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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