Wednesday, December 21, 2016

Unavoidable Costs

I have libertarian friends (it's true). And one of them posted this particular meme

Now I don't think either of these statements is accurate on its own;  if something is a right, it's a right and there is no "should be," and libertarian "no one has a right to your labor" talk stops the moment money changes hands, thereby buying the right to that labor. But that's beside the point.

Health care and education are what I call unavoidable costs.

All living human beings require health care. There is a cost to providing it, and there is a cost to not providing it.

The costs of providing it are well known and constantly debated in this country, though we have made the issue complicated by insisting that not only should people providing the service be paid, but the insurance company paper-pushing bean counters make some sort of profit because reasons, but the bottom line remains the same-- there are large costs to providing health care. However, not providing health care also comes with costs. There are perhaps uncountable costs in terms of lost productivity due to un- or poorly-treated conditions. There are the unknowable costs of losing a potential leader, scientist, or pillar of the community because they died at age ten from an abcessed tooth. And there is the moral and spiritual cost to a nation that stands by and lets some people die because, for whatever reason, they don't have enough money. There is a moral and spiritual cost to being a nation where families lose members even though the ability to save those people exists.

In short, no matter how we answer question  "Who gets health care and how will it be paid for," there is a cost. There is no answer to the question that costs us nothing as a country or a culture. It is an unavoidable cost.

Likewise, there is no way to answer the question of education that doesn't cost us something. Providing a full, quality education to every single citizen would cost a bunch of money. But leaving any sector of the population uneducated is also expensive, in productivity costs, in human costs, in ability to carry their own weight costs. To leave some people un- (or under-) educated costs us all, particularly in our ability to maintain a functioning democatic(ish) form of government.

Providing education comes with a cost. Not providing education comes with a cost. This is the flip side of There Is No Such Thing As A Free Lunch. There are no decisions about health care and education that are free.

Education and health care are unavoidable costs. We can talk about rights and privileges, but they still have unavoidable costs. We can talk about delivery and payment systems, free market versus government management versus etc etc etc, but education and health care are still unavoidable costs, and what may seem like reducing the costs is most often just moving the costs around.

And this is a bigger problem than ever because both health care and education have expanded. A few centuries ago, health care was cheap and not very good and people mostly just died young (for which countries and cultures paid a price, but there was no alternative). A few centuries ago, a polymath like Thomas Jefferson or Ben Franklin could literally learn almost everything there was to know, and laborers who didn't know anything could still pull their own weight in the world. Nowadays, health care options are extensive and expensive and long-lived citizens can use many of them. Meanwhile, education is now an ocean instead of a bucket, and the educational requirements to be even working poor have increased dramatically.

End result-- the unavoidable costs have gotten greater and greater.

So there's a strong political push for some sort of plan that means I don't have to spend a bunch of My Money on Those People (who I believe do not deserve it).

This is not a new thing. Charles Dickens wrote A Christmas Carol to argue against a world where the poor were left to struggle and die, condemned by a business-oriented government because they were excess population, poor because they were just too lazy and undeserving. In a telling detail usually omitted from modern renderings, the ghost of Jacob Marley invites Scrooge to look out the window, where he sees London teeming with the tortured, chained spirits of uncountable businessmen and politicians who failed to take care of their fellow humans. Ebeneezer Scrooge was never meant to be a single unique miser in need of redemption, but an embodiment of the troubled spirit of his age.

We can try to reduce the cost of health care and education for Those People, and when that leads to other costs (welfare, lost productivity, children in poverty) we can refuse to pay those costs, too, but the costs of health care and education are inescapable, even if we pay them by transforming into a country where the poor can never rise above the class they're born into.

There will be tension between "I think I should get a pony" and "I don't think I should ever help anyone with anything," and between those extremes there will always be plenty of room to debate how much is "enough." But to think all this can be judged against an imaginary setting at which we as a society pay nothing for health care or education...? There is no such situation. The costs are unavoidable, and the most useful conversation we can have is not about how to do away with them, but how to best meet them in a way that reflects costs we can bear to pay.


  1. What about the people (in government) who absolutely believe that government should pay for those things but don't manage to make it happen? What about the people who advocate in many ways, including spending money on campaigns, but nothing ever changes? Once again, I give you Chicago. Is there anyone in Chicago who would think, in the terms you so often use, about "THOSE people" as undeserving? No one. The problem is not determining whether something should be done (meaning, spending money). The problem is doing it. The corruption is in the doing, not the thinking. Hypocrisy is at the heart of human nature. We are all hypocrites. Vulnerable people are going to suffer for it. If I hadn't seen with my own eyes how greedy the biggest preachers of generosity are, I couldn't write this. I think that focusing on the mess between talking the talk and walking the walk could be helpful, but it sure is messy.

    Sometimes this discussion gets very theoretical (good guys and bad guys) and is not based on the Byzantine machinations which are actually the real backstory. I know that you expose a lot of corruption on this blog. Much of it should be making national headlines. There is a reason it doesn't.

  2. The libertarian viewpoint makes no sense. There are many government services, performed by people, that everyone has a right to. In a democratic form of government, of, by, and for the people, people have the right to anything that there is a general consensus that they have a right to. Even in primitive hunter/forager groups, everyone had equal access to the shaman. There is no point in having a society if it doesn't take care of the needs of its most vulnerable members. Misfortune can happen to anyone. There is no point in living in a society where a few people game the system, hoard most of the resources, and prey on others. People live in groups (communities) in order to collaborate and pool resources. You help other people, that makes the group stronger, which is good for you in the long run. As John Donne said, "No man is an island..."

  3. Of course we, as a society, do not think that a person has a right to education, we think a person has a right to some education. 1-12 in my state, for example. Anything beyond 12 is not a right, but something that might be purchased.

    The same issues confront medical care. How much medical care is a right? Do I have the right to be treated by the best doctor in the world, even if she is the one most likely to help my condition? Presumably not, because not all of my fellow citizens could possibly have that same right.

    1. So your opinion holds for everyone in society? The consensus on anything can, and always has, changed over time.

      Of course, logistically, if there's one "best" doctor in the world, they can't treat everyone. But everyone should have the right to the same level of care. I had to have both hips replaced. If I hadn't, I would be in a wheelchair, in constant pain, a burden on everyone, and very liable to develop diabetes or have a stroke. It's not fair that I could have that done because I was lucky enough to have a job that provided good insurance, while other people who are not as lucky have to suffer needlessly. I don't have more intrinsic worth than they do.