Can we take care of everyone?

Here is one reader (first quoting me) from the comments section of my post on health care:

"I would admit that we cannot take care of everyone and that we face tough trade-offs."


Here is another:

"I would admit that we cannot take care of everyone and that we face tough trade-offs."

Why can’t we? Other industrialized countries do it. We’d have to raise taxes by a nontrivial amount, to be sure, but we certainly could do it if we wanted to. You don’t get points for intellectual honesty by ruling some policy options out of bounds a priori without explaining why.

Every day about 155,000 people die.  They die in Europe too.  People die from heart attacks and they die from flu.  Children drown in buckets and people die in car crashes.  We don’t call these health care problems but they still kill you.  We could spend the Laffer-health-maximizing percent of our gdp on health care and these people still would die, sooner or later.  Most would still die sooner.  We could repeal the Bush "tax cuts" and they still would die.  The world also has several billion very poor people, and other billions of moderate but not wealthy means.  They count too. 

We can take some limited group of these people and make them better off by selective health interventions.  But we should choose the targets of our benevolence carefully, and we should remain cost effective.  No matter how good a job we do, many more people will slip through our fingers.  Those who are "taken care of" receive only marginal improvements for temporary periods.

The liberal tendency is to want to feel that you are taking care of everybody.  Policies, such as national health insurance, maximize this feeling.  In the process the idea of margin is often forgotten.

Philosophical observations: Conservatives, liberals, and libertarians all exhibit different attitudes toward death.  Conservatives are obsessed with death; look at their emphasis on abortion, capital punishment, and the need to kill people in our foreign policy.  In their view death is everywhere, and we must make hard decisions to limit it (banning abortion and invading other countries, for a start).  Liberals promote an ethic of caring, and prefer not to let death enter the political calculus too much.  Most of all, they will tell us death is to be avoided.  But thinking too closely about death leads us to feel we are not taking care of everybody; furthermore it shows this ethic to be ill-defined or impossible.  Libertarians are closer to the liberal attitude, although a liberty ethic replaces a caring ethic.  If libertarians thought too much about death, they would have to admit that it is the greatest loss of liberty possible (even worse than taxes), which might lead to government intervention.  At the very least it would imply an emphasis on positive rather than negative liberties.

The conservative attitude toward death — at least in general terms — is the most accurate and realistic of the bunch, but also the most dangerous.  By rubbing death in our faces, it can inure us to the horrors of killing people or letting them die. 


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