A Defense of National Healthcare

Surveys

1. A plurality of economists favor universal health insurance: “Economists have not reached a consensus on the merits of universal health insurance—45.8% favor the idea, but almost an equal  number (38.7%) oppose it” (page 4 of https://docs.google.com/viewer?a=v&q=cache:O7ozLHOnfz0J:ew-econ.typepad.fr/articleAEAsurvey.pdf+&hl=en&gl=us&pid=bl&srcid=ADGEESiz6VO1qKHPH2gBdqyZgRdcIMmCZ-Hgy-GfrqjL5oPh4rd01GF3brJao2LEq-akOHynVUOOCfX3q1dzg1iQqhtW1fbqVNFUkgPfHPwA3BOt1_nwPa2xOcAu1Fm2M-yww6AMMSFp&sig=AHIEtbRX4NF6yKkLvSkONY06TXpkDK4Jig). While not a majority, the responses show slight support for national health care, and shows that the economic evidence against the merits of national health care is likely far from overwhelming. 
2. Citizens with national health care are more satisfied with their health care systems: “Americans are more dissatisfied than citizens of other nations with their basic health care. One-third of Americans told pollsters that the U.S. health care system should be completely rebuilt, far more than residents of Australia, Canada, New Zealand, or the U.K. Just 16 percent of Americans said that the U.S. health care system needs only minor changes, the lowest number expressing approval among the countries surveyed.” (http://www.foxnews.com/story/0,2933,136990,00.html) This is despite the fact that the U.S. is the 11^th happiest country in the world (http://247wallst.com/2012/05/22/the-happiest-countries-in-the-world-2/). The OECD consists of at least 30 countries that could be considered developed countries (http://en.wikipedia.org/wiki/Organisation_for_Economic_Co-operation_and_Development), and the U.S. is the only developed country without a national health care program (http://www.foxnews.com/story/0,2933,136990,00.html). So, Americans are not dissatisfied with their health care due to undue pessimism. 
3. Doctors support national health care: “Of more than 2,000 doctors surveyed, 59 percent said they support legislation to establish a national health insurance program, while 32 percent said they opposed it, researchers reported in the journal Annals of Internal Medicine…The Indiana survey found that 83 percent of psychiatrists, 69 percent of emergency medicine specialists, 65 percent of pediatricians, 64 percent of internists, 60 percent of family physicians and 55 percent of general surgeons favor a national health insurance plan. The researchers said they believe the survey was representative of the 800,000 U.S. medical doctors.” (http://www.commondreams.org/archive/2008/04/01/8018)

International Comparisons

1. WHO rankings: The World Health Organization ranked the health care systems of 190 nations, with France’s being ranked the best and America’s being the 37^th best (http://www.who.int/whr/2000/en/whr00_en.pdf, http://en.wikipedia.org/wiki/World_Health_Organization_ranking_of_health_systems#cite_note-whowhr2000-0). Note that many in the top 10 have national health care. Admittedly, the Who’s ranking system favors equality of health care access and quality, which is not directly related to overall quality of health care. However, WHO rankings are one set of evidence for national health care, and it seems unlikely that inequality alone can explain the U.S.’s low ranking considering that (1) only 62.5% of the rankings can be explained based on equality considerations, (2) America’s rankings are incredibly low, (3) American health care access is not completely unequal (http://en.wikipedia.org/wiki/World_Health_Organization_ranking_of_health_systems#Methodology). 
2.  The U.S. is the only advanced country without national healthcare: “The U.S. is the only industrialized country that does not offer government-sponsored health coverage for all citizens.” http://www.foxnews.com/story/0,2933,136990,00.html). 
3. U.S. has long wait times: Only Canada had longer wait times.  “Sixty percent of patients in New Zealand told researchers that they were able to get a same-day appointment with a doctor when sick, nearly double the 33 percent of Americans who got such speedy care. Only Canada scored lower, with 27 percent saying they could get same-day attention. Americans were also the most likely to have difficulty getting care on nights, weekends, or holidays without going to an emergency room.” (http://www.foxnews.com/story/0,2933,136990,00.html)

Research 

1. “Two US-based economists ran the numbers and found large, positive effects for near-universal health care on the self-assessed health of individuals in Massachusetts.” (http://larrywillmore.net/blog/2012/03/12/the-effects-of-romneycare-in-massachusetts/ ) 
2.  “After the passage of Romney’s reforms, the rate of per capita health-care spending growth slowed in Massachusetts both in absolute terms and relative to the national average.” (http://www.frumforum.com/romneycare-bent-the-cost-curve/ ) 
3. Extending health insurance to the uninsured reduces healthcare costs: “In the program this article describes, increasing individuals’ access to health care reduces the overall costs of care. ” (http://npalliance.org/blog/2012/02/26/expanding-health-insurance-coverage-should-reduce-costs/) (Original study here: http://content.healthaffairs.org/content/31/2/350.abstract)
4. Greater health care coverage results in greater public health: Taken together, our results strongly indicate that expansions in health system coverage lead, on average, to improved general population health." (http://eche2012.abstractsubmit.org/presentations/2993/)

Various

1. National health care also offers peace of mind: This is an often overlooked point. With guaranteed coverage, one does not need to worry about finances if medical disaster strikes but only about becoming well. 
2. Some argue that U.S. health care fares so poorly due to excessive government intervention. However, this argument is implausible since better health care systems use more such intervention.

The Great Libertarian Inconsistency

Libertarians pride themselves on their consistency, but how consistent are they?

They believe that the state should not "initiate force" (their terminology) except to prevent others from doing so in a way that directly violates the negative rights (rights to be left alone such as not being robbed or killed) of others. They do not support using coercion to benefit third parties (e.g., the welfare state) or in using force to stop actions that may indirectly harm third parties (e.g., libertarians support drug legalization regardless of what harms may result indirectly to third parties from licit cocaine use).

However, libertarians support the use of law enforcement to protect individuals from other individuals that may directly violate their right to be left alone. Such law enforcement requires taxes, which are coercive.

Libertarians argue that indirect third-party harm (e.g., resulting from a lack of safety regulations) or the poverty of others (e.g., resulting in part from a lack of welfare programs) are not the responsibility of individuals.

But then, why is it my responsibility to pay the necessary taxes to prevent your house being robbed, but not my responsibility to pay taxes so someone can have necessary medical care? I'm no more directly involved in the case of a third-party being robbed than I am in the case of someone suffering due to a lack of necessities.

The only consistent libertarians on this matter have been anarchist libertarians.

Libertarians must also choose between their support of private property rights with freedom of contract on one hand and their limited conception of the state on the other when it's the case that the state gradually grows in size and scope via private property and freedom of contract. If private property owners can control what others do on their property, then why can't the state of a national territory control what others do within it's boundaries if that state is the result of freedom of contract and private ownership?

For example, large landowners may voluntarily incorporate their land, and then later, via contractual agreements, allow tenants to live on their land provided they pay rent (taxes) and then vote on various policies affecting the land's management.

The Myth of Libertarian Economists

Many on the left discount economics as right-wing propaganda, while many libertarians present economics as supportive of libertarianism. However, the presentation of economists as libertarian is largely a myth, meaning not that no economist is libertarian, but that relatively few are.

In fact, surveys suggest the typical economist is a moderate Democrat, not particularly extreme one way or the other.

Consider the following:

1. 2.9:1---The ratio of Democrats to Republicans among economists (http://www.insidehighered.com/news/2005/12/21/politics). Among social scientists, economists are the least Democratic and sociologists are the most Democratic, with 21.1 Democrats for every Republican.
2. Many economists believe Obama's 2012 jobs plan, which cuts the payroll tax and increase spending, would likely prevent a 2012 recession (http://www.bloomberg.com/news/2011-09-28/obama-jobs-plan-prevents-2012-recession-in-survey-of-economists.html).
3. Economists also believed that Obama had "the superior economic plan, a firmer grasp of economics and [would] appoint better economic advisers" (http://www.economist.com/node/12342127?story_id=12342127) compared to McCain. Of 142 economists, 80% believed Obama better understood economics. Even among Republican economists, 46% versus 23% believed Obama possessed better understanding. 81% thought Obama would appoint better advisers than McCain. "On our one-to-five scale, economists on average give Mr Obama’s economic programme a 3.3 and Mr McCain’s a 2.2."
4. According to a survey of 264 economists, "most economists are supporters of safety regulations, gun control, redistribution, public schooling, and anti-discrimination laws. They are evenly mixed on personal choice issues, military action, and the minimum wage. Most economists oppose tighter immigration controls, government ownership of enterprise and tariffs. In voting, the Democratic:Republican ratio is 2.5:1."(http://econfaculty.gmu.edu/klein/PdfPapers/KS_PublCh06.pdf) Generally, economists are slightly liberal but mostly moderate .
5. Economists overwhelmingly favor free trade, with 66.7% of the 264 economists strongly oppose tariffs to protect American industries and 20.1% oppose it mildly, whereas 2.3% strongly support, 3% mildly support these tariffs, and 7.6% have mixed feelings (page 4 of http://econfaculty.gmu.edu/klein/PdfPapers/KS_PublCh06.pdf).
   
6. Economists are mixed on the minimum wage, with 20.5% strongly opposed, 17.8% opposed mildly, 14.4% having mixed feelings, 18.9% mildly supporting, and 28.4% strongly supporting. This means 38.3% oppose the minimum wage, while 47.3% support a minimum wage. Generally, economists have mixed feelings about the minimum wage, considering that 14.4% also have mixed feelings (Ibid.).
7. Economists overwhelmingly favor occupational safety regulations, with a total of 71.5% favoring safety regulations and only 16.9% having mixed feelings (Ibid).
8. Economists overwhelmingly favor pharmaceutical safety controls, with a total 70% favoring such controls and only 15.5% having mixed feelings (Ibid).
9. Economists overwhelmingly favor air and water regulation, with 79.9% supporting and only 8.3% having mixed feelings (Ibid.).
10. Among other issues, economists strongly favor anti-discrimination laws, gun control, controls on hard drugs, support prostitution controls, support gambling controls, strongly oppose government ownership of industry, strongly support redistribution (that's right, economists overwhelmingly support the welfare state), strongly support government production of education, oppose tighter controls on immigration, support foreign aid, and also strongly support strengthening the economy through monetary and fiscal policy. I didn't break all of these figures down since you can read the data yourself in the link I provided.

Though economists don't lean far to the left, it's fair to say they are slightly liberal moderates. These results demonstrate that libertarian economists are almost entirely pseudo-experts or just don't care what consequences policies have (e.g., economists favor foreign aid and government redistribution of wealth). We often think that economists are libertarian simply because libertarian economists are more vocal.

Of course, economic evidence and consequences are not everything to consider in designing policy. Positive economics studies only what empirical data tell us about consequences. Normative economics concerns what consequences are desirable or whether consequences matter in determining policy.

Private Property vs. National Sovereignty: A Matter of Scale

Libertarians generally argue that the state is wrong in controlling private property except where necessary to prevent direct violations of negative liberty on the grounds that private property is necessary for adequate freedom. However, private property can be used as a means of social control just as national sovereignty can, often to similar extents of control with similar origins, for private property are more alike than different except as a matter of scale.

Basically, the relevant similarities between the state and private property over land are so great that private property is effectively like a small scale state, and states are like property on larger scales even though states, like corporations I'd add, are controlled by many individuals.

It's therefore special pleading for libertarians to treat the state as if it had little or no right to control it's territory while treating treating owners of corporations and other private assets as possessing near absolute rights.

Consider some of the following similarities between private property and national sovereignty:

1.Origins: In the case of national sovereignty, an individual or group may find and claim territory as sovereign by finding it, stealing it, or bargaining for it. Likewise, individuals and groups may attain private property in the same manner. Also, private property may expand as state territory may expand.

2. Hierarchy: Just as sovereign state territory operates under a particular hierarchy with rules designating and regulating authority, so does private property. Private property could be controlled by a single individual or through complicated procedures and bylaws. Consider corporate stockholder conventions, corporate bylaws, and more generally, freedom of contract as examples of private hierarchy and institutional rules.

3. Control: Like sovereign states circumscribe personal conduct within their boundaries, so do private property owners within their property (e.g., a mall may restrict speech on its territory just as the state may limit speech within its territory). Even abstract institutions such as corporations and government agencies limit behavior of those operating within the institution or using the institution (e.g., a corporation may control its employees as a government agency does. Also, a government agency may stipulate the conditions and terms under which a citizen may use its services just as a corporation may). Further, the state regulates private property within its borders just as landlords and gated communities regulate the behavior of their tenants and their properties.

4. Interchangeability: Private property may become public property (e.g., through sale or confiscation) while public property may become private property (e.g., through privatization, sale, and, perhaps rarely, through force [e.g., consider past cases of mercenaries and private armies. The Dutch East India Company once had its own army]).

Please note that the previous list of similarities apply equally well to land as it does to more abstract entities (e.g., corporations share the same similarities listed above as agencies though their aims may vary).

Even today, overlap frequently exists between the private and public sectors. Privatization (e.g., school voucher programs, private prisons, private police, military contractors, etc.) and the use of public domain in service of business interests are examples of such overlap. Even where these sectors do not clearly overlap, striking similarities sometimes exist between private and public entities. For instance, oil companies act as keepers of the commons by claiming ownership over natural resources. One might also consider the case “innovators” who patent natural phenomena such as human genes (though one might reasonably argue that patents are still necessary to motivate discovery in such cases just as private property might be necessary to motivate oil drilling. However, I’m unsure of whether such incentives are truly necessary and would need to conduct more research before developing a sufficiently certain conclusion).

Private property does not obviously maximize personal liberty, at least private property as libertarians wish it to be defended from state intrusion. Privatization inevitably leads to corporatism when not reigned in. Once corporations are in power, they, like monopolies, have every incentive to raise prices and lower overhead costs. Rent seeking among business interests would only be worse once they operated all major government functions (e.g., tax collection, prisons, military, police, education, etc.). Libertarians obviously don't intend rent seeking to occur, but that would be the long-term consequence of full privatization in a libertarian state.

Further, even negative liberty requires physical resources in order to accomplish certain goals; negative liberty is valued not inherently but because of what ends it is used to accomplish.

Scale is what characterizes the primary differences between private and public institutions (while the private sector does not have its own dedicated police force, it can count on public law enforcement). “Scale” here refers quantitative differences in such features as land area, number of parties involved and relative authority (e.g., a landlord controls his apartments in which tenants live, but the larger and more powerful state regulates the landlord’s property).

In summary, private property and state institutions are more alike than different except as a matter of scale.

Equal Opportunity Causes Equal Outcomes

Oftentimes, people defend inequality, particularly economic inequality, on the basis that such inequality is justified by guaranteeing equal opportunity but not equal outcomes. However, the statement “equal opportunity doesn’t cause equal outcomes” is internally inconsistent.

Consider that opportunity is usually defined as a set of circumstances that makes it possible to do something, not including chance.

In this case, if one does not achieve something, then failure was the result of chance or lack of necessary circumstances for success.

Therefore, in practice failure and consequently inequality result from the lack of opportunity (equal economic opportunity means equal chances of economic success but without failure, meaning that there is economic equality).

Also, even if one rejects the overall claim as stated in this post's title, functionally equality of opportunity must be measured at least in part by measuring equality of outcomes (e.g., the more disproportionally group A excels than group B, the more likely it is, all else being equal, that group A enjoys more opportunities than group B).

Some might respond that unequal opportunity is acceptable provided that unequal opportunity derives from particular sources, particularly differences in personalities and behaviors. Here, debates over the existence, nature, and importance of freewill come to mind. However, freewill is a topic for another post.

Why I Lack A Coherent Worldview (Part 4: Of Specificity, Pragmatism, Choice, and Final Remarks)

Consider specificity. To hold beliefs at all we must rely on inherently ambiguous concepts. How do you define "truth"? What does it mean for something to be "true"? One might mean that true statements correspond to reality (i.e., the Correspondence Theory of Truth), but that's circular. Plus, what is "reality"? If we can't clearly define these terms, then we likely can't clearly define concepts such as "false," "objectivity," "probability," and so on.

I don't mean that "truth" is meaningless, nonexistent, or "relative" (whatever that means), but simply ambiguous and circular. Such ambiguity demonstrates limits of analytical philosophy. Humans want the universe to be remarkably less ambiguous than it is. We can form many guidelines for epistemological discourse but few formulaic rules. Objectivity is more intuitive than formulaic (this does not mean objectivity is not rational; rationality and intuition are not mutually exclusive [e.g., rationality maybe subconscious]). The world's incredibly detailed complexity force us to ignore some details, some of which maybe crucial to forming true beliefs. We have no choice but to generalize in answering most questions of reality's nature.

Consider pragmatism, specifically regarding objectivity. Objectivity is not always useful and sometimes counter-productive. For instance, optimism, which is rarely realistic, often motivates achievement of goals and improves personal happiness. In extreme situations, a "noble lie" maybe necessary to protect society's welfare (e.g., keeping battle plans secret while under attack). There are other examples but the general idea is obvious.
Consider Choice. You might not have a choice in what you believe or value. I personally don't believe freewill exists, but that's for another post.
Final Remarks. No doubt, I missed some crucial points, but I primarily intended to convey general ideas and didn't feel like writing a dissertation for each blog post.

The general ideas are these: you can't be consistent about everything, there are sometimes pragmatic reasons for being inconsistent, values are unknowable, faith is unavoidable in judging the empirical world, specificity has practical limits in increasing objectivity, and objectivity is not always practical. The main conclusion of these general ideas is that a coherent worldview is unattainable and impractical (by "practical," I mean tending to accomplish a certain goal).

By "coherent," I refer to a consistent worldview with full explanatory power.

There are degrees of coherence with some views such as that of libertarians being significantly more coherent than others. Coherence, in itself, however, is not a strength. If anything, too much coherence is a weakness since it is likely incorrect and impractical. A coherent worldview maybe completely wrong and counterproductive.

The following are unavoidable constraints on objectivity:

1. I don't know how objective I am, but am highly confident that most are not nearly as objective as they think. While there are degrees of objectivity, objectivity itself is rare in issues beyond the most basic commonsense. At best, I can hope to become more objective by questioning my beliefs and listening to what critics say.
2. I'm sure some of my beliefs are incorrect including some I'm sure of.
3. I'm sure some of my beliefs are contradictory.
4. I'm sure some of my beliefs will change.
5. I'm sure I have a huge cognitive blindspot of which I'm completely unaware.
   

The above constraints apply to everyone.

Why I Lack A Coherent Worldview (Part 3: Of Faith)

Theists often accuse atheists of relying faith in holding commonsense beliefs (e.g., the world is not flat, science is generally reliable, other people exist, etc.). Atheists respond by noting that the previous argument suffers from the tu quoque (or two wrongs) fallacy. Of course, they're both correct.

On one hand, beliefs about the empirical world ultimately depend on assumptions. On the other hand, there's no non-circular reason to favor some assumptions over other assumptions, rendering whatever conclusions one has arbitrary.

You can't question everything as a practical matter. If a child asks you why the sky's blue, then questions each of your answers, then what are you left with? If you re-trace your reasoning from conclusions to premises, you find a set of assumptions that you cannot defend or suffer circular reasoning. Doubt favors thinking over acting; faith favors acting over thinking.

Even science and commonsense mostly depend on faith:
There's no strong evidence you're not dreaming--lucid dreams occur. Nor is there much evidence other minds exist. The most serious example of faith in science is our trust in induction. Our acceptance of induction is an example of pragmatic faith. Philosopher Hans Reichenbach argues that induction is our best chance of forming reliable conclusions of the empirical world since induction will yield reliable conclusions if the universe is uniform, but no method will be reliable if the universe isn't uniform.

Almost all, if not all, faith is pragmatic, and not necessarily by serving the same goals. Religious faith helps people cope with hard times, optimism can motivate people, and faith in empiricism and induction offers a chance of forming true conclusions of the external world.

You can't avoid using faith even if logical axioms are self-evidently true. The only question is at what point in your reasoning you choose to apply faith. Like logic and observation, faith is another necessary tool for forming reliable conclusions.

If someone accepts an internally consistent position on faith, then no debate is possible.