Is there a Rawlsian argument for redistribution as a form of social insurance?

Here is one presentation of such an argument, but keep in mind these points:

1. The strongest argument for redistribution is when redistribution boosts economic growth and benefits all or most of society.  That is by no means always the case, but it is sometimes true and of course it is not a Rawlsian argument.

2. The second strongest argument for redistribution is that it is sometimes intrinsically better if a poor, needy person has a resource, as opposed to a wealthier person having that same resource.  That is in fact what most people think, no matter what argument they give you.

3. As we’ll see, the Rawlsian argument is parasitic upon #2, so why not use #2 directly?  Admittedly, #2 is a difficult conclusion to establish in a scientific manner, but the Rawlsian gloss, upon examination, makes it weaker not stronger.  It does however make the argument look a) more academic, and b) apparently more in line with neoclassical economic modes of thinking.

4. Most political philosophers, or indeed most philosophers, are not Rawlsians, even if they have been influenced by Rawls, which is frequently the case.  So why should you, if you’re an economist, be a Rawlsian?  Is it that you read Rawls and the critics, sided with Rawls, and then sat down to derive its implications?  Or did you find it a convenient rationalization for something you already believed or wanted to believe?

4b. Rawls is almost always invoked selectively, rarely being applied across national borders or across the generations, cases where it yields screwy results.  Rawls himself hesitated to approve of economic growth, because it does not maximize the well-being of the original “worst off” generation, which of course has to do some saving.  He had sympathies with the idea of Mill’s stationary state.  It’s fine to reject those conclusions, as indeed you should, but again maybe you’re not really a Rawlsian.  You are a selective Rawlsian, if that.

4c. Most people — rightly I might add — believe just as much in redistribution or maybe more when the position of the unfortunates is certain in advance. How many times have you heard social immobility cited as a problem that requires redistribution for its solution?  That argument is fine on its own terms, but again we’re back to #2.  The funny thing about econo-Rawlsians is that they want to cite the uncertainty of the wealth distribution as a reason for redistribution, and then they wish to turn around and cite the certainty of the wealth distribution as yet another reason for redistribution!

Yes, maybe you can apply a Rawlsian transform to those situations with certain allocations, using a “…but*if* these people were all behind a veil of ignorance…”  But look, a Rawlsian transform is appropriate with only some probability, so if you adhered to Rawls as the “most likely correct moral theory,” you still in these cases of certain distributions ought to believe in less redistribution.  But that is not how people’s opinions are structured, nor is it how they should be structured, so in other words again we are not really Rawlsians but rather again motivated by #2.

5. When it comes to redistribution as social insurance, the biggest problems with the Rawlsian method is this.  People have all sorts of preferences across the distribution of income.  Some are merit-related, some liberty-related, some non-Rawlsian-fairness related, some insurance-related, maybe even some rooted in prejudice.  The list of motives and reasons is long.  As the veil is typically used by economists, it strips away all of those preferences but…the preference for insurance.  So it is no wonder that the final construct produces an argument for insurance.  You get out of the construct what you put into it.

6. If you already believe in #2, #5 won’t bother you much.  But #2 is doing the real work here.

7. Almost everyone stops applying #2 at some point or margin.  For instance, do you always and everywhere favor boosting the scope of the Obamacare mandate?  It would save lives.  If you don’t favor increasing the mandate, are you a despicable killer?  In fact what I observe is people taking the status quo, and its current political debates, as a benchmark of sorts, and choosing sides, yet without outlining the “stopping principles” for their own recommendations.  That’s a pretty sure sign a person is not thinking about the issues clearly.

8. Even #2, which I think of as a kind of “brute egalitarianism,” isn’t as straightforward as you might think.  We do not always apply it to people in other countries, wealthy people who are poor in net terms because they are about to die, ugly men who cannot get sex, and many of the disabled.  Just about everyone is more of a particularist, situation-based egalitarian than they like to let on.

In sum, the arguments for (some limited) redistribution are stronger than the arguments for Rawls.


My god is this an unwieldy and unpleasant read. I'm sure it could be written better. I'm half temped its written so poorly so as to intentionally make it hard to follow. (I also think it's a pretty poor account of Rawls, but that part doesn't surprise me.) It's too bad it's so poorly written. It's useful to have clear and useful accounts. This isn't one.

I thought it was pretty clear, logical, and useful.

"The strongest argument for redistribution is when.."
Get thee to a freshman composition course!

Why are economists among the worst writers in the academy?

Putting aside the locution and grammar, redistribution is theft, with or without the veil of ignorance.

Indeed. I've never been impressed with Rawls. Veil of Ignorance is simply utilitarianism married to the observation of human risk-aversion.

4b. I think it's a "Rawlsianism in One Country" sort of thought process for most people
4c. Seems like a garbling of the veil. Ex ante, we are uncertain about where we'll land up. One of the possibilities is that we will land up in a position that ex post is almost certainly very negative. Both the uncertainty and certainty are relevant to the Rawlsian argument. obvi
5. what is merit? isnt talent/merit something that is as arbitrarily distributed as any other factor (wealthy parents etc). merit is easily subsumed into the veil.

John Rawls was a Rawlsian In One Country Rawlsian. He pointed out that Open Borders would just encourage irresponsible overpopulating nations to swamp responsible nations.

part right, part wrong. You have to consider the "duty of assistance" before you get any of the other conclusions here. I assume you're signed up for that, Steve? If not, please don't invoke Rawls further.

irresponsible overpopulating nations

Rawls also couldn't imagine how a reasonable person could think abortion should be prohibited by law. The haut bourgeois New England intelligentsia are not your friends.

(And it doesn't seem to occur to Steve Sailer that pastoralists who have a large mass of kids earn their own living see their utility improved by those children. They're not some slum chick rutting on the DSS dime).

We need a name for this idea that redistribution is good, but should be limited to one country. Perhaps... national socialism?

How about 'social insurance' in the sense that when a large section of the population becomes economically insecure, we have crazy political positions gaining popularity. Also leading to economic positions which economists dont like. So, libertarianism without some social insurance is self-undermining as we get even more economic controls, after a populist takeover, than in the alternative.

All these recent events should lead to a change in the important of consequences of economic vulnerability.

* change in the importance we assign to consequences of economic vulnerability. *

Agreed. The 'social contract' - wealth flows to the masses and the wealthy get to keep their heads.

It's truly remarkable that the libertarian/classical liberal right lost the moral high ground.

Theft is just, freedom through slavery and employers are responsible for poverty. The double think of the left is spectacular.

A fine justification for redistribution,but this wasn't Rawls' justification.

These discussions (in the pdf and above) are great, but their distance from practical politics seems wider than they have ever been in my lifetime. Congress really seems dedicated to embarrassing themselves, and then (just now in the news) expressing shock that campaign donations large and small are drying up.

I really hope that we get a turn to something where Rawlsian-not-Rawlsian matters, but I fear tax reform will be another 12 car pileup. Some will want blatant passthrough tax benefits for the rich, and a few might stubbornly believe deficits matter. I fear that will be the whole fight, tax giveaway straight from national debt, or not. Far from theories of redistribution or government.

And yes, #2 is very strong directly. Especially with #1 as the sweetener.

In other news, Trump's "sons of bitches" moment will murder all rational politics for months.

The tax plan? It's about not helping the sons of bitches who want to eat.

'when redistribution boosts economic growth'

Or, slightly rephrased, acceptable as long as the rich continue to get richer.

What is public education? 2 with 1? Or 1 with 2?

On #8, we do try to distribute extra years of life to people who are close to dying and accommodation/accessibility to people with disabilities. Many argue that we overspend in trying to do so.

These occasionally involve redistribution (e.g., of parking spaces), but usually do not because it's easier to buy medical care and ramps with money than with illness and inaccessibility.

I'm more a Senian type of economist making emphasis on loss aversion. Redistribution of what? Opportunity to avoid pain. A safety net is then important. At the same time redistribution has a very important political dimension: it's important for me to think of rights and citizenship as a question of positive liberty plus as a right to be called by your name: when to attend to school and the teacher names you in order to take attendance, or when you are waiting at the public health care system and you are named by the nurse. Being named, being attended by, is a very important dimension of citizenship. You can play the game when you have put your team shirt on with your number on it.

It's striking how sensible Rawls was on immigration policy:

"Concerning the second problem, immigration, in #4.3 I argue that an important role of government, however arbitrary a society’s boundaries may appear from a historical point of view, is to be the effective agent of a people as they take responsibility for their territory and the size of their population, as well as for maintaining the land’s environmental integrity. Unless a definite agent is given responsibility for maintaining an asset and bears the responsibility and loss for not doing so, that asset tends to deteriorate. On my account the role of the institution of property is to prevent this deterioration from occurring. In the present case, the asset is the people’s territory and its potential capacity to support them in perpetuity; and the agent is the people itself as politically organized. The perpetuity condition is crucial. People must recognize that they cannot make up for failing to regulate their numbers or to care for their land by conquest in war, or by migrating into another people’s territory without their consent."

I read that as saying that a "definite agent" can choose and administer any policy for the benefit of citizens. That could be moderate immigration for higher economic growth. (Rather than isolation, a geriatric shift in demographics, and decline.)

Or, say, restaurants!

Rawls would probably say that it is your right as a people to sell your birthright for a mess of pottage if that's what you choose as a people, just as you have a democratic right to choose instead to avoid deracination.

Heh, and yet the Kardashians have more followers.

That has to be joined, on Rawls's account, with a duty to end poverty and misrule in so-called "burdened societies", something which is obviously not close to being done, so as-is, you're pulling the bit out of context. In context, I am pretty sympathetic to it. Out of context, when you make it try to stand on its own, it's not a position Rawls would accept, nor should others.

Right, Matt! If Rawls were here, he would confirm that whatever he may have written, when properly interpreted, supports *exactly* your more-felt-than-reasoned policy preferences.

Please actually refer to the whole text of _The Law of People_ and not just take the footnotes as if they were the main point. It's not a long text! You can do it.

From Rawls' footnote:

"This remark implies that a people has at least a qualified right to limit immigration. ... Another reason for limiting immigration is to protect a people's political culture and its constitutional principles. See Michael Walzer ... for a good statement. He says on page 39: "To tear down the walls of the state is not, as Sidgwick worriedly suggested, to create a world without walls, but rather to create a thousand petty fortresses. The fortresses, too, can be torn down: all that is necessary is a global state sufficiently powerful to overwhelm the local communities. Then the result would be the world of the political economist, as Sidwick described it [or of global capitalism, I might add] -- a world of deracinated men and women."

Rawls apparently didn't think highly of deracination.

It's interesting how Sailer both didn't respond to the point (which is obvious to anyone who has actually read Rawls) about how Rawls's remark on immigration depends on first having met the duty of assistance to burdened societies, and then mixed together a quote from Rawls and from Walzer as if they were saying the same thing. That...does not inspire confidence that Sailer is trying honestly to understand the position, as opposed to cook things up for his own view.

So....Rawls as Neocon interventionist. I can dig it.

Given that most poverty is "misrule" in ultimate origin and remedial only by societal-smashing violence, this is a call to conquest I wonder if many Rawlsians would be comfortable with.

"People must recognize that they cannot make up for failing to regulate their numbers or to care for their land by conquest in war, or by migrating into another people’s territory without their consent.”

Tell it to the Europeans that displaced the native Americans. Of course civilization has advanced dramatically since the 17th century, the ideas of the Enlightenment have eliminated that sort of expansion.

the ideas of the Enlightenment have eliminated that sort of expansion.

Or there isn't a large mass of nearly empty territory into which to expand. Or land just isn't as important as a factor of production.

Rawls and his followers (whether faithful or distorted) are trying to make a logical the primitive sense that we all have that there is something called "fairness". Of course now we understand that this sense of fairness is almost certainly an evolutionary kludge, with evolution creating necessary instincts in humans so they can cooperate together in small groups. As such it is unlikely to be able to extrapolated to anything other than small hunter gathering groups trying to survive, and certainly not applicable except in a very distorted sense to our modern economy. Rawls didn't have this understanding so perhaps we can forgive him for this mistake. But we should know better now. There is not such thing as logical fairness - it can't be defined more than as a set of non-logical instincts inserted into our genes by evolution. But of course another instinct is that people like to ascribe logical justifications to their instinctual actions.

+1 ChrisA. Cooperation is necessary when ape-men live in the savanna, it is less so now. How is Asia treating you?

Unfortunately I am no longer in Asia, moved to Europe.

High levels of oxytocin among Northern Europeans indicates the opposite.

Dontcha think evolutionary "hangovers" like "fairness" should follow a distribution, a "bell curve" if you will?

If so, who are the normal humans? The outliers or the median?

"who are the normal humans" - like most philosophic questions, simply a matter of opinion.

Sure, but believers in genetic influence set up a bit of a contradiction when they insist a minority position is "correct."

Correct for them perhaps, without being correct for most people.

I think the fundamental problem with Rawls' "veil of ignorance" concept is ... that's not how babies are made.

Some advanced thinkers feel that the next stage in moral arc of the universe would be random baby distribution. For example, here's a 2016 article in Aeon:

"If babies were randomly allocated to families would racism end?

by Howard Rachlin
is the Emeritus Research Professor of Psychology at Stony Brook University. His most recent book is The Escape of the Mind (2014).

and Marvin Frankel
Marvin Frankel obtained a PhD in psychology at the University of Chicago. He is currently a professor of psychology at Sarah Lawrence College. He has published numerous articles on clinical psychology.

Academics making the case for a variant of the Brave New World? Why does this not surprise me?

Of course now we understand that this sense of fairness is almost certainly an evolutionary kludge, with evolution creating necessary instincts in humans so they can cooperate together in small groups.

No we don't 'understand' that. That's simply the latest shtick from that segment of the chatterati who appear in every age: the one's who fancy they've found the secret sauce.

So then you are amoral? If fairness is just an illogical instinct then all of morality can be dismissed just as easily. That means it is fine for anyone to do anything to you (as long as they don't get caught, of course).

No I am not amoral, I have the same instincts as most people but I don't try to create a rationalism for them.


We have learned so much about the roots of human "moral" reasoning from evolutionary psych and economics. But people still talk about "fairness" as if it is self evident and universal....

Boring. I studied Rawls in law school before I flunked out. The teacher called on me and asked me to explain Rawls. I told her that Rawls is simply making a mountain out of a molehill by observing most people are risk-adverse rather than risk-neutral or risk-loving (I flunked that class). I mean, what if you, behind the 'veil of ignorance' take a gamble that you'll be in the 1% the way Ray Lopez is? Does that invalidate Rawls?

As for TC's point "The second strongest argument for redistribution is that it is sometimes intrinsically better if a poor, needy person has a resource, as opposed to a wealthier person having that same resource. That is in fact what most people think, no matter what argument they give you" - this is simply because the poor, needy person has the potential to tear down society through violence. The rich person does too, but there's lots more poor than rich, so Christian ideology, which idolizes the poor, makes it imperative that you placate the poor by buying them off. This in fact was the impetus behind Keynesian "make-work" and "Big Government" economics, as well as the Progressives before Keynes, and the labor union movement of the late 19th century: buy off the working man so that they don't make trouble.

On a final point, what is TC's point of this post? Let's go back to talking about fun stuff like nuking Kim. Seriously.

Bonus trivia: just finished watching Baywatch (2017) and it was pretty good, don't know why it got low reviews. I reckon it's because of 'pseudo PC sexism' and the fact most obese young Americans can't relate to the fit actors, though the fat guy did get the babe in the end, I thought that was a cute subplot. And model-actress Kelly Rohrbach, from a rich finance family, went to Georgetown!

So so lonely

@msgkings - you follow me since you envy me. As close as to the 1% as you'll ever get....

Sure, go with that.

"You get out of the construct what you put into it."

And that's why Rawlsian theory is mostly a waste of time.

The shallowness of TC's "analysis" can be made more obvious by considering the logical negation of #2: It is NEVER the case that a "poor" person possessing a resource is intrinsically better than a "wealthier" person. For instance, it would NEVER be intrinsically better to give a 20 year old poor entrepreneur $2000 than giving that same amount to, say, Sumner Redstone. Mush for Brains, Tyler, mush for brains. (I chose Sumner due to his wealth and dementia, any other near vegetable would do, as long as s/he is "wealthier".)

It seems like the veil of ignorance is most popularly applied to domestic policy recommendations on the margin, conditional on a certain baseline level of cooperation and social production and centralized decision-making that isn't so easily taken for granted in the international setting. As for taking the status quo as a starting point, that also seems like a reasonable and practical choice for marginal thinkers. Most of the apparent contradictions discussed in this post can be resolved if we can agree to be explicit about when we are using marginal vs. globally optimal reasoning. We should also strive to specify what we view as the applicable domain of each toy model, since inevitably no single model will cover every scenario. In my opinion toy model choice is heavily correlated with ideology but it can be made more systematic and rigorous in some cases.

"it is sometimes intrinsically better": that's not an argument, it's an assertion.

It is an assertion that kids getting education is better than Paris Hilton's dog getting more diamonds. Yes. Are you going to take the flip side, that the dog is the real victim?

Exhibit #137000 that there's a bloc economists are bored with investigating economic questions and thus invade other disciplines with their intrinsically different imaginations, making a dog's breakfast of it in the process.

Leave normative questions to philosophers, theologians, and the literary wing of political science.

Yes, agreed with you here.

Tyler, regarding # 2, the poor "inherently deserve" the same resource to the extent said resource is essential to their basic survival. Sex isn't as important as food, water, and shelter.

Why? Rawls discusses this, and it comes down to moral luck. Most of how we turn out can be attributed to two things that are largely out of our control: (1) genetics and (2) development from utero to early adulthood.

The specific policies we adopt to help the poor depends on our priors and public policy, but the reason why we can't just stand around and shrug our shoulders at the plight of the less fortunate is moral luck.

This is a bit out there, but I think one of the great moral projects of human civilization is to marshal artificial intelligence and genetic engineering to reduce the arbitrary effects of being part of the lucky sperm club.

Yeah it's not as if governments will use this in a horrifying way.

Status is hierarchical. You can't level the field. You can only change the rules and how the points are tabulated. But someone will be at the top and someone will be at the bottom. No one in high school has a career or an independent source of income. Does that mean there is no status? How about chimps? No money at all. And yet status is violently enforced. A litter of dogs. A tribe in the Amazon...Etc ad nauseam.

This entire method of thinking entirely misunderstands what luck means. There is no such thing as moral luck, and there is no such thing as free will. Sentient beings do respond to incentives. Does not mean it's free will. Assuming free will gets you all kind of stupid and ridiculous conclusions from false premises.

This matters because there's no "in our control" or "out of our control" , there is only what IS. And it's not a "sperm lottery" you ARE your parents, plus or minus some genetic randomness. You have billions of meat sacks containing a DNA replication machine. The meat sack is only there to keep the DNA replication machine going. Status is important for the DNA replication machine, so whenever we have a society, it reflects some hierarchy of status.

How many pieces of paper with pictures of dead people on them someone has. Yeah, Rawls, that's philosophy. Diogenes weeps. Good riddance.

Sentient beings do respond to incentives. Does not mean it’s free will. Assuming free will gets you all kind of stupid and ridiculous conclusions from false premises.

You have a disarming capacity to argue yourself into the strangest of statements.


The arguments for 'redistribution' almost always never deal with the 'redistribution.' They instead are arguments about what steady state distributions are better or worse.
The process, action, of getting from distribution A to distribution B is taken as some relatively simple and basically invisible function.

However, it is the process itself as much as the outcomes, that matters to social impact and well being. The processes of having things taken and having things doled out,
for example, are fundamentally different than the processes of gift giving and receiving, or donation and centralized distribution, or loss and finding, even though these could
conceivably have the same end distributional results.

Ignoring the process is a fatal flaw in most discussions.

Framing it as redistribution raises the hackles, unless you think.

Buying insurance is redistribution also--from one policyholder who isn't sick to one who becomes sick. It's just that I don't know whether it will be me or you.

I think people are being influenced by the word redistribution. I think of it as avoidance of risk, or possible payment to my future self when something unanticipated or anticipated occurs, without having to save for the worst case, and sharing the risk with a large pool of others who have the same common sense to understand the law of large numbers and distribution of risk.

Insurance as redistribution. The flaw with that redefinition: insurance is a consensual reallocation of risk where the probability of catastrophic events in an overall population can be estimated. It also has clauses which prohibit fraud. You can't take out fire insurance and burn your own building down to collect the cash.

If you want to sell income insurance please be my guest. It exists in many forms, most commonly as life insurance.

Taxing everyone and forcing them to give money to idle adults is not insurance. That's a Marxism level of changing the meaning of words. And if in fact you want to call it insurance then make it consensual. I will gladly support your efforts while opting out.

Consent, as the lefties say truthfully, is how we should judge interactions.


Please where a wrist band which says: "I do not wish to buy health insurance. It is my dying wish that you do not provide me health services if I show up at the emergency room without cash. Furthermore, I disinherit my children from any social security benefits, just as I wish that you would deny my parents theirs. Furthermore, since I do not have children in school I refuse to pay for yours as you paid for mine. I do not want to have the fire department visit my home in the event of an emergency; I have an outdoor firehose which should be just fine. As for the roads, I will walk."

You are living in the '50s when you use the word lefties. Social insurance was started in Germany in the late 19th century and has been adopted by all industrialized countries.

Where does that leave you: That makes you 17th century man. Or maybe man who lives in an underdeveloped country.

Good luck.

Income insurance. Health insurance. Not sure if you're actually as stupid as you sound or if you're trolling.

You and Bill Cosby would be great friends, I think you agree on the irrelevance of consent.

+1. Of course it's today's Progressives (who are recycling their 19th century name) who are living in the 1950s when age demographics and economic growth made these pyramid schemes look sustainable.

I was unaware that there were any economist-Rawlsians. Surely the minimax criterion of the solution to the veil of ignorance problem made them laugh and turn elsewhere -- Nozick maybe.

Cowen has made a leap that I never would have expected, namely that redistribution can be supported for economic as opposed to social reasons (point 1 above). I've commented several times that a high level of inequality correlates strongly with financial and economic instability. Sure, correlation is not causation (Cowen's usual response), but at some point the evidence of (some) causation cannot be denied. What are the factors that might cause financial and economic instability? There's the often cited savings glut/inadequate demand. But I would look beyond that factor to the related factors, namely depressed rate of return to productive capital, reaching for higher yield via greater risk, reliance on rising asset prices for higher yield (owners of capital) and economic growth (central bank), and declining or flat productivity growth as the result of the other cited factors. I tell my "conservative" friends that I oppose redistribution solely on social grounds (mobs with pitchforks and torches descending on the Hamptons?), but for economic reasons. On the other hand, making the leap that Cowen has made is unlikely for those who don't share Cowen's knowledge and objectivity. Partly for that reason, last year I gave my Godson, upon entering the freshman class at Chicago, a copy of A Theory of Justice. It was a used copy because the book is out of print, which doesn't exactly provide much hope that Rawls' argument will be taken very seriously by those inclined to oppose redistribution for any reason, economic or social.

" It was a used copy because the book is out of print"

No it isn't - both the "original" and the "revised" version (which incorporates changes made to the various translations) are still in print. Even a minute on Amazon or the Harvard University Press web page show this. I don't know that anything very important follows from that, but it's obviously the case.

Check the price for a hardcover: is it the price for a book or a collector's item?

Hardcover university Press books are _always_ super expensive. That's sad, but true, and has nothing to do with whether they are in print. (The one exception is Princeton University Press, which actually makes hardcovers just expensive (around $40 usually) and not very expensive.) But, A Theory of Justice has been available in paperback (and that's what everyone uses) since 1971 non-stop. The first edition was briefly out of print after the 2nd edition came out, but even that soon was brought back. The idea that it's be out of print is just flatly wrong, and really weird. Nothing interesting turns on this, but it's just a really strange thing to assert.

A paperback isn't a book; it's a cheap, throwaway novel, not philosophy to be read and read again and again but entertainment to be consumed and forgotten.

2. Why am I reading the word 'intrinsically' on a site with the word 'marginal' baked into the title? Diminishing marginal utility is why redistribution makes sense. We can't calculate exactly how much to do it because it's not a one-good world and preferences are heterogeneous, but let's not turn richer people into Nozickian utility monsters. I think we probably should redistribute more (from me and others richer than I am) but a political process is the only mechanism we have for reconciling all those preferences. You can't prove the optimal level.

The beauty of it is you can give away as much money as you want. You can redistribute your income right now!!

I'm sure it's good to hear it, since youd think from every publication in America that it's illegal to give away your money, since Republicans passed a law against it. The truth is, it's even tax deductible in most cases!!

Nothing is stopping you from doing it. All we ask is that you leave us out of it.

Where exactly is the data showing that the "Obamacare mandate" saves lives? I have seen no QALY analysis that shows any of the expected inflections from its adoption or implementation, mortality data sure looks like it continues to follow pre-existing trendlines.

In general, I am highly skeptical that lives are saved by insurance, insurance is a way to make paying for healthcare less onerous as the alternative for the unfortunate is not going without healthcare, but bankruptcy and Medicaid. The latter, to be sure, is far from the ideal situation to be facing we confronted with major illness, but the vast majority of people do get care. With traditional Medicaid, healthcare could always be had once assets and incomes were exhausted, now insurance can be had with less exhaustion of income and assets.

I see no reason why protecting lower-middle class assets and income would save lives prima facie, and have seen no good evidence that is do so through less direct channels. I could buy that people with insurance might do more preventative care, except for the fact that I do not see that post-Obamacare; A1c, BP, LDL, FEV1, and many more markers show that my patient population (from Medicare expansion states) are not better managing their chronic conditions. They are also are not more likely to have primary care.

So again, what is the mechanism by which we expect insurance to save lives rather than money?

It isn't all about, or even mostly about, saving lives -- it's also about the quality of life. I've seen the lack of adequate and affordable medical care (in other words, depending on emergency rooms rather than scheduled office visits) cost otherwise healthy people the full use of limbs or leave them with lives of chronic pain or fatigue. Medicine is as much, or more, about healing and maintaining good health than about "saving lives."

Great, show me the metrics.

Where is the inflection point in the DALY curve? Why is my ED seeing the same number of people? Why are our patients not maintaining health any better than prior to passage of the mandate?

We doctors are not idiots and we actually do track the impacts of disability as well as mortality. Heck we track markers that precede the onset of systematic disease. Why do none of these healthcare measures show a sharp inflection point for something that was supposed to change lives?

My answer is pretty simple - changing how you pay for healthcare does not lead to more healthcare. The truly indigent poor were covered before, by the old Medicaid rules. The working poor either had insurance or liquidated for medical care. The pool of people who had: serious medical needs, inability to pay, and unwillingness to liquidate to Medicaid was vanishingly small.

Now sure, nobody likes to liquidate all their hard saved assets to get medical care, but we are talking about what people actually did.

So how much is quality of life worth? Well given how trivially easy it is to exercise (e.g. walking), how few of my patients do so, and the fact that opportunity cost is something like a few grand a year suggests to me that perhaps they honestly do not value their health all that much.

As is, we are told that the Obamacare mandate does all manner of magic ... which just magically does not show up in any actual health metric.

I think this post misses the point that we have two selves: the present self and the future self. The present self, depending on the starting point, can anticipate that it will grow old, or might even get sick, or have a disability, or someone it is responsible for may also have that item.

Rather than save for all these contingencies, and to avoid procrastination, I will join with others to purchase insurance.

4b - yes Rawls himself was as Rawlsian in one country, but that just means he himself understood that the moral force of his argument was constrained to outcomes he found palatable for other reasons. An unwillingness to apply a global veil is a flaw in the argument.

Redistribution is an investment in the future and an insurance policy against revolt. I pay property taxes to send other's children to school. I contribute payroll taxes to fund the safety net and military excursions in the Midddle East. The sooner we remember that we are in this together the less volatile the future will become. Or we can all apply to join the free society BTC dudes and avoid the drudge of compromise that is democracy.

Did Rawls not stop to think about how ridiculous "inequalities are allowed only if they benefit the least we'll off in society" is? How did anyone take this seriously?

Rawls: "In this paper I assume that differences in observed income
are due to exogenous differences in luck." Why would anyone take seriously an academic paper founded on an assumption? Why even read such a paper unless as a thought experiment or for entertainment?

Because that is the most likely explanation for differences in income.

I think you took a cheap shot at those favoring progressive redistribution. Behind a veil of ignorance, high persistent inequality is a reason for a utilitarian to favor progressive redistribution -- John Harasnyi's point (preceding, and later correcting, Rawls). After birth, a combination of high within-lifetime inequality and risk aversion is a reason for even the rich to favor some progressive redistribution. There is no contradiction or cheap argument; just different points of decision.

And just who is going to redistribute?

Daniel Kahneman said "success = talent + luck" and "great success = a little more talent + a lot of luck"

I think that is true, but it is a human bias, a protective belief, to give ourselves more agency. You have to believe hard work matters, to plant the field that may face flood or drought.

In western cultures at least, luck is underrated.

The United States is an intentionally designed democracy. When you put intentionally designed and democracy together the logical conclusion is that you design the society/government in order to deliver the most good to the most people. That is, if everyone is given an equal say in the design of the society/government, and everyone is rational and informed, the majority will choose a design that spreads the benefits around as equally as possible because that way they are most likely to benefit.

The older I get, the more I think that luck, on all levels, is the main driver of human outcomes. Recognition of the role of luck is the whole reason we band together into societies. We recognize that our chances of survival of and success are much higher as part of a group.

Perhaps it would have worked after the Civil War for freedmen but no one would support it.

The very use of the term "redistribution" displays a status quo bias, since it suggests that there is something natural and given about the set of institutions that led to the current distribution of wealth, and therefore that changing that distribution amounts to REdistribution. Why is it that it's "redistribution" that requires justification, and not the current set of institutions that have produced the current distribution? As a practical matter, of course, those who advocate moving from the status quo are generally expected to explain why, but as a logical and philosophical matter, I don't see any reason to believe that by some amazing coincidence of history, we are living in a time and place that has exactly the right (judged by any standard you like) set of institutions and wealth distribution.

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