The ultimate debate on democracy, liberty and freedom. (1 Viewer)

[KFunk]

Also, while on the topic of healthcare, are you guys aware that because of the government trying to restrict the PBS, many better/newer psychiatric medications are unavailable to those of us who need them? For example, I can't get a particular type of anti-depressant, or mood stabiliser, or a few other things because they're not approved for that purpose and you need authority under Medicare to get them, despite the fact all the conventional treatments have severe side effects or don't work on me. So under your utilitarian paradise, should people have to suffer because the government restricts/regulates prescription drugs?

Isn't the PBS a seperate issue in this case? The PBS is about government subsidising of drugs but, as far as I know, it doesn't dictate which drugs are actually available (for those with the money) in Australia - that is really an issue to take up with the therapeutic goods administration (TGA). Treatment with with prescription only drugs that aren't on the PBS still takes place in Australia (e.g. the artificial antibody infliximab which is very useful for Crohn's and other inflammatory disease but is very expensive ~ $20,000/year or similar).

PBS still makes a lot of good quality drugs affordable for a lot of people. By acting as a sole monopoly buyer we can also negotiate better prices with the producing pharmaceutical companies. Utilitarians don't claim to be able to eliminate all suffering - any political position claiming to be able to do so is unrealistic. Rather, their aim is to minimise predictable suffering. We have limited resources devoted to health, sadly, and so they are rationed out on the basis of cost effectiveness. I personally feel that mental health often looses out because of underlying social biases and a lack of understanding, but that is a somewhat separate issue.

The PBS has holes - all healthcare systems do. People battle on with Crohn's, unable to afford infliximab and others like yourself have to make do with medications that aren't suited to their genetic/metabolic/psychological dispositions (fortunately personalised medicine approaches are becoming more prominent over time). While your criticism is still a reasonable one, you need a broader argument to make your case to the tune that 'society as a whole would be better off with alternative system X'. The data I mentioned above in relation to the US brings in to doubt the claim that libertarian approaches to healthcare will result in better health for the masses.

We need ideals to aim towards, but the fact that we fail to meet these ideals is not really reasonable grounds for criticism. No doctrine is likely to be able to live up to its ideals in full. Instead we need empirical comparisons of existing, or likely outcomes. Many countries have chosen to veer away from the US model when designing or updating their healthcare systems because of these very comparisons.

 

[Enteebee]

Why not means-test free education (to Year 10) and healthcare then? That's some sort of pragmatic compromise for me. Also, how do you define a have-not?

I'm guessing you'd want to do this while eliminating tax brackets? Otherwise it seems you're taxing people twice. Seems a lot less complicated to just 'means test' in the form of tax brackets or the GST than to do it for schools/healthcare... but I have no big problem with your proposal, would just have to see all the details.

Have not = Person who can't afford healthcare, education etc without welfare/charity.

No, because it doesn't, because people are still paying taxes on top of health costs. (There's another contentious issue with me.)

It's a hypothetical. If it was shown, not that it has been, would you then support it? If so, you're a utilitarian.

But it's majoritarian, which is where I have an issue with it - tyranny of the majority is still tyranny and all? If 51% of people are happy, what about the other 49%

If 51% are a little bit happier but 49% are a lot less happy then it would seem (while we have to be rather abstract in our quantifications) that the utilitarian thing to do would be not to impliment a policy that would lead to this.

I don't see how regulating medication, just for one example, gives the greatest happiness to the greatest number of people. You could use the same argument for regulating anything, and that's not really good, because it doesn't take into account people's wishes especially if a sizable minority don't support regulation.

If we didn't tax sales of cigarettes, a lot more people would continue smoking and dying, suffering through much more pain than the pain that comes from not having the freedom to continue to buy cigarettes for so cheap... This seems to lead to a net happiness increase over not having the tax.

I would argue that as medications are dangerous and it is unlikely that laymen will be able to make informed choices, it is important to regulate their sale with a government regulatory body that is responsible to the people because while some people may miss out on good medications due to failings of the regulatory process, it is likely that more people would suffer pain from unregulated medications... It is important to be extra-vigilent when lives are at stake.

Greatest happiness for the greatest number of people

No, just the greatest overall happiness.

 

[KFunk]

.I would argue that as medications are dangerous and it is unlikely that laymen will be able to make informed choices, it is important to regulate their sale with a government regulatory body that is responsible to the people because while some people may miss out on good medications due to failings of the regulatory process, it is likely that more people would suffer pain from unregulated medications... It is important to be extra-vigilent when lives are at stake.

^ This is one of the reasonable arguments in favour of certain forms of regulation in my opinion. The average consumer can't be expected to have advanced knowledge of pharmacology or of the statistical interpretation of clinical trials. It thus makes sense to put in place bodies, like the TGA, which monitor the efficacy of available products. Naturally we want to iron out failings in this process and keep it as efficient as possible. Sometimes drugs do get held up for good reason though - some drugs are reported as being efficacious in the popular press even though such claims are based on studies with poor methodology. Regulatory bodies may be rightfully skeptical in such cases. On the other hand, I'm sure that the process also proves overly slow/cumbersome/conservative at times.

 

[Slidey]

KFunk is spot on, as usual.

Also, for some context regarding Australia's welfare system and its success/failure, here are Australia's world rankings:

Population: 21,277,200, 53rd

Life Expectancy 80.6 years of age or so, 6th (2007)
Index of Economic Freedom: 4th (2008)
Human Development Index: 3rd (2005)
Raw GDP: $908,826 billion USD, 14th (2007)
GDP per capita: $43,312 USD, 15th (2007
Australia is in the bottom-middle of expenditure on welfare in terms of GDP of the OECD countries. Not that this seems to mean much in terms of our welfare system's success.

One of the more amazing values above is Australia's raw GDP which is, despite a population of only 20 million, higher than all but about 13 other countries in the world. Compare with South Korea, a supposed emerging economic superpower, which is just one rank above Australia, yet with a population twice as big (which accounts for the GDP per capita being twice as low as Australia's). Australia's per capita GDP is about equal with America and the UK, while our raw GDP is about equal with India's and South Korea's, about 1/4 of China's, 1/3 of the UK's and about 1/14th of America's. Interestingly, raw GDP drops sharply, with the countries ranking more than just 4 ranks below Australia having less than half Australia's GDP!

Bet you didn't know Australia's economy was so big in the global context?

Trivia:

Australia also has the biggest uranium reserves in the world, one of the biggest coal reserves (certainly the biggest when you want clean and efficient coal) and large oil and gas reserves (enough to keep us going for another 100 or so years despite international reserves going dry much earlier). Oil isn't the same as petrol because petrol is mostly imported and depends on world scarcity, market whim, and monopolies. I doubt Australia will ever use its oil beyond government/industrial uses; we'll likely have renewable fuelled cars by then (or they'll use gas). 85% of Australia's energy comes from coal. Australia certainly isn't lacking in fuel, especially if we ever decide to use nuclear power.

 

[Iron]

Slidey is a slave to positivism. Discuss.

 

[dieburndie]

Notice how America spends the second largest amount per capita on welfare

I can't see this anywhere in the link you supplied.

 

[Slidey]

I can't see this anywhere in the link you supplied.

My bad. I misread. Looks like they spend the largest raw amount, but it's hard to tell what that is per capita (which is the only way to compare to other countries, really).

That link's fairly irrelevant to my post it seems.

Slidey is a slave to positivism. Discuss.

Guilty.

Although I like me a metaphysical debate every now and then.

 

[dieburndie]

My bad. I misread. Looks like they spend the largest raw amount, but it's hard to tell what that is per capita (which is the only way to compare to other countries, really).

It's a shame, because I thought that statistic would be very interesting if it was true.

 

[KFunk]

Also, I hate any argument that discusses "the masses." People are individuals, not a homogeneous mass, and what works for x% doesn't work for everyone. Just a thought.

That's just a matter of the aesthetics of word choice, in my opinion. You're reading homogeneity into the term - you needn't do so. I've written posts before about how it is detrimental to use terms like 'the average individual' whilst ignoring variation of traits within the population. "What works for x% works for everyone" is not an underlying premise in the arguments I make. In fact, the contrary is regularly drilled into me in medical lectures, but population based health decisions can be made in spite of this.

If it helps you read my arguments I can state my general conclusion like this: libertarian style health delivery, based on the available data as I see it (I am no expert of course!), leads to worse healthcare outcomes for most individuals in society. Or, if such a conclusion is too strong, one might say that it seems unlikely, in light of the data, that most individuals benefit from a libertarian healthcare system.

 

[Slidey]

It's a shame, because I thought that statistic would be very interesting if it was true.

It may still be true. Google "hidden welfare state wikipedia".

 

[KFunk]

I should also mention that it seems like lunacy to discard the plight of 'the many' or 'the masses' in favour of 'the individual', for what constitutes 'the many' if not a group of individuals? Such an approach doesn't seem to make much sense unless 'the individual' is taken to be a euphamism for 'individual freedom'. But what is freedom worth if individuals don't benefit from it? e.g. by attaining pleasure, good health and peace of mind. My general aim is to further human ends as far as they are compatible with one another (though I might state things differently in another mood). Actual data aside, I still find this hypothetical question interesting:

IF it were the case that libertarian health care structures lead to worse healthcare outcomes, why would you choose one over an alternative which featured some form of government control?

 

[Slidey]

I should also mention that it seems like lunacy to discard the plight of 'the many' or 'the masses' in favour of 'the individual', for what constitutes 'the many' if not a group of individuals? Such an approach doesn't seem to make much sense unless 'the individual' is taken to be a euphamism for 'individual freedom'. But what is freedom worth if individuals don't benefit from it? e.g. by attaining pleasure, good health and peace of mind. My general aim is to further human ends as far as they are compatible with one another (though I might state things differently in another mood). Actual data aside, I still find this hypothetical question interesting:

IF it were the case that libertarian health care structures lead to worse healthcare outcomes, why would you choose one over an alternative which featured some form of government control?

I love your brain.

 

[KFunk]

I love your brain.

Haha, and I yours. I was actually just marvelling recently at how much our political views seem to have aligned over time. A result of similar interests (evolution/scientific method/mathematics/cognitive science etc...) or mere chance? Who knows.

 

[Enteebee]

In answer to Chadd: Yup, I believe in a flat sales tax rather than income tax (i.e. pay for what you use by getting taxed on what you spend, not what you earn.)

Also, theoretically, any income tax would have to be a flat tax and at most it'd be in line with corporations tax, though both would be decreased from current levels. But then again, I hate income tax in general.

That answered one of my many problems... though I have more to build upon from there (I can see the benefits/problems associated with flattening our tax system), I'd like to hear your responses to the other criticisms. To me it just seems that more pragmatic approaches seem to work than such strict dogma, it is true there seem to be situations where libertarianism works, but then there are others (such as the need to regulate various entities) where it simply does not work. I think the ordoliberalist concept of the state acting as a mechanism to ensure the free market leads to something close to its allocative efficiency seems to be the best pragmatic heuristic we can work off for economic matters.

I also strongly agree with the points made about the use of the word 'masses'.

 

[melanieeeee.]

You're a pretty awesome poster

so are you

 

[Iron]

I should also mention that it seems like lunacy to discard the plight of 'the many' or 'the masses' in favour of 'the individual', for what constitutes 'the many' if not a group of individuals? Such an approach doesn't seem to make much sense unless 'the individual' is taken to be a euphamism for 'individual freedom'. But what is freedom worth if individuals don't benefit from it? e.g. by attaining pleasure, good health and peace of mind.

I love you too KFunk, but problem I have with this is that it assumes equality of individuals. The whole weight of history seems to me to suggest that there are in fact a minority of 'great individuals' (creative, powerful, cultured, brutal) who break out from the masses (followers, people who need and seek stability, structure, who accept other people's versions of reality) and lead them.

 

[KFunk]

So suppose that those who display the pagan virtues - like bravery, strength, beauty, skill, humour and grace - that you admire are in the minority. I'm guessing that you (either honestly or in that ironic, devil's advocate kind of way that entertains me so much) wish to cultivate the existence of such individuals. Need our respective aims be incompatible? Even if you find 'great' individuals to be in the minority, do you really have much reason to think that the ideals I espouse, if pursued, would serve to hinder their coming into being?

In particular, consider that I favour maximising health across the board (and education, though in a different sense). Wouldn't ensuring higher health standards make it more likely that great individuals could emerge, untarnished by ill-fated epidemic or accident? In the case where your reply is that 'such events would not befall a great person' then why should the environmental circumstances matter at all, given that it is all written in their destiny in the first place?

On the other hand, if mass destitution is really a necessary condition for the great individual then I say: so much the worse for the Ubermensch.

 

[Iron]

Of course I would never suggest that your ideals were hindering my supermen, but many others are.
For instance, the equality of all men before law is just an extention of the Christian ideal of an equality of believers in the Kingdom of Heaven. But equality is just another prejudice of the weak for the strong. Guilt, conscience, sin etc etc are merely invented weapons of the weak to overcome the strong. If supermen are convinced (which they are) that their instincts to power, domination etc are wrong, then their greatness will be lost. Similarly, if the Doctors in your example are convinced that they are no more superior than anyone in society (when they're pretty high up the ladder), then it is unlikely that they will make great doctors. Utilitarian ideals will likely prove insufficient. Their work must be handsomly rewarded, they must be recognised as great, better, powerful. Without this, nothing will get done.

 

[Iron]

...
The desire to be recognised as superior to others is necessary if one is to be superior oneself

 

[banco55]

Of course I would never suggest that your ideals were hindering my supermen, but many others are.
For instance, the equality of all men before law is just an extention of the Christian ideal of an equality of believers in the Kingdom of Heaven. But equality is just another prejudice of the weak for the strong. Guilt, conscience, sin etc etc are merely invented weapons of the weak to overcome the strong. If supermen are convinced (which they are) that their instincts to power, domination etc are wrong, then their greatness will be lost. Similarly, if the Doctors in your example are convinced that they are no more superior than anyone in society (when they're pretty high up the ladder), then it is unlikely that they will make great doctors. Utilitarian ideals will likely prove insufficient. Their work must be handsomly rewarded, they must be recognised as great, better, powerful. Without this, nothing will get done.

I find it difficult to take these ruminations on the "supermen" seriously because I'm sure if it came down to it you wouldn't want to live in the kind of society that's arguably most conducive to producing them.