Wednesday, August 08, 2007

Hoisted from Comments: This is a Defense?

by Tom Bozzo

Arnold Kling responds via comment to Ken's post:
I disagree with your interpretation of my essay. I did not say that getting screened for colon cancer is a bad idea. I just said that it is not a human right. I did not say that clinical trials are a bad idea. I just said that undergoing a therapy that is just in the clinical trial stage is not a human right.
Going to the replay, Kling said:
But none of these medical services [diagnosis of a back injury, colonoscopy, experimental treatments] is a necessity. You would not say that someone's human rights were violated if they did not obtain these services.
The problem is that neither "necessity" nor "human rights" is defined. He might as well say:
But none of these medical services is a blimlimlim. You would not say that someone's dalg glidj were violated if they did not obtain these services.
I mean, who could argue with that? [*]

Since actually "necessity" and "human rights" aren't (or at least shouldn't) be nonsense words, we can argue. At EconLog, it can be hard to find a "right" that's defended beyond the "inalienable right to the fruits of [one's] labor." [**] Even on that score, Kling is on thin ice. He grants that colonoscopies "may be a helpful precaution against colon cancer" seemingly without recognizing that "helpful" means "preventing untimely death," which is the ultimate alienation of property, and I don't mean by terrestrial taxation. (Also, the age and frequency recommendations for colon cancer screening already involve some cost-benefit calculations, raising another question of just what Kling considers "cost-effective health care.") Diagnosis of back injuries can mean the difference between the ability to work and the ability to collect a disability stipend.

The care may not be "necessary" in a guarantee-of-success sense, but nevertheless there's a clear nexus betwen health status, health care, and the Lockean rights that Cato Institute libertarians may like to claim.

Kling continues:
As to uninsured children, if they are orphans then certainly it makes sense for the government to insure them. Otherwise, their families have the primary responsibility for paying for their health care. I stand by my position.
I stand by Kling's "right" to stand by his position [***], but this doesn't do much to rebut Ken's claim that libertarianism run amok makes people think (some) economists are bonkers.

Surely, you might say, someone with a PhD in economics from MIT (as has Kling) must be aware that there's some middle ground between "orphans" and children of better-off parents who voluntarily self-insure (if any). Not so fast! Kling was a perpetrator of one of those "the poor never had it so good" arguments you see every once in a while, including (I sh1t you not) a subhead "The Disappearing Lower Class." [****] That once led me to offer what I now might call "Shorter supporters of the bankruptcy bill:"
The poor and working classes aren't poor because they have access to better cars, occasional air travel, VCRs, microwave ovens, and washing machines. However, they shouldn't have spent their (or their creditors') money on any of it.
Or, if you want to think of the issue in such terms, both household budget constraints and relative prices partly why the relatively poor can enjoy some modest amenities of millennial technology while lacking in health insurance and/or routine health care.

You can add up everything a not-that-well-off family spends on modern conveniences and not come close to the price of a health plan that covers preventive care. In such cases, which I submit without proof are not uncommon among the uninsured and underinsured, there isn't a real choice at hand.

Or, if people "choose" to consume preventive health care at inefficiently low levels but will respond to prices, then they have to have a lower price put in front of them to fix whatever incentive problem there might be. This is, perhaps not surprisingly, the opposite of what most "market-based" health care "reforms" would do — i.e., raise effective prices of certain health care services in hopes that people consume less.

Believe it or not, Kling's comment here is a less crass formulation of his argument than what he offers on his own blog:

But are those children all orphans? If not, then I think that their parents can be held responsible for paying for their health care. If the parents choose not to buy health insurance, then they may have to pay cash or take out a loan to pay for medical services...

It strikes me that the advocates of expanding SCHIP, the Federal program that covers children, have successfully framed the issue as if the children were all orphans. This ought to go down as one of history's finest achievements in demagoguery.

This may go over swimmingly at the Cato or Club for Growth water coolers, but in the rest of the world, "that'll learn their parents to be more responsible" isn't the first thought (perhaps even in wingnuttier districts) when a kid who has chosen his or her parents badly gets sick.

[*] Apologies to the estates of Margaret and H.A. Rey. I actually don't argue with Kling in regard to the right to experimental or unproven treatment, but that's a plastic apple mixed in with edible oranges in his post.

[**] Which, to steal a phrase from Stephen Pinker, "would have been unthinkable throughout most of human history," and remains totally impractical today.

[***] It gives us stuff to blog about, if nothing else.

[****] They could be said to "disappear," after a fashion, if one can limit one's routine to the libertarian paradises of upper-middlebrow suburbia.

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