the operator to be out of the damage zone). Another technological solution would be to automate such heavy weapons, thus taking humans out of the danger zone. Either of these options would increase the cost of the weapon system and would thus require weighing the financial cost against the wellbeing of soldiers. Fortunately, many of those who are fiscal conservatives when it comes to human wellbeing are fiscal liberals when it comes to corporate profits, so one way to sell the idea is to ensure that it would be profitable to corporations. There is also a moral argument that can be made for using the weapons as they are, even if they are harmful to the operators. It is to this that I now turn.
From a utilitarian standpoint, the ethics of exposing operators to damage from their own weapons would be a matter of weighing the harm done to the operators against the benefits of using such heavy weapons in combat. Infantry operated heavy weapons do seem to be very useful in combat. One obvious benefit of such weapons is that they allow infantry to engage vehicles, such as tanks and aircraft, with a reasonable chance of success. Taking on a tank or aircraft with light weapons generally does not turn out in the infantry’s favor. As such, if the choice is between risking some overpressure damage or facing a much greater risk of being killed by enemy vehicles, then the choice is obvious. As such, if the effectiveness of the weapon against the enemy adequately outweighs the risk to the operator, then it would be morally acceptable for the operators to take that risk. There is, however, still the question of the damage suffered during practice with the weapons.
The obvious way to argue that it is acceptable for troops to risk injury when training with heavy weapons is that they will need this practice to use the weapon effectively in combat. If they were to try to operate a heavy weapon without live practice, they would be far less likely to be effective and thus more likely to fail and be injured or killed by the enemy (or their own weapon). As such, the harm of going into battle without proper training morally outweighs the harm suffered by the operators in learning the weapon. This, of course, assumes that they are likely to end up in battle. If the training risks are taken and the training is not used, then the injury would have been for nothing—which takes this into the realm of considering odds in the context of ethics. On approach would be to scale training based on the likelihood of combat, scaling up if action is anticipated and keeping a minimal level when action is unlikely.
Making rational choices about the risks does, obviously enough, require knowing the risks. As such, there must be a proper study done of the risks of operating such weapons. Otherwise the moral and practical calculations would be essentially guessing, which is morally unacceptable.
When Obama was president, the “red line” he drew for the Syrian regime was the use of weapons of mass destruction, specifically chemical weapons. President Trump has also embraced the red line, asserting that Syria has gone “beyond a red line” with its recent use of chemical weapons. Trump has said that this attack changed his attitude towards Syria and Assad. Presumably the slaughter of civilians with conventional weapons did not cross the red line or impact his attitude very strongly. Those of a cynical bent might contend that the distinction between conventional and chemical weapons is accepted because it grants politicians the space needed to tolerate slaughter while being able to create the appearance of a moral stance. This moral stance is, of course, the condemnation of chemical weapons.
As I wrote in 2013, this red line policy involving chemical weapons seems to amounted to saying “we do not like that you are slaughtering people, but as long as you use conventional weapons…well, we will not do much beyond condemning you.” This leads to the question I addressed then, which is the question of whether chemical weapons are morally worse than conventional weapons.
Chemical weapons are clearly perceived as being worse than conventional weapons and their use in Syria has resulted in a level of outrage that the conventional killing has not. Some of the reasons for this perception are rooted in history.
World War I one saw the first large scale deployment of chemical weapons. While conventional artillery and machine guns did the bulk of the killing, gas attacks were regarded with a special horror. One reason was that the effects of gas tended to be rather awful, even compared to the wounds that could be inflicted by conventional weapons. This helped establish the feeling that chemical weapons are especially horrific and worse than conventional weapons.
There is also the ancient view that the use of poison is inherently evil or at least cowardly. After all, poison allows one to kill in secret and without taking the risk of facing an opponent in combat. In historical accounts and in fiction, poisoners are typically cast as villains. One excellent example of this is the use of poison in Shakespeare’s Hamlet. Even in games, such as Dungeons & Dragons, the use of poison is regarded as an inherently evil act. In contrast, killing someone with a sword or gun can be morally acceptable or even heroic. This view of poison as cowardly and evil seems to have infected the view of chemical weapons. This makes sense given that they are poisons.
Finally, there is the association of poison gas with the Nazi concentration camps. This connection has served to cement the connection of chemical weapons with evil. While these explanations are psychological interesting, they do not resolve the question of whether chemical weapons are morally worse than conventional weapons. It is to this issue that I now turn.
One good reason to regard chemical weapons as worse than conventional weapons is that they typically do not merely kill—they inflict terrible suffering. The basis of the difference is the principle that while killing is morally wrong, the method of killing is morally relevant to its wrongness. As such, the greater suffering inflicted by chemical weapons makes them morally worse than conventional weapons.
There are three counters to this. The first is that conventional weapons, such as bombs and artillery, can inflict horrific wounds matching the suffering inflicted by chemical weapons.
The second is that chemical weapons can be designed so that they kill quickly and with minimal suffering. An analogy can be drawn to capital punishment: lethal injection is regarded as morally superior to more conventional modes of execution such as hanging and firing squad. If the moral distinction is based on the suffering of the targets, then these chemical weapons would be morally superior to conventional weapons. Horrific chemical weapons would, of course, be worse than less horrific conventional (or chemical) weapons. As such, being a chemical weapon does not make a weapon worse, the suffering it inflicts is what matters morally.
The third is that wrongfully harming people with conventional weapons is still evil. Even if it is assumed that chemical weapons are worse in terms of the suffering they cause, the moral red line should be the killing of people rather than killing them with chemical weapons. This is because the distinction between not killing people and killing them is greater than the distinction between killing people with conventional weapons and killing them with chemical weapons. For example, having soldiers kill everyone in a village using their rifles seems to be as morally wrong as using poison gas to kill everyone. The result is the same: mass murder.
In addition to supposedly causing more suffering than conventional weapons, chemical weapons are said to be worse because they are often indiscriminate and persistent. For example, a chemical weapon deployed as a gas can easily drift and spread into areas outside of the desired target and remain dangerous for some time after the initial attack. As such, chemical weapons are worse than conventional weapons because they harm and kill those who were not the intended targets.
The obvious counter to his is to note that conventional weapons can also be indiscriminate or persistent. While bombs and artillery shells are accurate, they do still result in unintended causalities. They can also be used indiscriminately. Land mines present an excellent example of a conventional weapon that is both indiscriminate and persistent. Chemical weapons could be designed to have the same level of discrimination as conventional area-of-effect weapons (like bombs) and to be non-persistent (losing lethality rapidly). As such, it is discrimination and persistence that matter rather than the composition of the weapon.
While specific chemical weapons are worse than specific conventional weapons, chemical weapons are not inherently morally worse than conventional weapons. In fact, the claim of a moral distinction between conventional and chemical weapons can have terrible consequences: it allows a moral space in which to tolerate murder while maintaining the delusion of taking a meaningful moral stance.
While pharmaceutical companies and their stockholders have profited greatly from flooding America with opioids, this has come at a terrible cost to others. Showing that the idea of gateway drugs can prove true, there has proven to be a clear path from legal opioids to illegal opioids (such as heroin). As would be expected, the use of opioids can have a terrible impact on health. One example of this is endocarditis.
Endocarditis is, roughly speaking, an abscess on a heart valve. While not limited to drug users, it is not an uncommon consequence of injecting opioids. Since the abuse of opioids is increasing, it is no surprise that the number of drug users suffering from endocarditis has increased significantly. As would be imagined, the treatment of endocarditis involves a very expensive surgery. As would also be imagined, many of the drug users getting this surgery are on Medicaid, so the taxpayers are footing the bill for this expensive treatment. To make matters worse, people typically return to using opioids after the surgery and this often results in the need for yet another expensive surgery, paid for by Medicaid. This does raise some serious moral concerns.
There is, of course, the very broad moral issue of whether Medicaid should exist. On the one hand, a compelling moral argument can be made that just as a nation provides military and police protection to citizens who cannot afford their own security forces or bodyguards, a nation should fund medical care for those who cannot afford it on their own. On the other hand, a moral argument can be made that a nation has no obligation to provide such support and that citizens should be left to fend for themselves in regards to health care. Naturally enough, if the nation is under no obligation to provide Medicaid in general, then it is under no obligation to cover the cost of the surgery in question. On this view, there is no need to consider the matter further.
However, it does seem worth granting for the sake of argument that the state should provide Medicaid and then consider the ethics of paying for endocarditis surgery for opioid addicts. Especially when they are likely to continue the behavior that resulted in the need for surgery. It is to this discussion that I now turn.
While it certainly appears harsh to argue against paying for addict’s heart surgery, a solid moral case can be made in favor of this position. The easiest and most obvious way to do this is on utilitarian grounds.
As noted above, the surgery for endocarditis is very expensive. As such, it uses financial and medical resources that could be used elsewhere. It seems likely that a great deal of good could be done with those resources that exceed the good created by replacing the heart valve of an addict. This argument can be strengthened by including the fact that addicts often return to the very behavior that resulted in endocarditis, thus creating the need for repeating the costly surgery. From a utilitarian perspective, it would be morally better to use those resources to treat patients who are far less likely to willfully engage in behavior that will require them to be treated yet again. This is because the resources that would be consumed treating and retreating a person who keeps inflicting harm on themselves could be used to treat many people, thus doing greater good for the greater number. Though harsh and seemingly merciless, this approach seems justifiable on grounds similar to the moral justification for triage.
Another approach, which is even harsher, is to focus on the fact that the addicts inflicting endocarditis on themselves and often doing so repeatedly. This provides the basis for two arguments against public funding of their treatment.
One argument can be built around the idea that there is not a moral obligation to help people when their harm is self-inflicted. To use an analogy, if a person insists on setting fire to their house and it burns down, no one has a moral responsibility to pay to have their house rebuilt. Since the addict’s woes are self-inflicted, there is no moral obligation on the part of others to pay for their surgery and forcing people to do so (by using public money) would be like forcing others to pay to rebuild the burned house.
One way to counter this is to point out that a significant percentage (probably most) health issues are self-inflicted by a lack of positive behavior (such as exercise and a good diet) and an abundance of negative behavior (such as smoking, drinking, or having unprotected sex). As such, if this principle is applied to addicts in regards to Medicaid, it must be applied to all cases of self-inflicted harms. While some might take this as a refutation of this view, others might accept this as quite reasonable.
Another argument can be built around the notion that while there could be an obligation to help people, this obligation has clear limits. In this case, if a person is treated and then knowingly returns to the same behavior that inflicted the harm, then there is no obligation to keep treating the person. In the case of the drug addict, it could be accepted that the first surgery should be covered and that they should be educated on what will happen if they persist in their harmful behavior. If they then persist in that behavior and need the surgery again, then public money should not be used. To use an analogy, if a child swings their ice cream cone around playing like it is a light sabre and is surprised when the scoops are flung to the ground, then it would reasonable for the parents to buy the child another cone. If the child then swings the new cone around again and the scoops hit the floor, then the child can be justly denied another cone.
An obvious counter is to contend that addicts are addicted and hence cannot be blamed for returning to the same behavior that caused the harm. That is, they are not morally responsible for what they are doing to themselves because they cannot do otherwise. This does have some appeal, but would seem to enable the justification of requiring addicts to undergo treatment for their addiction and to agree to monitoring of their behavior. They should be free to refuse this (which, ironically, assumes they are capable of free choice), but this should result in their being denied a second surgery if their behavior results in the same harm. Holding people accountable does seem to be cruel, but the alternative is unfair to other citizens. It would be like requiring them to keep rebuilding houses for a person who persists in setting fires in their house and refuses to have sprinklers installed.
These arguments can be countered by arguing that there is an obligation to provide such care regardless of how many times an addict returns to the behavior that caused the need for the surgery. One approach would be to build an analogy based on how the state repeatedly bails out big businesses every time they burn down the economy. Another approach would be to appeal to the value of human life and contend that it must be preserved regardless of the cost and regardless of the reason why there is a need for the medical care. This approach could be noble or, perhaps, foolish.
As a point of ideology, many conservatives advocate the broad application of free market principles. One key part of this ideology is the opposition of regulation, at least regulation that does not favor businesses. Since health care is regarded as a business in the United States, there is an interesting question in regards to the extent that health care pricing should be regulated by the state.
Because of the high cost of health care in the United States, there have been proposals to place limits on the cost of health care services. Some areas have implemented such proposals, but there is a general lack of such regulations on pricing. Those who oppose such regulations often contend that pricing should be set by free competition between health care providers and that consumers of health care should be savvy shoppers. The idea is that savvy health care shoppers will take their business to providers that offer better services or lower costs, which will force the competition to lower costs or improve quality.
There are various problems with the idea of savvy health care shoppers. The first is the challenge consumers face in finding the prices that health care providers charge. While it can be difficult to predict what services a consumer might need, health care providers often have a range of prices depending on who is paying for the services. For example, insurance companies negotiate prices with providers and these differ from what consumers without insurance would pay. Health care providers, although they always have a database of billing codes and costs, are generally reluctant to provide this information. This makes savvy shopping difficult.
A second problem is that health care consumers typically lack the medical knowledge to make informed decisions about health care. While a person might have some challenge in sorting out what sort of phone or laptop they should buy, sorting out what sort of medical care they might really need is typically beyond the skill of most people. That is why people go to medical professionals. As such, being a savvy shopper is rather difficult.
A third problem is that it is something of a mistake to describe a health care consumer as a consumer; it is usually more apt to call them a patient. While this might seem to be a mere difference in labels, the difference between consumer and patient is significant.
A rather important difference is that a patient is typically in duress—they are injured or ill and thus not in a very good state to engage in savvy shopping practices. While an informed rational consumer will be looking for the best deal, a suffering patient is concerned primarily with getting better. As people say to not go grocery shopping on an empty stomach, it would be best to not shop for health care when one is not healthy—but that is exactly when one needs health care. There are also the more extreme cases. For example, a person who is badly injured in a car crash is not going to be shopping in a savvy manner for emergency rooms as they are being transported in the ambulance.
It can be countered that there are cases in which a person can engage in savvy shopping, such as elective surgeries and non-emergencies. This is a reasonable point—a person who is not in dire need can take the time to shop around and be a savvy consumer. However, this does not apply to cases in which a person is sick or injured enough to impeded such savvy shopping.
Another important difference between consumer and patient is that the consumer often has a reasonable choice between buying a good or service and doing without. In contrast, patients usually have a real need for the good or service and doing without would be a real hardship or even fatal. When one must buy the good or service and the provider knows this, it makes it much harder to be a savvy shopper. This also provides a segue into the matter of regulating prices.
While free market pricing can work when consumers can easily do without the good or service, it runs into obvious problems for the consumer when the goods or services are necessities. To the degree that the patient cannot do without the health care goods or services, the patient is at the mercy of the provider. So, while a person can easily elect to do without the latest iPhone if they cannot afford it, it is much more difficult for a person to do without their chemotherapy or AIDS medication. True, a consumer could do without liposuction or breast implants, but such elective surgery differs from non-elective treatments.
The stock counter to such concerns is that if a consumer finds the price of a good or service too high, they can go to a lower priced competitor. Assuming, of course, that there is real competition. In the case of health care, the opportunity to find a lower priced competitor can be problematic. A patient might not have the time to shop around on the way to an emergency room. In many places, there is not any local competition with lower prices. As such, this free market advice is not very helpful.
In the case of pharmaceuticals, patients often find that there is no competition. When a company has a patent on a medication, the United States’ government uses its coercive power to enforce that patent, ensuring that the company retains a monopoly on that medication. Because of this, a patient who needs the medication has two basic choices: do without or pay the price. There is no free market competition, so without regulation on the part of the state, the company can decide to charge whatever is desired—subject to the cost of bad press, of course.
This monopoly system does create something of a quandary for a principled proponent of the free market. On the one hand, without such patents a free market of drugs would make it irrational for for-profit companies to invest in costly research. This is because as soon as the drug was developed, the competition would just duplicate it and can sell it cheaper because they would not need to recoup the cost of development. A solution, which would not be very free market, would be to have the state fund the expensive research and then provide the results to companies who would then compete without monopolies for consumer dollars. Another “solution” would be to let the market remain free and hope that medications would somehow be developed.
On the other hand, if the state stepped in to regulate prices as part of the agreement for using its coercive power to protect the monopoly, then there would also be no free market competition. But, the state could see to it that the companies charged prices that allowed profits while not gouging patients.
My own view, as might be suspected, is that since patients are essentially a coerced market when it comes to health care and medication, the state should act to regulate prices. In the case of pharmaceutical companies, this should be part of the bargain with the state that allows them to maintain their monopolies. After all, if taxpayer dollars are to be used to protect monopolies, then they should get something in return—and this something should be reasonably priced medication. In the case of health care providers, while they do not usually have a monopoly, they do have a coerced market. Just as the state justly steps in to prevent price gouging during large scale natural disasters, it can justly do so in regards to personal disasters—that is, injury and illness.
I am certainly sensitive of the desire of health care providers and pharmaceutical companies to make a profit and, as such, I would certainly advocate that the regulations on pricing leave them a reasonable margin of profit. While it might be objected that a reasonable margin of profit it hard to define, my reply is that if price gouging can be recognized in other areas, it can (and is) be recognized in the realm of medicine.
While Trump claimed that he would help the forgotten people of America, his rural and small town supporters will most likely be harmed by the implementation of his agenda. Trump also ran hard on repealing Obamacare and engaging in what some would characterize as trade wars. If the administration makes good on these promises, many of his supporters will be harmed. Some have gone as far as asserting that Trump’s presidency will prove to be a disaster for the white working class.
Since these are factual claims, they can be countered by evidence to the contrary and it is worth considering that the predictions of woe might prove to be in error. That is, the Trump administration will lead the working class and forgotten people to a new age of prosperity, health and wellbeing. While not logically impossible, this does seem unlikely. As such, the most reasonable bet is that the Trump administration will prove to be good for Trump and his fellow economic elites but not so good for everyone else.
After Trump won, a cottage industry of writing articles explaining why people supported him when doing so seemed contrary to their interests. It is, of course, tempting to liberal intellectuals to explain this support in terms of such things as racism. It is also tempting to think that people were willfully ignorant of Trump’s long history of misdeeds (such as how students were exploited by Trump University), that many of his supporters were pathologically delusional in believing that he would truly act in their interests or that they were simply stupid. I will, however, advance a different account, that the Trump supporters who will be hurt by Trump and the other Republicans are moral heroes.
While there are many ways to be a moral hero, one standard way is for a person to willingly suffer harm for the sake of the good of others. The stock philosophy 101 example is, of course, the soldier who throws themselves upon a grenade to save their fellows. This is often presented in utilitarian terms: the willing suffering of the few is outweighed by the good this generates for the many. If the Trump supporters knew they would be hurt by his policies, but believed that their suffering would make America great again, then they could be regarded as moral heroes for their sacrifice. If, however, they thought they would benefit from Trump’s policies and got it wrong, then they would not be moral heroes, but merely have been acting from self-interest.
While a noble sacrifice for the good of the many would be heroic, it does not seem that Trump’s policies will be good for the many Americans. Rather, it seems that Trump and his fellow Republicans will be crafting policies that benefit the rich at the expense of the many. For example, his tax plan will be amazing for the rich but harmful to those who are not well off. As such, without an assumption of ignorance, those who supported Trump and will be harmed by his policies cannot be considered moral heroes. At least in the context of utilitarianism. However, there are other moral theories and one of these might make them moral heroes.
Trump, like most people, does not seem to operate based on a considered moral theory. This is no more surprising than the fact that most people do not operate based on considering theories in physics, biology, medicine or engineering. However, these theories still apply to what people do and it is reasonable to consider what sort of moral theory Trump and his fellows would fit into.
The way Trump has treated contractors, students at Trump University, women and others indicates that Trump operates from selfishness. This would suggest that the most likely moral theory to apply to Trump would be ethical egoism. This is the view that a person should act to maximize value for themselves. Alternatively, that each person should act entirely in their own interest. This is in contrast with altruistic ethics, which include the view that each person should not always act solely in their own self-interest, but should consider others.
Ethical egoism seems to fit many Republicans and hence it is no surprise that the frat-bro Republican philosopher Paul Ryan has embraced the ethical egoism of Ayn Rand. To be fair, after John Oliver critiqued Rand, Ryan did assert that he does not embrace her objectivism. However, consideration of Rand’s policies show that they are consistent with the ethics of Rand as expressed in her view that selfishness is a virtue.
While Trump would seem to fit within ethical egoism, this moral theory would make the Trump supporters who will be hurt by Trump chumps and not heroes. After all, a moral hero in ethical egoism would be a person who acts to maximize their self-interest. This will typically be at the expense of others. A moral hero of an ethical egoist would not back Trump if they believed that doing so would be contrary to their interests and would not maximize value for them. However, there is still a chance for moral heroism.
While Trump certainly has the selfishness part of ethical egoism down, classical ethical egoism enjoins everyone to maximize their self-interest. In the ideal laid out by Adam Smith, this would result in competition that is supposed to benefit everyone by the magic of the invisible hand of the market.
It is true that Trump, Ryan and their ilk are presenting polices that do not just benefit themselves. Many of these polices do benefit others, but it is a select group of others, namely the economic elites. While this could be explained in terms of ethical egoism, that Trump and Ryan are doing the right thing because benefiting these elites benefits them (Ryan, for example, enjoys the financial backing of these elites and this enables him to get re-elected) there is also an alternative. This could be called “ethical oligarchism.” This is the moral view that people should act to maximize value (or in the interest of) the oligarchs. This can, of course, be a nationalistic ethics—that people of a country should act in the interest of their oligarchs. It could also be a general view that transcends borders—that everyone should act in according with the interests of the oligarchs of the world.
On this view, the Trump supporters who will harmed by Trump’s policies are moral heroes—they have sacrificed their own good for the good of the oligarchs.
One way to argue that the state is obligated to provide health care (in some manner) to its citizens is to draw an analogy to the obligation of the state to defend its citizens from “enemies foreign and domestic.” While thinkers disagree about the obligations of the state, almost everyone except the anarchists hold that the state is required to provide military defense against foreign threats and police against domestic threats. This seems to be at least reasonable, though it can be debated. So, just as the United States is obligated to defend its citizens from the Taliban, it is also obligated to defend them against tuberculous.
Another approach is to forgo the analogy and argue that the basis of the obligation to provide military defense and police services also extends to providing health care. The general principle at hand is that the state is obligated to protect its citizens. Since anthrax and heart failure can kill a person just as dead as a bullet or a bomb, then the state would seem to be obligated to provide medical protection in addition to police and military protection. Otherwise, the citizens are left unguarded from a massive threat and the state would fail in its duty as a protector. While these lines of reasoning are appealing, they can certainly be countered. This could be done by arguing that there are relevant differences between providing health care and providing armed defenses.
One way to do this is to argue that the state is only obligated to protect its citizens from threats presented by humans and not from other threats to life and health, such as disease, accidents or congenital defects. So, the state is under no obligation to protect citizens from the ravages of Alzheimer’s. But, if ISIS or criminals developed a weapon that inflicted Alzheimer’s on citizens, then the state would be obligated to protect the citizens.
On the face of it, this seems odd. After all, from the standpoint of the victim it does not seem to matter whether their Alzheimer’s is “natural” or inflicted—the effect on them is the same. What seems to matter is the harm being inflicted on the citizen. To use an obvious analogy, it would be like the police being willing to stop a human from trying to kill another human, but shrugging and walking away if they see a wild animal tearing apart a human. As such, it does not matter whether the cause is a human or, for example, a virus—the state’s obligation to protect citizens would still apply.
Another approach is to argue that while the state is obligated to protect its citizens, it is only obligated to provide a certain type of defense. The psychology behind this approach can be made clear by the rhetoric those who favor strong state funding for the military and police while being against state funding for medical care. The military is spoken of in terms of its importance in “degrading and destroying” the enemy and the police are spoken of in terms of their role in imposing “law and order.” These are very aggressive roles and very manly. One can swagger while speaking about funding submarines, torpedoes, bullets and missiles.
In contrast, the rhetoric against state funding of health care speaks of “the nanny state” and how providing such support will make people “weak” and “dependent.” This is caring rather than clubbing, curing rather than killing. One cannot swagger about while speaking about funding preventative care and wellness initiatives.
What lies behind this psychology and rhetoric is the principle that the state’s role in protecting its citizens is one of force and violence, not one of caring and curing. This does provide a potential relevant difference; but the challenge is showing that this difference warrants providing armed defense while precluding providing medical care.
One way to argue against it is to use an analogy to a family. Family members are generally obligated to protect one another, but if it were claimed that this obligation was limited only to using force and not with caring for family members, then this would be rightfully regarded as absurd.
Another approach is to embrace the military and police metaphors. Just as the state should thrust its force against enemies within and without, it should use its medical might to crush foes that are literally within—within the citizens. So, the state could wage war on viruses, disease and such and thus make it more manly and less nanny. This should have some rhetorical appeal to those who love military and police spending but loath funding healthcare. Also to those who are motivated by phallic metaphors.
As far as the argument that health care should not be provided by the state because it will make people dependent and weak, the obvious reply is that providing military and police protection would have the same impact. As such, if the dependency argument works against health care, it would also work against having state military and police. If people should go it on their own in regards to health care, then they should do the same when it comes to their armed defense. If private health coverage would suffice, then citizens should just arm themselves and provide their own defense and policing. This, obviously enough, would be a return to the anarchy of the state of nature and that seems rather problematic. If accepting military and police protection from the state does not make citizens weak and dependent, then the same should also hold true for accepting health care from the state.
As a final point, an easy way to counter the obligation argument for state health care is to argue that the state is not obligated to provide military and police protection to the citizens. Rather, the military and the military, it could be argued, exists to protect and advance the interests of the elites. Since the elites have excellent health care thanks to their wealth and power, there is no need for the state to provide it to them. Other than the elites in government, like Paul Ryan and Trump, who get their health care from the state, of course. On this view, support for using public money for the military and police and not health care makes perfect sense.