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 I believe that people should not use marijuana, I believe that the sale and consumption of the drug should be legal. Given the espoused principles of the Republicans, they should agree with me. To make the case for this, I will consider some of the core espoused principles of the Republicans.
First, Republicans employ the usual rhetoric of freedom (in early 2015 they had a Freedom Summit in Iowa) and allowing people the freedom to grow, sell and use marijuana would be consistent with the notion of freedom. But, of course, the vague rhetoric of freedom is just that—vague rhetoric. So I will turn to more specific principles.
Second, there is the standard Republican claim that they prefer to have matters handled locally rather than by the power of the federal government. Some states and the District of Columbia have legalized marijuana at the local level. To be consistent, the Republicans should accept the local decisions and allow the citizens to exercise the freedom they voted for. To impose on the local governments and the citizens would be contrary to this espoused principle.
Third, Republicans often speak of “getting government off our back” and in favor of small government. The laws regarding marijuana and their enforcement certainly put the government on the back of citizens. As the Republicans like to say, why should the state be telling people what they can and cannot do? These laws have also led to an increase in the size of government, which is contrary to the small government ideal.
Fourth, Republicans are typically eager to oppose regulations and want to set the market free. Legalizing marijuana by removing the existing laws would reduce regulations, thus being in accord with this ideological point. The free market has clearly spoken in regards to marijuana: people want to buy and sell it. To impose harsh laws and regulations on these transactions is to impede the free market and to have the government pick winners and losers. The Republicans should be in favor of this freeing of the market from burdensome regulation.
Fifth, Republicans speak lovingly of job creators and job creation. The marijuana industry is run by job creators who create many jobs in growing and distributing the crops. They also create jobs in the snack and fast food industries as well as in the paraphernalia business. Legalizing marijuana would help grow the economy and create jobs, so the Republicans should support this.
Finally, the Republicans express a devotion to lowering government spending. Enforcing the marijuana laws is rather costly and legalizing marijuana would help reduced government spending. This would allow more tax cuts. Given these key Republican principles, they should eagerly embrace the legalization of marijuana.
It might be noted that Republicans, despite these espoused principles, should be opposed to legalizing marijuana. One reason that has been stated is that marijuana is harmful, and specifically harmful for the children.
I, of course, agree that marijuana is harmful and certainly agree that children should not use it. However, there is the matter of consistency. Obviously enough, harmful things such as alcohol, automobiles, tobacco, junk food and guns are legal in the United States and Republicans are staunch supporters of these things—despite the harm they do. As such, Republican support of marijuana would be consistent with their support of such things as guns, fossil fuels and tobacco. As far as the matter of children, marijuana can be handled in the same way as cars, guns, tobacco and alcohol. That is, marijuana can be illegal for children.
There is also the fact that while marijuana is harmful, it does not seem to be significantly more harmful than tobacco and alcohol. Its use also kills far fewer people than do cars and guns. Naturally, I do agree that it should be illegal to drive, etc. while high—just as it is illegal to drive when drunk. As such, the harmful nature of marijuana
It might be objected that marijuana is simply immoral and thus must be kept illegal. The obvious challenge is showing why it is simply immoral and then showing why immoral things should be made illegal. This can be done—but the adoption of the principle that the immoral must be illegal would probably not appeal to Republicans if it were consistently applied.
Despite the devastation of the economy by the financial folks, there are still people who are crying out against regulation of the economy. In many cases these people are just spewing words placed into their minds by pundits. They speak about the free market, the invisible hand, and market forces as if these are benevolent deities that will make all things right. Naturally, they regard any attempts to limit these divine forces as socialism, communism, and oppression.
Interestingly enough, many of the same folks who cry for a free market are also a bit obsessed with severely limiting personal privacy and personal liberty. These folks cry out against same sex marriage and cry for the Patriot Act and its ilk. They do not even seem to realize that they are crying for a free society for the money people and a restricted society for all the rest of us.
My own view is a fairly moderate one. While I am not a Hobbesian, I do agree that some people do need to be compelled to behave by the use of force. I also agree with Mill that it is better to have more liberty than less but also that freedom does, ironically, require restrictions on people’s liberty. Put in a nutshell, I think we should restrict people to the degree required to prevent folks from harming each other but that we should not go beyond this. I am, of course, just stealing Mill’s view.
Unlike some folks, I think that this also applies to the market. While some folks cry for a free market, they do not cry for a lawless society. Interestingly, these folks see the need for laws restricting behavior such as theft and murder. They also see the need for laws protecting property and rights. They rightfully regard a lawless society as a place of danger and as undesirable. However, they seem to think that human behavior is magically changed by the market. So, while we cannot allow people to engage in same sex marriage, we can safely allow financial folks to run free and wild. After all, their reasoning goes, the market will sort things out.
However, if the market can do this, then it should also apply across all of life. After all, if the financial folks can be allowed to run wild and free within the magic of the free market, then the same should apply to everyone. Unless, of course, those financial folks are not human beings but some other different race that can do just fine without laws or restrictions.
So, if human beings need laws to regulate their behavior, this also applies to their economic behavior. Thus, we should no more have a lawless economy than we should have a lawless society. Naturally, the financial folk will complain that they cannot make as much money as they could without such limits. But, I am sure that rapists believe that they could commit many more rapes if only people did not insist on preventing them from doing so.
In the United States, Obama’s call for national health care reform has ignited a firestorm of controversy. One rather interesting result of the furor has been the accusation that Obama plans to create death panels. While the accounts vary, the general idea is that these alleged panels are intended to review cases and decide whether care (and the patient) should be terminated or not. Not surprisingly, this accusation is not true-there is nothing in the actual proposals about such death panels.
As I do every semester, I am teaching an ethics class in which the students have to write an essay on a moral issue. When the students ask what position they should take, I generally suggest that the argue for what they believe (rather than vainly trying to guess my view in the hopes of getting a better grade). But, I also suggest that they consider writing an argument against what they actually believe. Since I am against death panels, I thought I’d try my hand at my own suggestion and make a case for them. When reading, please keep in mind that what follows is not my actual view. Hence, there is no cause to accuse me of Nazi (or even socialist) leanings.
From an intuitive moral standpoint, private citizens are rather restricted in regards to when they can ethically end the life of another person. In general, such killing is restricted to clear cases of self defense. For example, if someone pulls a gun on me while I am out for a run and demands my fancy GPS watch, it would be morally acceptable for me to kill him on the spot. After all, he presents a clear and present threat to my survival (as Locke would say, I have no reason to think that someone who would rob me of my property would not take the next step and try to rob me of my life).
In the case of the death panel matter, it does not seem that this sort of individual right can be used as a justification. After all, a patient who is in need of critical and expensive care is not likely to be a clear and present threat to my survival.
Of course, it could be argued that such a person would be a threat because he is using resources that could save my life. However, killing an innocent person because they happen to have resources that could save my life does not seem to be morally defensible. For example, if am in a ship wreck and at risk of drowning, I have no right to kill another passenger and strip her of her life vest. As such, there seems to be little support for death panels here.
Perhaps, however, the matter changes when the focus is expanded to include society as a whole. After all, actions that would be blatantly immoral for an individual can often be transformed, by the “magic” of the collective, into acceptable actions. For example, what would be murder on the individual level becomes transformed to acceptable killing in the context of war (although, obviously, not everyone buys this).
In many cases, the moral transformation is brought about by an appeal to the general good (essentially an appeal to utilitarian considerations). For example, killing folks in war can be morally justified by appealing to the advantages of the war to “national security” or “national interest.” Not surprisingly, more cynical folks might point out that “national interest” is often the interest of a select few and it might be contended that such actions are no better than those of any organized gang of criminals.
Now, if such things as war can be morally justified, then justifying death panels should be easy enough on the same sort of grounds.
In the case of war, killing folks is most often justified on utilitarian grounds. For example, some folks must be killed (including the inevitable innocent bystanders) in order for the collective good (national security, for example) to be served. Now, let us turn to applying this sort of approach to the death panels.
While the United States and other Western countries have significant medical resources (enough so that certain folks, such as Michael Jackson, can have their own personal doctors) these resources are not unlimited. In fact, it can be contended that the resources are not sufficient to provide adequate health care to everyone.
Now, it is obvious that people who are in need of critical care use far more resources than other folks. It is also obvious that the elderly have more health issues than younger folks. Now, looking at the matter by the numbers, it seems likely that the resources used to maintain a critically ill person or an elderly person could be used to provide health care to a significant number of folks with less serious conditions. Typically, these would often be younger folks as well-folks who also still have years to contribute to the good of the state.
Looked at in terms of the general utility, it would seem to make practical and moral sense to allocate medical resources so that they do the most good for the general populace. As such, it would seem to be acceptable to terminate the care of the critical ill in favor of the less ill. It could also, on similar grounds, be argued that the focus of health care should be on the younger folks rather than the harder to maintain elderly folks. To use a car analogy, it makes more sense to spend less on maintaining a new car than to pour large sums of money in order to keep an old clunker going.
Since the United States is supposed to have a free market economy, the critical ill and the elderly who have the funds to purchase the medical care they need should be allowed to do so. After all, they are paying for the resources they are consuming and hence are not creating an undue burden on the health care system. Naturally, folks who are lacking in such funds would be imposing burdens on the system by consuming beyond what they can afford to pay for. As such, they would be robbing society of valuable resources.
Naturally, it might be pointed out that some critically ill people or elderly folks might have made valuable contributions that justify their being treated at the public expense. There might also be such folks who are making ongoing contributions or who can be expected to make such contributions in the future. For example, a medical student who is badly hurt in a accident may be expensive to treat, but it is likely that she will be able to contribute more than he treatment would cost.
This is, of course, where the death panels come in. These panels would serve to assess the relative worth of each patient and decide who will receive the medical resources and who will not. For those who balk at such an approach, the obvious reply is that this sort of thing is done in the case of triage. In this case, it is a triage of a different sort but would still seem to be justifiable on similar grounds. In this case, the person’s place in the medical queue is based not on her likelihood of survival but based on the value of her survival to the national good.
Of course, some folks might contend that the idea of having folks decide who lives and who dies is a horrific idea. It might also be wondered where people could be found with the adequate experience to make such calls. Fortunately, the United States has plenty of people who have experience in such things. For example, Governors in states that have the death penalty already serve on death panels. As another example, the folks who make decisions about going to war already are on a death panel as well. After all, they have an active role in deciding who will live and who will die. As a final example, folks in insurance companies sometimes make decisions that deny care to people. Since such decisions about life and death are fairly routine, there should be little problem finding people to serve on such panels.
So, death panels seem like a great idea and the United States should hope that Obama makes the rumors a reality. Obviously, philosophers and runners should get an automatic exemption from being reviewed by death panels. This is so obvious that there is no need to even argue.
Since at least the time of Adam Smith, people have been debating the matter of free markets. Grossly oversimplying matters, the idea is that if the folks who are involved in economic exchanges are left unregulated, the interplay of the “market forces” will result in an overall positive result. Competition, it is claimed, will lead to better and cheaper products and this means that via the power of the invisible hand, everyone will win.
Of course, the free market of this sort tends to not need to a better world for all. Rather, the result tends to be the creation of monopolies as the most ruthless, cunning, and lucky assimilate or destroy the competition. The stock example of this is, of course, the robber baron era of the United States. Folks also point to the fact that the United States economy was in a constant turmoil of surges and recessions during the halycon days of yore. Naturally, people also point to the deregulation of the 1990s and early 2000s as contributing factors to the ecomonic mess we are in these days.
Since at least the time of Marx, people have also been critical of the free market and have instead urged for a controlled market. The more extreme folks have even pushed for real socialism (state ownership of business and industry). These folks usually claim that this will be better for everyone by eliminating the evils of the free market.
Of course, when we look at many of the socialist and allegedly communist countries, we tend to see rather poor economies. While folks often point to Europe as an example of the success of socialism, these countries are not (despite the cries of the right) true socialist states.
The fact that totally free markets and totally controlled markets are recipes for disaster should hardly be surprising. After all, looking outside of economics reveals that total freedom and total control always seem to spell disaster.
For example, consider the matter of law. If there was no law and no enforcement of law, we’d be in what thinkers like Hobbes and Locke called the state of nature. While Locke painted a pleasant picture of this state and Hobbes cast it as a nightmare, both men agreed that a state without laws would be undesirable. Empirical evidence also reveals that if we consider what occurs when law and authority fail. Somalia is, of course, one modern example.
On the opposite end of the spectrum, states that attempt to repress and oppress their citizens, create horrific states. North Korea is an excellent example of this.
Most folks need, as thinkers such as Aristotle and Hobbes have argued, to be kept in check by laws and punishments. This is because most people are not ruled by ethics or reason, but are ruled by desires. To think that the economic realm is magically exempt from this is a delusion of extraordinary magnitude. This is especially true when you consider the obvious: people really like wealth and will often do awful things to get it. So, leaving people unregulated as they try to get rich is an alarmingly stupid idea. As such, people need to be regulated in their economic activities as well.
That said, what makes life valuable is freedom. Mill argues quite eloquently for this in his writings on the subject of liberty. Freedom is also important in allowing people to be their best. As the free market folks and any athlete will tell you, competition does lead to improvement. Of course, as any athlete will tell you, the competition has to governed by rules. Being a runner, I think that the sports analogy is quite a good one.
In a race, everyone is free to compete to the limits of their abilities. This competition drives people to do their best. Likewise, economic freedom provides people with the motivation and operating room they need to excel. Races are, of course, governed by rules. You cannot kill other runners, use a car, make use of illegal drugs and so on. This keeps the race from degrading into something nasty. Likewise, economic activity needs to be governed to keep it from going from a progressive activity to a destructive nightmare.
As in general law, the challenge is to find that right balance: enough freedom so that people are not repressed, oppressed and unable to be their best. But, enough regulation so that people cannot get away with doing wick and destructive things. That ideal balance is crucial to having a healthy society and a healthy economy.