Over at the LPUK blog, Guthrum (who I think is LPUK Head of Policy, though I’m not 100% on that LPUK Party Chairman) writes that:
One of the greatest problems that a Libertarian has is trying to convey the message that Libertarians would not close all of the hospitals in the country, and the dead, dying and ill would be lying in hedgerows and/or the work house.
But the argument that follows does nothing to deflect that criticism. Now, it may well not be LPUK policy to stop funding hospitals etc, but I think that a reasonable reading of libertarian political philosophy would mean that at least some dead, dieing and ill would be denied treatment. I take it that Guthrum is arguing (or trying to argue) that libertarianism as an ideology need not lead to the bad situation he outlines, not that he’s making a point merely about LPUK party policy (or else all he’d have to do is link to a policy document).
Anyway, libertarians believe that any State significantly larger than Nozick’s minimal State is unjust. The State should provide police, military, courts, enforce contracts and so forth, and nothing else. Or rather, the State is not justified in using coercive taxation to fund anything else it wants to do. Now, hospitals pretty clearly come in the “anything else” bracket, so the libertarian line ought to be that that hospitals cannot be funded out of coercive taxation. Any funding of hospitals must be on a purely voluntary basis.
In this hypothetical libertarian world, it is plausible that at least some people would lack health insurance. Perhaps they do not have enough money for it, and perhaps their employer won’t provide it because they are unskilled, and hence easily replaceable. I don’t think that that’s an implausible picture – there are plenty of unskilled, easily replaceable workers in this non-libertarian world!
Well, these people would be beholden on private charity. Medical treatment costs money, and if it’s not going to come from the State, it’s got to come from private individuals (of course, the money the State raises in taxes was once the property* of private individuals – I do not intend to gloss over than fact). If there’s no private charity in your area, you won’t get treatment if you lack insurance etc. If there’s insufficient private charity, hospitals will have to close.
Guthrum’s argument against the view that libertarians would close all of the hospitals in the country, and the dead, dying and ill would be lying in hedgerows and/or the work house is along the lines of “well, the NHS is crap anyway”. Maybe so. But that isn’t an argument for either:
a) libertarian ideology would not lead to some poor people etc not getting medical treatment, when they would under the NHS
b) libertarian ideology would lead to some poor people etc not getting medical treatment, when they would under the NHS, but that doesn’t matter (perhaps for reasons of justice). This is what I think Nozick would say.
But Guthrum’s argument doesn’t get him to either (a) or (b) and it is those that he needs. Guthrum is thus right to suggest that:
One of the greatest problems that a Libertarian has is trying to convey the message that Libertarians would not close all of the hospitals in the country, and the dead, dying and ill would be lying in hedgerows and/or the work house.
It is a great problem, because libertarians don’t have an ethically palatable answer to that problem, and it’s right that non-libertarians find the libertarian position distasteful at best.
—
* I use “property” in a non-moralised sense – I do not imply, nor do I believe, that it is wrong for the State to tax redistributively.
Peter,
First of all, just let me correct you on the individuals at the top of the Party.
The Head of Policy at LPUK is Tim Carpenter.
Guthrum is the blogging name of Andrew Withers. Andrew is currently the Party Chairman.
You can see all of the Party leadership on the website
http://lpuk.org/pages/libertarian-party/leadership.php
With regards to the LPUK policy on the NHS, let me say this.
There are no plans by LPUK to close any Hospitals, Clinics or Doctor surgeries. There are no plans by LPUK to diminish any health related medical or clinical facilities currently providing front line services.
Where the changes will occur are the methods of funding for each of those facilities.
Primarily this will mean reform of the National Insurance scheme, taking it back to the original scheme as proposed by Bevin all those years ago.
At present any funds collected via NI end up in the General Fund, we are proposing that National Insurance be set aside as a self contained financial unit, that will directly fund those Hospitals, clinics etc. What will change in this is that the vast number of agencies, quangos, taxpayer funded ‘charities’ and Area Health Trusts will no longer be funded from this source of revenue, unless and until they can justify and prove that they add value to the clinical services offered to the public.
For the public, paying into the NI scheme, healthcare will still be ‘free’ at the point of delivery, but decisions about how those services will be delivered in each locality will be decided and run by clinicians, not business managers and administrators.
Where we currently have a system that sees each Hospital having twice as many managers as doctors, and three times as many administrators as beds, there is clearly something wrong, and it is this mismatch that we will initially be addressing.
Beyond that initial reform, we will then invite the commercial insurance industry to compete with the National Insurance scheme, offering alternative ways for the public to contribute. We feel that this competition will see a reduction in individual cost to the public, and will generate new sources of funds for the Hospitals.
At the same time Doctors will be permitted to compete with each other and allowing them to provide specialist services if they wish, again giving the public further choice, and increasing the service levels provided by Doctors.
There will be no forced closures nor will there be a fire sale of NHS assets. Any Hospital that would rather operate being entirely funded by commercial insurance would be able to do so, but a strict set of criteria would be met in order for that to happen.
Firstly, that they would not be able to refuse treatment in emergency cases, and that National Insurance would be on an equal footing to commercial insurance.
Further, any assets of that Hospital would be covered by covenants, to ensure that private asset stripping could not occur.
At that point, they would be able to operate free from government control, and compete in the marketplace with any other hospital.
LPUK, contrary to popular believe is not run along ideological lines. Our policy is formulated on Libertarian principle, but not on purist philosophy. We are realists in this world, but we do believe that individuals know what is better for each one of them rather than the state one size fits all approach.
a reasonable reading of libertarian political philosophy would mean that at least some dead, dieing and ill would be denied treatment.
Unless you’re aware of some way to magic resources out of thin air, this seems to be a reasonable reading of reality, rather than merely of libertarian political philosophy, given that resources are finite and wants, including health care related ones, are infinite, or at least are sufficiently large and costly as to dwarf the former in size. I mean, presumably you’re not saying that the NHS actually treats anyone and everyone who wants treatment, because it’s obvious from a cursory look at the news that this is not the case (google Susan O Boyle, for instance).
So I don’t think you can pull the “look at the evil libertarians, they don’t want people to have healthcare” because unless you are seriously suggesting that anyone is entitled to any healthcare they want regardless of the cost or probability of effectiveness, you’re engaged with the same messy problem as the rest of us are.
The fact is that under a libertarian system, some poor people would not get health care which they would have gotten under the NHS, and some poor people would get health care which they would not have gotten under the NHS. I don’t find this, in itself, ethically unpalatable.
This may be slightly tangental, but you seem to be adopting the North American understanding of “libertarianism” (which, admittedly, seems to have seeped into British political consciousness). The traditional meaning of “libertarian” is someone who opposes any and all authoritarian structures unless they meet a high burden of justification. This might seem to be simply fighting over a word, and so it is, but it has a political point, as Noam Chomsky (with characteristic vigour) explains here:
http://www.videosift.com/video/Chomsky-Libertarianism-vs-American-Libertarianism
Yes, I think you’re assuming that when LPUK members refer to “a libertarian” they mean someone who believes in libertarian political philosophy, along the lines of Nozick etc.
They don’t. As Ian P-J said above, “LPUK… is not run along ideological lines.” I found this when I tried to submit some questions using the “ask a libertarian” feature on their website. I asked about entitlement to (pre-tax) income, the relationship of taxation to theft etc. He responded with “this is a Libertarian ideological question and not really related to real world politics which is what LPUK is about”.
With this attitude you can’t expect their policy measures (eg a welfare safety net financed through taxation) to be consitent with philosophical libertarianism.
Grace,
Scratch the surface.
LPUK are VERY MUCH about Nozick-style libertarianism.
They just try and dress it up as something else.
Dan,
It’s a question of scale though, isn’t it? At the moment, lots of people get healthcare treatment who, in your ideal political world, would be left to die on the road side.
Just because we live in a world of scarce resources doesn’t mean there’s no moral difference between a world in which resources are used to help the poor, albeit imperfectly (our world), and a world in which they are no, in the name of “freedom”, so that rich people don’t have to share (your world).
I must say, you are very good at finding clever-looking little arguments to try and wriggle out of the nasty implications of libertarianism. Instead, why don’t you save yourself the exertion and grow a backbone so you can bite the ethical bullet, accepting that libertarianism means abandoning the poor so that the wealthy can stay wealthy, under the one-sided justification that this promotes freedom and fairness, whilst not considering the impact on the freedom and fairness of the poor who are left behind?
“LPUK are VERY MUCH about Nozick-style libertarianism.
They just try and dress it up as something else.”
I don’t think they get their inspiration from writers like him though. Anarchy, State and Utopia isn’t even on their list of recommended books. The impression I’ve got from reading blogs of party members (like Devil’s Kitchen) is that their policies aren’t the practical application of a consistent, rigorous libertarian philosophy, but rather spring from a jumble of anti-state ideas.
eg on the discussion board i once raised the question of prostitution and whether it was possible to make a libertarian case in favour of making it illegal (along feminist lines, its relationship to rape etc). I didn’t get any attempt to engage with the question or even any reasoned reponses, but just some platitudes about freedom. (Party members used to write the responses.)
I think you’re ascribing to them a greater concern with political philosophy than they actually have.
I think it’s telling that Dan (from what I’ve read on this blog and TSR) is always ready to try to defend philosophical libertarianism, while the LPUK leaders I’ve had contact with aren’t (eg not grasping the point of thought experiments and not having heard of Nozick).
Grace,
Right-Libertarianism is different to other ideologies in that it’s fairly tightly defined, in least in terms of policy prescriptions. Libertarians cannot be in favour of non-voluntarist State funded healthcare. The only reason LPUK’s official policy is not to abolish the NHS is that it’d be a complete electoral liability to anyone not already convinced of libertarian ideology.
I agree that many libertarians don’t do political philosophy (or at least, don’t do it well – Dan is an honourable exception in that he’s really good at philosophy). But political philosophy is important to libertarianism – look at how the leading libertarian blogs trot out the standard libertarian catchphrases – “tax is theft”, “statism is slavery” etc. Well, those statements are simply ridiculous unless backed up with some fairly esoteric philosophy. Libertarians, perhaps to a much greater extent than liberals, need political philosophy.
Also, who are you on TSR?
Dan,
I pretty much agree with the first half of Paul’s response to you. In our world, the reason people don’t get treated is due to decisions made on medical grounds (eg. that a particular drug is not cost effective – it doesn’t get enough bang for our buck in terms of healthcare results). That’s a totally different criteria to that which gets used in libertarian world, and one that looks a lot more defensible to me (though of course, it’s not perfect). In contemporary UK, nobody dies of easily preventable medical problems because they’re too poor. That ain’t true of Libertopia.
I’m anna_c_100 (don’t post much)
What is TSR?
A student forum (warning: it’s mostly full of complete idiots, ESPECIALLY the political bits!)
http://www.thestudentroom.co.uk/
Paul: I must say, you are very good at finding clever-looking little arguments to try and wriggle out of the nasty implications of libertarianism. Instead, why don’t you save yourself the exertion and grow a backbone so you can bite the ethical bullet, accepting that libertarianism means abandoning the poor so that the wealthy can stay wealthy, under the one-sided justification that this promotes freedom and fairness, whilst not considering the impact on the freedom and fairness of the poor who are left behind?
I must say, you really do come across as a condescending prick the majority of the time.
No, libertarianism does not mean ‘abandoning the poor.’ Personally speaking, I wouldn’t abandon the poor, and given your considerable self-righteousness when talking on the topic, I hope that you wouldn’t either. All I’m saying is that it’s wrong, immoral, and exploitative (you want to talk about fairness? I’d be happy to.) to coerce some people into paying for the healthcare of others – that is not to say that I have any problem with people voluntarily and charitably giving their own money to this end. The fact is that in libertopia, there is no reason why the majority of the poor would not be able to afford either private or collectively supplied healthcare – see, for example the mutual aid societies which performed this function for the poor, and performed it very well before the NHS. Yes, there will be a small minority who are not covered – and it is here that charity is going to have to come into the equation. I’m sure you’ll scoff at the idea, but I’m confident that in a world without the comforting pretence that one’s charitable duties to the poor are discharged via the state, people will not hesitate to give enough.
Peter: I pretty much agree with the first half of Paul’s response to you. In our world, the reason people don’t get treated is due to decisions made on medical grounds (eg. that a particular drug is not cost effective – it doesn’t get enough bang for our buck in terms of healthcare results). That’s a totally different criteria to that which gets used in libertarian world, and one that looks a lot more defensible to me (though of course, it’s not perfect). In contemporary UK, nobody dies of easily preventable medical problems because they’re too poor. That ain’t true of Libertopia.
If you think that the decision, say, to withhold cancer treatment from Linda O’Boyle (not Susan as I said earlier, I’ve been watching too much BGT) solely because she decided to pay for some treatment out of her own pocket was made on medical grounds, I think we must be using entirely incompatible definitions here. The point is that resources are scarce, and they are going to have to be allocated one way or another – and it seems to me that political means of distribution can be entirely as unjust as any other means of distribution. Once you start defending your favoured messy real-world system against my favoured messy real-world system, you can’t just stipulatively position yourself onto the moral high ground by criticizing libertarians. Saying that ‘nobody dies of easily preventable medical problems because they’re too poor’ is simply false – Linda O Boyle had an easily preventable medical problem (‘easily preventable’ is not the same as ‘cheaply preventable’) and she died from it because she was too poor to pay for the treatment herself. (Incidentally, a back of the envelope calculation tells me that had she not been coerced into paying the proportion of her taxes that went to the NHS, she would have been able to pay for treatment herself). I don’t see any reading of the facts that contests this, to be honest. You may want to say that, all things considered, her dying of an easily preventable medical problem was not such a terrible thing, but again, this kind of claim is much less sweeping than the ones you’ve been making.
But political philosophy is important to libertarianism – look at how the leading libertarian blogs trot out the standard libertarian catchphrases – “tax is theft”, “statism is slavery” etc. Well, those statements are simply ridiculous unless backed up with some fairly esoteric philosophy. Libertarians, perhaps to a much greater extent than liberals, need political philosophy.
You’re right that most libertarians are terrible at political philosophy, but most of anyone are terrible at political philosophy. I’m not sure we need it to any greater degree than anyone else, though. And I prefer ‘on a par with forced labour’ to ‘theft,’ although it might not be so snappy.
Dan,
What do you think about the coercive power of multinational corporations, which is often linked to state power? Is that something you’d like to see abolished, or at least attenuated, as well?
James,
It’s a complicated question, but the upshot is that I’m incredibly concerned by it. For a start, I don’t think the modern corporate form is a legitimate one (limited liability is an unjust and immoral state privilege). I think the conflation of free markets (real free markets) with the kind of corporate state-capitalism that passes for free markets these days is a terrible development, helped in no small part by the (strategically disastrous IMO) political alliance between libertarians and conservatives in the past few decades. Although libertarians get bad press because they are seen as apologists for large corporations, I think this is abut as far from the truth as you can get – large corporations are often terrified of the competition they would face in a free market, which is why they frequently use their size and power to influence states to put up artificial barriers to entry. This is all too often made worse by well meaning but misguided left wingers who think that expanding the size of the state is the only way to curb the power of the corporations, oblivious to the fact that the more powerful a central government is, the more attractive target it is for special interests. (For a perfect example of this, check out some of the socialist historian Gabriel Kolko’s work on the New Deal where he demonstrates just how hard big business lobbied for most of the purportedly ‘anti-business’ reforms.) I’ll stop rambling, except to say that yeah, my position on the coercive power of corporations is that it is both disturbing and only made possible through the state.
(There’s actually a really interesting discussion on the whole topic of libertarian attitudes to corporations here: http://www.cato-unbound.org/2008/11/10/roderick-long/corporations-versus-the-market-or-whip-conflation-now/ – a lot of people who I’ve shown this to had no idea that libertarians thought this way.)
Думается, если долго стараться, даже самую сложную мысль можно так подробно раскрыть.
Ha, Peter I am probably one of the idiots you speak of on TSR. (PoliceStory), we’re all just horrible capitalists.
Although I’m more close to LIB, than say bag DH or Caroline.
[...] This is not, it must be noted, an attempt to smear libertarians with emotively shocking examples: it’s a logical outcome of their political beliefs, which honest Libertarians will, and do, accept. If you don’t believe me, Peter Hawkins (a former Libertarian, no less) has argued the case very well here. [...]