Bad Luck vs. Bad Design

In a post on the topic of health care rationing (responding to a progressive post which argued that denying care to people unlikely to see much return was one of the benefits of a centralized health system) Megan McArdle of The Atlantic makes the following observation:

There’s another intuition that at least libertarians have, which is that it is not as bad to have undesirable things result from an impersonal process than from an active decision. It is bad if someone’s house burns down and they couldn’t afford insurance. It’s worse if someone’s house burns down, and they were in the class of people deemed unworthy by a bureaucrat of having their house rebuilt.

I think almost all progressives have the opposite intuition. They think it’s better to try to produce an optimal result, even if that results in individual injustices (which it will–government rules are very broad brush, and will always involve error at the margins). I’m not sure how to bridge that intuitive gap.

It strikes me this is indeed one of the determining differences between those skeptical of and those confident in the ability of a centralized beaurocracy to actually improve the administration of health care (as opposed to its availability, which obviously could be improved simply by throwing enough money around.)

Given the range of viewpoints found around here, I’m curious what others think of this. Is this indeed one of the major dividing lines between progressive and libertarian/conservative viewpoints?

Share With Friends


Now an Ohio Catholic!


  1. I think you (and Ms. McArdle) are on to something here. This is a cultural issue of a completely different kind than the culture wars. The political scientist Daniel Elazer (http://www.jcpa.org/djeindex.htm) has argued there are three political cultures in the US: traditionalist, moralistic, and individualistic. Although they intermingle throughout the country, the first is predominately in the South, the second in New England and the Upper Midwest, and the third in the West, the Heartland (MO through OH), and Mid-Atlantic (although it also finds plenty of adherence in the South and elsewhere. The moralistic political culture sees politics as a (the?) proper arena for addressing the common good and good governance issues are very important to it. People from this political culture are more likely to see the problems that arise from government actions as temporary and fixable (rather than inherent bugs in the system), and thus less problematic.

  2. Those who adopt this libertarian positions are simply ideologues. Government is bad so it can’t do any good, case closed. I prefer to let the evidence speak. And the evidence tells me that single-payer healthcare gets you the best all round result of universal coverage and efficiency (health outcomes by cost). Given the record of the so-called communist countries in the 20th century, I’m also fully aware of the evidence that suggests that governments do an appalling job running many businesses. So instead of screaming “socialism” like an ideologue, it would be better to actually peruse the evidence.

  3. Huh?

    MM, did you even read the piece, or did you paste in some boilerplate? Topic is not whether single payer is better or not, but rather whether it is a greater injustice if someone doesn’t have the ability to pay for something they want, versus they are actively denied something they want because it has been determined that it doesn’t fit cost benefit analysis.

    Nor is McArdle making the question up — the question arises based on her ongoing debates with several thoughtful progressive bloggers who are themselves in favor of health care reform. If you’d like to follow that laudable example by engaging in rational discussion, do feel free.

  4. If you want to get pissy, Darwin, that’s your prerogative. But you should recall that McArdle is a libertarian, which means she holds (as a matter of ideology) positions about the relative roles of the free market and the government that do not gel with Catholic social teaching. Engage her all you wish, but let’s not beat around the bush here.

    She talks about a government bureacracy making a healthcare decision to deny treatment. She fails to note that this is what the current US private system does as a matter of course (especially those who are not protected by the meager protections of the employer insurance system). It’s the ideology, stupid.

  5. It would be nice, MM, if you gave Ms. McArdle and/or Darwin the courtesy of reading the post before saying stuff like “X is a libertarian, and libertarians are idealogues who reject Catholic Social Teaching; ergo, I don’t need to respond to anything they write.”

    If, as your rantings writings suggest, you cannot appreciate the idea that people have good faith differences of opinion about how to best achieve the common good – and that these differences of opinion can be based on legitimate moral intuitions – then there is little reason to take your arguments from ignorance seriously. Thus far, you haven’t even commented on the subject of the post, or even written anything that suggests an awareness of what the post was about.

    I have little sympathy for libertarians in general, but I think the post raises an interesting question, even if I would frame it differently. I think it’s more accurate to describe the first system as a situation in which the people and their elected representatives have decided that the state will not intervene to help people, and the result will be that the poor are systematically disadvantaged. I think that may be acceptable for home insurance, where risks are relatively low, but unacceptable for a basic right like health care. In the second situation, the people and their elective representatives have evaluated the relevant trade-offs and have made some attempt to prevent the burden from falling simply on those who are already less fortunate. Both are deliberate decisions about the role of the state; neither is purely impersonal. I favor the second situation over the first, simply because I think it better reflects the preferential option for the poor. I don’t deny, though, that there are good reasons to be skeptical of the model of the benevolent bureaucrat; there are trade-offs here as in every contested area of public policy (that’s why they are contested).

  6. While I’m not sure if there’s any point in attempting to spoon feed debate to someone, I’m mildly curious as to the result:


    Would you see any difference in morality and/or justice between these two situations:

    1) I am unable to afford medical coverage which would have provided unlimited chemo treatments in the event of pancreatic cancer, and so when I come down with it, I get several of the standard treatments that often work (but don’t in my case) but am not able to get a very expensive, experimental treatment which had a 5% chance of helping me.

    2) A centralized government authority in a single payer country determines that cancer treatments with less than a 5% chance of success should never be funded period.

    My guess is that you’d see no difference between these two situations, since I’d guess you’d take an “outcome based morality” approach to the situation and say that it really doesn’t matter why someone was denied, they result is the same.

    However, I think for many people there would be a significant perceived difference between the two situations (though this might not be the case if the person had not realized that their insurance didn’t cover certain types of very expensive care — thus giving them a similar sense to the government situation.)

  7. Why bother, Darwin? It’s like trying to point out the forest through the trees. There was nothing ambiguous about the subject or purpose of the post. My guess is that if someone who didn’t identify themselves with a suspect school of thought offered the same observation it would have been welcomed and proudly accepted by MM. He’s made it clear that he’s okay with the rationing of care, he just think it’s the role of the government to do it, rather than your pocketbook. It’s a fair question to ask, I just don’t think the former method is baptized in CST, as some would have us believe. Still waiting for a just and sensible third way to be offered…

Comments are closed.