The extreme tension in Caplanian thought

Bryan writes:

Fortunately, the government can handle this problem without spending trillions or heavily regulating the insurance or medical industries.   All it needs to do is provide a means-tested subsidy to make private health insurance more affordable for those who need it most.  The subsidy should be based on income, wealth, chronic health status – and, given Balan's focus on the deserving poor – on past and current behavior.  People who engage in voluntary risky behaviors – smoking, drinking, over-eating, mountain-climbing, violence, etc. – should receive a smaller subsidy, or no subsidy at all.  The same goes for people who failed to buy long-term insurance when they were healthy and employed, then ran into health or financial troubles. 

First, I am worried about a governmental process which first judges the "deservingness" of each poor person before setting the proper subsidy.  Do they videotape your life as you go along, or do they convene a Job-like trial when you submit receipts for reimbursement?

Second, causality is so often difficult to determine in medicine.  Say a poor guy had a heart attack but he ate grilled meats for thirty years.  Was that irresponsible behavior or not?

Third, and most of all, Bryan loves to stress the heritability of intelligence, income, and even life expectancy, among other variables.  But how can your parents be your fault? 

This is a fundamental tension in Caplanian thought, namely the desire to promote intuitions of both meritocracy/desert and facts about heritability.  Bryan can't have it both ways.

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I have a hard time understanding where to draw the line. Don't subsidize someone who smokes, but do subsidize someone who never developed a marketable skill?

> namely the desire to promote intuitions of both meritocracy/desert and facts about heritability. Bryan can't have it both ways

Caplan isn't more contradictory than others. Imprisonment is an institution of just deserts, and I suspect it's somewhat heritable. It is, according to Rushton:

"It turns out that criminal tendency is also heritable. About 50% of identical twins with criminal records have twins with criminal records, while only about 25% of fraternal twins do."

A caveat might be that not all criminals get caught and IQ (heritable) might affect the odds of being caught.

You can't beat prison though - it seems to be effective in maintaining order. So it will stay, contradictory or no.

I think the other point, about the difficulty of enforcing of truthful statements about one's smoking or mountain climbing, is valid. We would need a Stasi to find out whether you lied about smoking. Or you might have climbed Mt. McKinley and forgotten about it. "Oh yeah, right - forgot about that." We spotted you up there, sir, on the summit - we saw you on satellite. "Yes. I already just admitted it."

I would rather pay taxes to help the "undeserving" poor than live in a nanny state.

i think mountain climbing is a poor comparison: most mountain climbers are in terrific physical condition and are more likely to die in an accident than become chronically ill. kb

Thank You Obama

My mother has advanced dementia and other health problems. Her medicines run almost $10,000 a year. However thanks to her former employer 100% of her medications were covered - until Obama care.

Now she must spend about $3,250 out of pocket for her medications. Out of an income of about $24,000 a year.

Her pension from her former employer is very small. However the promise of paying for her medications was a big part of her retirement planning.

Thank you Obama for taking 13% of my mother's income to pay for your health plan.

may I refer you to an old play, George Bernard Shaw's the Doctor's Dilemma.

Why are you all acting like Caplan has never explained his position on desert?

Mountain climbing and other risky sports don't have any negative long-term effects. Either you hurt yourself in the process or you don't. They could, therefore, easily be handled by exclusion: Injuries from risky sports do not need to be covered by base insurance. I'd like to see the numbers first whether the risk really outweighs the positive effects on health that kb and Shane have described.

I thought there was a Medicare programme that covered 80 year olds?

Seeing as the bill was just signed last week, I truly doubt any changes have actually occurred, and thus conclude the Obama Mother must be a troll

To Stephen

I contacted her former employer's benefit office. You are correct, they have not made a final official decision. However they suggested that I should assume that they will discontinue the program and look into alternatives for my mother.

"On March 23, 2010, the President signed into law comprehensive health care reform legislation under the Patient Protection and Affordable Care Act (HR 3590). Included among the major provisions of the law is a change in the tax treatment of the Medicare Part D subsidy. AT&T Inc. (†AT&T†) intends to take a non-cash charge of approximately $1 billion in the first quarter of 2010 to reflect the impact of this change. As a result of this legislation, including the additional tax burden, AT&T will be evaluating prospective changes to the active and retiree health care benefits offered by the company."

My mother did not work for AT&T but her employer is in the same boat.

Jeffery, what can I say? You are an out of touch moron? This is what my family is facing and calling me names proves what?

Infopractical – I see a major difference between a mandate to purchase something with discounts for “good behavior† and imposing specific criteria for getting a handout (HUD, welfare, etc†¦). In the case of health care mandates, you are forced to spend money on a particular type of insurance due to the mere fact that you are alive – you have no choice. In what is proposed here, you could reduce the cost by excluding many legal activities from your lifestyle. If you don’t like HUD or welfare criteria, you can simply not participate and suffer only a possible opportunity cost, not be monetarily penalized for not participating in a government program. As with many programs/ideas like this, the real fear of more liberty-inclined citizens is a “slippery slope†.

If the government truly has the power to coerce you to purchase something or participate in a program simply because you are alive, the path to further erosions of liberty appears unblocked from a philosophical standpoint. Is there a limit to what government can’t make you do? If this is truly constitutional, I don’t see that limit. This is what produces such an emotional reaction on this topic by many folks. Of course we don’t want to see sick kids or the elderly not treated, we just see the long term tradeoffs of this approach to that problem being very ambiguous and frankly frightening in regards to the power of the big government/big business coalition.

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