Leslie Green, professor of philosophy at Oxford, recently published a post on his blog called “Why it is hard to be a campus conservative”. I said elsewhere that I have rarely come across anything that was both condescending and stupid to the extent this post is, but that’s not exactly true, because I have already heard the kind of things Green says in this post countless times in conversation. The only difference is that he lacked the good sense not to write it down. I could also have added that his post was incredibly tone-deaf, something that should be obvious to anyone who is familiar with the reasons conservatives have to complain about how they are being treated on campus, which Green evidently isn’t. It was also featured as a guest post on Daily Nous, where it drew a lot of criticism in the comments. (On Daily Nous, the post’s title was changed to “Because they are universities”, which somehow manages to make it even more condescending than it already was.) Given how much criticism this post has already received, if I were a better man, I may have just left it at that. But I’m not, so I won’t. Moreover, this will be the occasion to make a few points about the left-wing bias in academia, which I think are important.
Green claims that, when conservatives complain that universities have been taken over by “liberals” and that faculty/students of “conservative” opinion are afraid to speak up (I’ll come back to the significance of the fact that he put scare quotes around both “liberal” and “conservative”), what they mean is that universities are full of people who believe things like:
- Species arose through natural selection.
- No author of any gospel ever met Jesus.
- Homosexuality is a normal variant in human behaviour.
- The United States lost a war against Vietnam.
- Human activity is a significant cause of climate change.
- The United States has worse public health than do countries with nationalized health care.
Even more threatening to conservatives, according to Green, is that people at universities insist that belief should be proportionate to evidence and formed in a rational way. (Note that, at this point, there are no more scare quotes around the word “conservative”.) This is a pretty common explanation of both why conservatives are underrepresented in academia and why they complain about the way they are being treated. It’s also remarkably ignorant and stupid.
First, although several of the examples Green mentions, such as the belief that species arose through natural selection, are indeed clearly true, not all of them are. Not only is the claim that the US has worse public health than countries with nationalized health care not a “banal truth”, as Green calls it on his blog, but it’s not a truth at all. For instance, healthcare in Russia is largely provided by the state and the Constitution states that every citizen has a right to free healthcare, but public health in Russia is definitely not better than in the US. Perhaps Green was just talking about countries that not only have nationalized healthcare, but are comparable to the US in terms of economic development. Although this may be true, it’s a rather uninteresting claim unless they have better public health than the US because they have nationalized health care, so I’m guessing that it’s what Green meant and it’s indeed a widely shared belief on American campuses. The problem is that it’s hardly obvious, if only because there are large differences in lifestyle between Americans and people in other developed countries where healthcare is nationalized, which could explain the difference in health outcomes.
I’m not even saying it’s not true that a nationalized healthcare system would improve public health in the US. (I’m personally agnostic on that question. Not because I’m not familiar with the evidence, but precisely because I am, which I’m afraid is more than I can say about Green. Moreover, as I explained a few months ago, public health is not the only consideration in this debate.) I’m just saying that, if you think reasonable people can’t disagree about that, it’s either because you’re a fool or because you’re not familiar with the evidence and the methodological difficulties that are involved in settling this question. I’ll let you decide which is the most likely explanation in Green’s case, but while you’re pondering this, keep in mind they are not mutually exclusive. Anyway, it’s bad enough that some of the things Green think are “banal truths” may not be true at all, but this is hardly the most important problem with his post.
Perhaps the most problematic aspect of Green’s post is that, despite what he believes, most conservatives do not complain about liberal bias on American campuses because they are full of people who believe that evolution is true or that the US lost a war against Vietnam. They complain about liberal bias on American campuses because they are full of people who think conservatives are just cretins who are incapable of forming their beliefs in a rational way and have no problem saying so on a regular basis. In short, they complain about liberal bias on American campuses because they are full of ignorant fools like Green, who know next to nothing about what conservatives actually believe or why they believe it. Green’s lazy rant is a perfect illustration of why it’s hard to be a conservative on campus. Of course, he didn’t do it on purpose, but that doesn’t make his post any less valuable.
Conservatives also complain because right-wing intellectuals are regularly prevented from speaking on American campuses by unhinged, illiberal left-wing thugs, who sometimes don’t hesitate to resort to violence. They point out that large segments of academia have become hotbeds of activism posing as scholarly enterprises. In other words, far from complaining because universities are places where people are devoted to the rational search for the truth, they complain because universities increasingly are not. I should add that conservatives are right about that and that one doesn’t need to be a conservative to worry about that. I know plenty of liberals who find the politicization of universities extremely concerning. You have to live in a parallel universe to deny that it’s a problem.
If Green actually listened to what conservatives say when they complain about liberal bias on campuses, he would know that, but it’s clear that he has no idea what conservatives really think and that he is only familiar with a caricature. When I say that, people often retort that it’s because I’m a European conservative, who isn’t even religious and isn’t really familiar with American conservatism. So if that’s what you’re inclined to say, I’m going to stop you right there. I’m far more familiar with American conservatism than any American liberal I know. I read American conservative publications every day, know many American conservatives personally and have read countless books about American conservatism. (For what it’s worth, I also listen to Democracy Now and read plenty of left-wing sources, because unlike most liberals I want to know what the other side thinks.) I even watch Fox News on a regular basis, so I’m quite familiar with the kind of things American conservatives say when they complain about liberal bias on campuses, which is clearly more than I can say about Green and people who take his post seriously.
This bias is a real problem that should concern everyone and deserves better than Green’s idiotic post. I’m one of a handful of openly right-wing people in academia, so I’m in a particularly good position to talk about it. In my experience, people who aren’t conservative have no idea what kind of shit those who are have to deal with in academia on a daily basis, which is part of the problem. Universities worry a lot about micro-aggressions, implicit bias, etc. against women and minorities. But there is nothing “micro” or “implicit” about the hostility conservatives have to face on campus. Nobody goes around campuses openly saying that women and black people are stupid, but not a day goes by on campus without people saying that about conservatives. In my field, conservatives are so afraid to speak up that some of them have created secret groups, where they can say what they think without fear of reprisal. Just think for a second about how toxic the environment must be in order for things to have come to that.
And don’t tell me that conservatives just need to grow a pair and speak up more often. I actually agree that conservatives in academia should speak up more often, but most people who say that have no idea how difficult it is, because they never had to face the kind of hostility that conservatives in academia have to deal with. Everyone is a war hero until they actually go to war. Moreover, conservatives aren’t the only ones who are afraid to say what they think in academia, the problem is far more widespread than that. One of the advantages of being so outspoken is that everyone tells me what they really think, because they know I don’t give a shit and don’t have to worry that I’m going to repeat it. You have no idea how many people have reached out to me privately to thank me for saying things nobody else will. Most of them are conservatives, but many are liberals, who have views that are at odds with the zeitgeist and don’t feel comfortable expressing them. Often, they don’t even agree with what I’m saying, but they’re just glad that someone is saying it so they can have another viewpoint. Which brings me to why the liberal bias on campuses is bad even for people who aren’t conservative.
The problem with political bias, no matter who it’s directed against, is that it makes people who share the dominant view stupid and uninformed. Most of the things liberal academics think are obvious really aren’t obvious at all, but they don’t know that, because they rarely get to hear the other side. And they rarely get to hear the other side not because conservatives have nothing to say against their arguments, but more often than not because they are just afraid to say what they think. As a result, intelligent conservatives in academia are typically in a much better epistemic position than similarly intelligent liberals, because they are familiar with the best arguments for the views they disagree with, whereas liberals are robbed of this opportunity by the fact that conservatives don’t feel comfortable speaking freely.
As people who read this blog know, I’m strongly in favor of restrictionism about immigration, a view that most academics think is not only misguided but obviously false and morally repugnant. The problem is that I have read and thought a lot about immigration. Moreover, because almost everyone around me thinks restrictionism is wrong, I’m very familiar with their arguments. But they’re not familiar with mine, because they have almost never met anyone who disagreed with them on that issue and wasn’t afraid to say it. So when I have a debate about someone about that, it usually becomes really embarrassing very quickly, but not for me. In almost every case, I know exactly what they’re going to say. I know what studies they’re going to cite and, since I have actually read them (which is rarely the case of my interlocutors), I can explain why they don’t show what they think they show.
To be clear, although I think I’m right about immigration, I’m not saying that I’m obviously right. Precisely because I have read and thought a lot about it, I know this debate involves many complicated issues, both empirical and philosophical. My point is that, because of the liberal bias on campuses, most academics don’t know that. They think it’s obviously true that restrictionism about immigration is both intellectually and morally bankrupt, which is why they typically look like fools when they have a debate about this with someone who actually has a grasp of how complex the issue really is. Of course, I’m not saying that nobody on the pro-immigration side of that debate knows what they’re talking about, I know some who do. But I don’t know many of them and that’s really not surprising given the abuse people who defend a restrictionist position are subjected to.
Nobody benefits from this state of affairs. This isn’t just bad because it makes academics politically uninformed. There is plenty of evidence that it actually affects their scholarship and make it worse than it would otherwise be. There has been a healthy conversation about this in social psychology, a field that heavily leans left, where some researchers have demonstrated that the lack of diversity harmed the scholarship in that field. This was the impetus for the creation of Heterodox Academy, which seeks to remedy this problem in academia. Unless you have a completely unrealistic view of human cognition, you have to realize that any environment that leans so heavily toward one side of the political spectrum, far from being a place where belief is proportionate to evidence, will be epistemically suboptimal. Echo chambers aren’t exactly ideal environments to discover the truth about anything. If you don’t want to take seriously the liberal bias on campuses, that’s fine with me, but then don’t complain when people elect a vulgarian like Trump or when Republicans defund universities.
Finally, I want to reply to one point some people have made in defense of Green’s post, because it adds insult to injury. Both he and other people have claimed that his critics were misguided because he wasn’t talking about conservatives in general but only about a specific type of conservative. It’s true that, in his post, he occasionally qualifies his claims with vague expressions such as “a certain kind of conservative”. But he doesn’t always do that and, in any case, this is largely beside the point. You don’t write a post called “Why it is hard to be a campus conservative” if all you want to do is point out that people who form their beliefs in a totally irrational way, which is the case of only a small proportion of the people who complain that it’s hard to be a conservative on campus (at least it’s not larger than the proportion of people who deny it’s a problem and form their beliefs in the same irrational way), are bound to be uncomfortable in places such as universities, which are supposed to be dedicated to the rational search for the truth.
Are there conservatives who complain that it’s hard to be conservative on campus for bad reasons? Well of course there are, plenty of them even. But that their reasons are bad is obvious, so when you write a post which you claim is about why it’s hard to be conservative on campus and only address those reasons, you are in effect suggesting that conservatives don’t also have plenty of good reasons to complain that it’s hard to be a conservative on campus. If that’s not what you think, then why not address the interesting reasons people have to complain that it’s hard to be a conservative on campus, instead of writing a post on reasons nobody intelligent cares about? Even if it were true that most conservatives complain about the liberal bias on campuses for the reasons Green seems to think, which it isn’t, it would still not be why most conservative academics, who aren’t typical of conservatives in general anymore than liberal academics are typical of liberals in general, complain about it. This defense of Green’s post is a classic case of gaslighting. It will only work against imbeciles, but despite what Green seems to think, most conservatives aren’t imbeciles.
EDIT: This post has now been published on Daily Nous in response to Green. Judging from some of the comments, the number of philosophers who lack basic reading comprehension skills is very preoccupying.
ANOTHER EDIT: To be clear, when I say that it’s difficult to determine whether switching to a single-payer healthcare system would improve public health in the US because lifestyle differences make international comparisons tricky, this is just one example of the kind of difficulties one has to solve in this debate, but there are many others. I repeat that, if you think that it’s obviously true that a single-payer healthcare system is more efficient and have a discussion with someone who has some familiarity with both sides of the debate, you will look like a fool, as this exchange on Daily Nous shows.
YET ANOTHER EDIT: This post has now been published in Areo Magazine. Brian Leiter also wrote a response to it, to which I in turn replied.
ONE LAST EDIT: I should note, in fairness to Prof. Green, that a former student of his reached out to me and told me that, although she agreed with my post, he had been a great tutor to her and never gave her any reason to complain about their interaction. I wanted to point that out because I know people frequently infer way too much about someone’s character based on something they wrote, especially on the Internet.
I’m one of those non-conservatives you mention who couldn’t agree with what you’re saying more.
It’s also not obvious that no writer of a gospel ever met Jesus. A significant number of very well informed scholars deny that. See for instance Richard Bauckham, Jesus and the Eyewitnesses.
And what on earth difference would that make? As though religious texts could be undone by their having been written a few centuries later retelling an oral record rather than contemporaneously.
As though “winning” and “losing” could be applied neatly to Vietnam.
As though liberal academics are devoted to evolutionary theory despite having entire fields of study devoted to denying them on campus.
I haven’t participated in U.S. university life for over 40 years, but I have ventured into a number of blogs run by liberal or leftwing U.S. academics, and the atmosphere is often one of intolerant, self-righteous puritanism directed against all heretics who dissent from the current liberal or leftwing orthodoxy.
I’m leftwing myself, a bit to the left of what is generally called “liberal” in the U.S., but I have the vice or bad habit of criticizing the prevailing orthodoxy and of trying to maintain a sense of humor and of perspective.
The U.S. has always been a puritanical society. When I was growing up in the 1950’s, that puritanism was directed towards any sexuality which deviated from the norm of life-long heterosexual
matrimony (with children), especially towards homosexuality and towards anything with a whiff of
socialism or worse, communism. Now the grandchildren or even the great-grandchildren of the hegemonic generation of the 1950’s direct their puritanical self-righteousness towards other sins, for example, the heretical idea that socialist medicine is not a panacea for the U.S. healthcare crisis (for the record, I’m in favor of free public healthcare), but it’s the same puritanical holier than thou energy. One might posit that the amount of self-righteous puritanical energy in any given society is a constant (maybe it’s genetically transmitted) and that it changes its focus according to historical circumstances.
Just joking about self-righteous puritanical energy being genetically transmitted or maybe not.
Read Jay Man’s blog about the American nations:
https://jaymans.wordpress.com/american-nations-series/
He makes a pretty convincing case that the puritanical energy you describe *is* hereditary, and especially in universities/higher Ed, which developed in Puritanical Massachusetts.
In the absence of God, universalism has become the religion.
The view that the United States lost the war in Vietnam is certainly arguable. Not that it makes the slightest moral difference.
Honestly, if I really wanted to push it, I could argue with every single belief in the list, but as you say it’s not really necessary.
Actually, Vietnam was a UN war, so the US did not lose the war in Vietnam. The UN did.
This is an excellent piece and it really should be published somewhere where it will get greater visibility.
Most progressives I know think that conservatives only want more ideological diversity in academia purely for more access to power to spread their influence more in society and that’s the resistance to it/why they don’t really care if conservatives have a difficult time speaking up. Plus, they find conservative views morally repulsive and unintelligent so they don’t think they are missing out on anything. If establishment conservatives wrote lots of articles calling for more progressives in the police or military rather than it mostly being controlled entirely by right wing interests than progressives may view conservatives call for more ideological diversity in academia as more sincere. But, I can’t recall large numbers of conservative complaining about the lack of diversify among industries they overwhelmingly dominate so it can be hypocritical.
Have you seen Leiter’s response to you?
I did and published a quick response to it.
You must be joking. In universities diversity of thought is everything. In the police and the military, whatever bias there is (I don’t know any stats) is not because of a march through institutions and ideological purge, but daily experiences and struggles with reality of life in the streets. Both the police and the military have very specific goals and a very specific set of tools is required. There is no “diversity of thought” in firefighting. If there is any bias it is purely by coincidence. Now, this is different in criminal law, but again, criminal law is mostly leftist.
A truly pedantic point (and I apologize in advance). It has been much debated whether species typically arose through natural selection. Though some think that natural selection has a lot to do with it, many think that drift, geographical isolation, and random changes in chromosomal structure are more important. What’s beyond intelligent debate is that species arose through biological evolution.
Yes, this exact point actually occurred to me after I published this post, but Green and his defenders could have, with some reason, replied that I was being pedantic, so I’m not sorry I didn’t think of it before and chose to talk about healthcare instead.
P. S. Just to be clear, while I think it would have been pedantic to make that point in the context of my response to Green, I actually think the underlying issue you raised is quite important and interesting.
In response to Green, it actually is worth a mention, since he apparently thinks that the proposition he uttered is so obviously true that only an idiot would contest it. But my making the point as a comment on you is extremely pedantic!
Well, I think Green could reasonably have argued that it was pedantic because, in the context of his post, it was clear that he really had in mind the belief that species arose through biological evolution. Of course, one of my issues with his post is precisely that it’s so imprecise throughout, so there is also that I guess.
I’m sorry, but I didn’t understand the point about health care. I thought that one of the most significant problems with the American health care system is that the United States spends more, both per capita and as a percentage of GDP, than do other western and western-influenced democracies. Apparently there are other ways of measuring this where it doesn’t look so bad. Can you explain how this relates to the proposal currently being considered in the Senate, which would shrink medicaid and introduces a cap on medicaid spending, revoke protections for patients who have pre-existing medical conditions, and eliminates the subsidies created by Obamacare to help low-income Americans afford health insurance? Can this way of thinking about health care costs help me understand how Graham-Cassidy will improve the cost of American health care?
Even if you don’t accept that health care is more expensive in the United States than it should be, the other big problem with the American health care system is that, unlike the nationalized systems all of our peer nations have adopted, it falls well short of universal coverage. Prior to Obamacare, approximately 16% of Americans did not have health insurance. This number has fallen in the years since Obamacare has gone into effect, but Obamacare does not and cannot feature universal coverage, either. Is there some reason for thinking that letting millions of people go without health insurance, and who thereby lack access to routine, non-emergency health care, leads to better health-care outcomes?
Because to me it looks like the orthodox conservative thinking about healthcare in the United States over the last 20 years or so is little more than a ghastly and satanic prioritization of tax cuts for the wealthy over the well-being of more vulnerable Americans. Do you have a better explanation for Trumpcare, the “skinny repeal,” and Graham-Cassidy?
Indeed, the claim that the US is an outlier when it comes to healthcare expenditures does seem to rest on defective analysis, as I explained elsewhere on this blog. I have no idea how it relates to the Graham-Cassidy bill or indeed whether this fact has any connection to it, but of course I never made any such claim either.
I haven’t looked in detail into any of the recent Republican proposals to overhaul the US healthcare policy, because I didn’t have time and they kept changing. But I would caution against assuming that, whatever Republicans propose in Congress, it’s something most conservatives like. This was definitely not true for Trumpcare.
One person to read, if you want to know how many conservatives think on these issues, is Avik Roy. Note that he isn’t always a fan of Republican proposals, but he is pretty influential among American conservatives when it comes to healthcare policy. Megan McArdle also is pretty influential on this topic.
As for your other questions, I think the post about why viewpoint diversity is important for the debate on healthcare I link to in my response to Green already answers them, or at least you should be able to figure out how a conservative might reply to some of the questions you ask by reading it.
For instance, you’re asking if there is a reason to let millions of people without healthcare insurance, and seem to think there obviously cannot be any good reasons to do so. But it really isn’t obvious, because it depends on a variety of complicated empirical and philosophical issues.
For example, if switching to a single-payer system would require that the taxes of millions of Americans be very significantly increased, it’s not obvious that the US should switch to such a system. Of course, progressives often deny it would require that many people pay a lot more taxes or claim that it would be more than compensated by the money they’d save because they wouldn’t have to pay for a private insurance anymore, but it’s hardly obvious.
People who think it’s obvious just don’t know the kind of things Random Critical Analysis explained about how the US healthcare expenditures are well explained by its higher living standard, they don’t think about the effect switching to Medicare-for-all without increasing how much it pays healthcare providers could have on the financial sustainability of many of them, etc.
Now, you could also say that, even if it means that some relatively well-off people would have to pay more taxes and this would still cost them more than before even when taking into account the fact that they wouldn’t have to pay for private insurance anymore, justice requires that we make them pay.
Well, it may be so, I’m certainly not suggesting that it’s an absurd view. But it’s definitely not obvious, unless you think that, for example, Rawls was obviously right against Nozick. But I don’t think there is any well-informed political/moral philosopher who would say that. After all, if this really were obvious, what does it say about what they spend their career thinking about?
I’m not a philosopher, and I would not say that Rawls was “obviously right” against Nozick, because it’s not a question of someone being right and other being wrong.
Rawls and Nozick seem to start from different basic values about what counts, what matters, and I’m closer to Rawls regarding basic values about what matters.
I don’t believe that the basic values about what matters of Rawls or of Nozick are right or wrong: they represent different worldviews, different political commitments, different “sides”.
Philosopher Robert Paul Wolff (who is a marxist) says that basic values debates can be reduced or be summed up by the simple question: why side are you on?
I agree with Professor Wolff.
“you’re asking if there is a reason to let millions of people without healthcare insurance, and seem to think there obviously cannot be any good reasons to do so.”
Yeah, basically. I think that when people have health insurance they feel more free to go to the doctor than they otherwise would, because they can do so with very little risk of incurring substantial debt. I guess I think it’s kind of obvious that people who lack insurance are less likely to seek medical care when they need it, and that this is likely to sometimes lead to less positive medical outcomes for those people. That seems bad to me. I’m not aware of any reason against establishing universal coverage that is strong enough to outweigh this, but I’m open to the possibility that there is, which is why I asked.
But notice that you didn’t provide one. You pointed out that *if* going single-payer were to cause a significant increase in taxes that was not offset by the corresponding reduction in insurance premiums, this fact *might* constitute a reason not to do it. But you did not provide any evidence that this *will* happen.
“For example, if switching to a single-payer system would require that the taxes of millions of Americans be very significantly increased, it’s not obvious that the US should switch to such a system.”
I do think it’s kind of obvious. That kind of system has been adopted by literally every single one of our peer nations in the entire world, and none of them have less affordable health care than we do–even when you measure by ACI, and all of them have achieved universal coverage. And according to your analysis, the most salient difference between us and them is that we are significantly wealthier than they are.
I can’t see any reason to be attracted to an argument like that without prioritizing a low top marginal income tax rate over the health, well-being, and *lives* of the Americans who aren’t covered under the current system or the alternatives proposed by conservatives in Congress. I find that to be a ghastly and inhuman set of priorities, and I don’t apologize for thinking less of people who share them.
“People who think it’s obvious just don’t know the kind of things Random Critical Analysis explained about how the US healthcare expenditures are well explained by its higher living standard…”
The RCA post doesn’t say anything about what would happen if the US were to switch to single-payer. That post argues that the US is as much of an outlier with respect to healthcare spending as traditional ways of measuring health care spending suggest. It doesn’t say that the US is not an outlier, and it doesn’t imply that it would be even less of an outlier if it adopted a single-payer system.
And, again, I find the argument you’re suggesting, that the US cannot afford a single-payer system that features universal coverage *because it is so much wealthier than the countries that can*, to be perverse.
I would have thought it was obvious that I was pointing out many people think switching to a single-payer system would result in a significant increase in taxes that would not be offset by the corresponding reduction in insurance premiums for many Americans. You can say that I didn’t argue for the claim that it will, but neither did you argue for the claim that it won’t. (Actually, as I explain below, you did argue for it with deeply flawed international comparisons resting on false premises.) If I wanted to defend this claim, it would require that I write a 5,000 words long post, so you can’t reasonably complain that I didn’t do so in reply to your comment. I’m just trying to explain why something you think is obvious is actually not obvious at all. Beside, as I already indicated, I don’t personally have a firm view on this, so I’m not going to write a post that makes a definite case about something I have no definitive view about.
I can see that you think it’s obvious, but I can also see that you are not well-informed on this topic. For instance, you claim that “literally every single one of [your] peer nations in the entire world” has adopted a single-payer healthcare system, but it’s completely false. For instance, the Netherlands, Germany and Switzerland don’t have a single-payer healthcare system. It’s also not true that healthcare is more affordable in these countries, once you control for the difference in standard of living, which is another point I was trying to make. Indeed, the fact of the matter is that, strictly speaking, the US has no “peer nations”, because it’s much richer than any other country, including rich European countries. As for what you say about the fact that none of them has less affordable healthcare than the US, it’s true but irrelevant and I don’t think you understood RCA’s analysis, as I point out below. Even for those which have a single-payer system, the fact that they have more affordable healthcare doesn’t mean it’s because they have a single-payer system, it could be for some other reason. As RCA argued in his post and as I explain below, for the most part it’s probably because the US is much richer.
I think you clearly didn’t understand RCA’s post. The author measures healthcare spending in the same way as everyone else, so what is interesting about his analysis is not that he proposes a different way of measuring healthcare spending. What is interesting is that he shows that, once you account for the fact that people in the US have a much higher standard of living than people in other countries, including other rich Western nations, the US is no longer an outlier with respect to healthcare spending. People typically don’t see that because they use GDP per capita to control for standard of living, but as RCA explains in his post, this is a very poor measure of consumption.
For the most part, what explains the fact that healthcare expenditures are much higher in the US is that people in the US are much richer, which means that 1) labor costs are much higher and 2) the demand for healthcare is much higher. Since healthcare is a very labor-intensive industry, 1 makes a big difference. As for 2, it’s probably compounded by the fact that the relationship between AIC and the demand for healthcare is probably not linear, which is another thing which makes most international comparisons deeply flawed.
This has obvious implications for the debate about what would happen if the US switched to a single-payer system. It doesn’t show that it would not save money, but it suggests that most arguments to the effect that it would, which are based on the kind of flawed international comparisons you were alluding to, show no such thing. Of course, as I briefly alluded to, there are many other things which could go wrong if the US switched to a single-payer system, such as the adverse that loss of revenue could have on the financial sustainability of many healthcare providers throughout the country. It really is a complicated debate.
“As RCA argued in his post and as I explain below, for the most part it’s probably because the US is much richer.”
I understand that this is your view. But what I am saying is that if we are wealthier, then we have more wealth. And if we want to, we can use that additional wealth to benefit the most vulnerable members of our society–who are poorly served by the system currently in place, and also the system that preceded it, as well as the systems that conservatives in the legislative and executive branches of the Federal government have proposed.
Any system that features universal coverage is going to provide health insurance for a bunch of people who do not currently have it, and will provide health care for people who are not currently getting it. That is obviously going to cost extra. It’s controversial how much extra it will cost, and it’s controversial whether and to what degree these additional costs will be offset by various things.
But there is no legitimate question as to whether the US has the resources to pay these additional costs. As you continually point out, the US is vastly wealthy. It’s not a question of wealth or resources. It’s a question of whether the US is willing to devote some of our wealth and resources to benefit vulnerable members of society. It’s not that the resources don’t exist. It’s that you prefer that people suffer and die of preventable illnesses in order to preserve a low top marginal rate.
“For instance, the Netherlands, Germany and Switzerland don’t have a single-payer healthcare system.”
Yeah, I was speaking loosely and ran together several different types of health care system that are importantly different. Sorry about that.
I wonder whether you agree with the following. In affluent liberal democracies other than the US, the default assumption—the position that you can more or less safely assume that others will hold, and so you don’t normally argue for it—is that adequate health care is a human right. In the US, a significant number of people think that health care is simply a commodity; many can afford it and many cannot, and that’s the way of things. Thus, discussions about the cost of healthcare in Europe and Canada and Australasia centre around whether universal healthcare can be more efficiently and more effectively delivered than it actually is. (In these countries, healthcare is universal, of course.) In the US, the discussion is often about whether healthcare could be made cheaper by being made universal. I entirely agree with you that the answer to the latter question is likely to be no. But this doesn’t make me favour denying healthcare to anybody.
To Mohan,
I could be wrong, but I can imagine the following position: health care is a right, but the market is the best means of providing it.
I admit, it seems odd — if X is a right *to some service*, then doesn’t it just *follow* that the government must provide it? Well, maybe. Probably, even. But maybe not; what if it was clear that a free market health care system without mandated coverage ended up providing better health care outcomes, and for more people, than a socialized system? In that case, it seems to me odd to think the following:
People have a right to X; if the market provides X, then more people will get X than if the government provides X; but the government should provide X anyway.
I bring this up, because both socialized and private systems (not that there is one) will have to use some kind of rationing. In the case of socialized systems, this will be determined politically; in the case of private systems, this will be determined on the basis of ability to pay. Given that both systems will have rationing, it’s not obvious to me that the best way to satisfy people’s right to health care is with a government system.
Of course, the US is rich enough to afford universal healthcare coverage, but this isn’t the issue. Green seems to think it’s obvious that, if the US switched to a single-payer system, public health would improve. But as I pointed out, this isn’t obvious at all, and may even be false. The fact that Green apparently thought it was obvious shows that he doesn’t know what he is talking about.
Back to you, it seems that you’re now making a different claim, namely that while it may not be obvious that a single-payer system would improve public health, it’s at least obvious that healthcare insurance coverage should be universal. Perhaps the best way to achieve that is not a single-payer system, but something more like Switzerland’s system, but one way or another everyone should have healthcare insurance.
Now, this may be true, but note that it’s a different question from what Green was talking about, and what I was responding to. Moreover, while it’s a different question, it’s no more obvious than the previous one. It’s clear that you think that it’s worth it for some people to pay more taxes in order to achieve universal coverage and that anyone who disagrees with that just doesn’t care enough about poor people. But it’s only obvious to you because you’re implicitly making a lot of non-obvious assumptions about the effect more taxes would have on the economy in general and poor people in particular.
You think more taxes would only harm relatively well-off people, and you may be right about that, but of course it’s typically the kind of things conservatives and libertarians are going to disagree with. For instance, suppose that, because of the taxes necessary to finance universal healthcare coverage, unemployment increases among poor people or social mobility decreases. Many people who currently don’t have healthcare insurance will have it, but many of them will also lose their job, and many will be stuck in poverty. If this were the case, it wouldn’t be so obvious anymore that universal healthcare coverage is a desirable goal, would it?
But these are precisely the kind of things many conservatives and libertarians think would happen if the US adopted a healthcare system that ensured universal coverage. You probably think they are wrong about this, and you may even be right about this, but if you think you’re obviously right, then I can guarantee you that you’re wrong about that.
You have to understand that the difference between conservatives and you is not that they care less than you about poor people. Some conservatives don’t care about poor people, but so do many liberals, and a great many conservatives care a great deal about poor people. They just disagree with you about what’s the best way to help them.
Of course, there are also some libertarians who could even admit that their favorite policies would hurt poor people, but think they are nevertheless justified on principled grounds, such as the view that there is something wrong in principle about redistribution, even if it would be justified on consequentialist grounds. I happen to disagree with them, but I still recognize that it’s not obvious that I’m right.
Those are complicated philosophical questions and there is a long tradition of very smart people who have argued for that kind of views. Don’t get me wrong, I really think they are wrong, so on that issue it’s not as on the issue of single-payer, where I don’t have a definite view. But one can be convinced that something is true, while recognizing that it’s not obvious.
As I say in my post, I think a certain kind of restrictionism about immigration is correct, but it doesn’t mean I think it’s obvious. And it’s not because I don’t think I have a very sold case for my view. I think my case is very solid. But one can be very confident in one’s views and still have enough intellectual humility to appreciate that some people who have different views are not idiots or monsters and have also carefully considered the issue. In the case of immigration, I think only a tiny proportion of the people who disagree with me have, but there are still some of them who have and their arguments are not so easily dismissed.
Mohan, I think your comment is very interesting and I will reply to it later, but I have spent all day replying to people who contacted me about the various controversies I’ve somehow found myself in the middle of this week and right now I need to take a break! Robert already said some of the things I would reply to you anyway, though I sometimes wouldn’t put them exactly the way he did.
“many conservatives care a great deal about poor people. They just disagree with you about what’s the best way to help them.”
Lol
I like how the liberals on this thread are being asked to answer for Ho Chi Minh but the conservative author of this post refuses to answer for Lindsey Graham.
Mohan, sorry it took me so long to get back to you, I had completely forgotten about this.
I only rely on my impression and haven’t seen polls or anything, but your characterization of the difference between how people in Europe and in the US strike as roughly correct, as far as I can tell. The only wrinkle I would add is that it seems to me that agreement in Europe with the idea that healthcare is a human right and access to it should be universal is more thorough than agreement in the US with the idea that it’s just a commodity, which is contested by a large proportion of the population, but perhaps this is because most Americans I know are academics.
Of course, if one thinks that healthcare is a human right and should be universal, the fact that it’s not obvious that making it universal would also reduce its cost shouldn’t deter one from wanting to make it universal. As you also note, once we have decided that access to healthcare should be universal, there is a separate, complicated question of what’s the best way to achieve that. The view that healthcare shouldn’t be viewed as just another commodity and that access to it should be universal strikes me as very reasonable, but I don’t think it’s obvious.
As I hinted at in my last reply to Justin, one could think that universal access to healthcare could only be achieved at the expense of other things which contribute to the well-being of poor people, in which case perhaps it’s worth it denying healthcare insurance to some people who would like to have it. I know many people think this is utterly implausible, and who try to show it by pointing out that many countries where access to healthcare is universal do pretty good or even better compared to the US in terms of absolute poverty rates, social mobility, etc., but most of these comparisons are pretty naive.
(This is an issue that has already been discussed on this blog and that I plan to revisit when I have time, as I still owe a commenter a reply to a detailed comment he wrote in the course of a long conversation we had about the work of Nima Sanandaji.)
Of course, one could imagine a more radical case against universal healthcare, which rests on a more principled opposition to redistribution. I don’t personally find that very plausible, but I know very smart people who do.
I can only speak for myself, but when I complain that universities have been taken over by “liberals” and that faculty/students of “conservative” opinion are afraid to speak up, what I mean is that universities are full of people who believe things like:
* Natural selection has not, and, indeed, could not possibly, have led to any cognitive, affective, or behavioral differences between the sexes, or between groups that evolved for many thousands of years in geographical isolation from one another.
* Conservatives are the sort of guys who insist that the authors of the gospels were personal associates of Jesus of Nazareth.
* Homosexuals have always wanted long-term, committed, monogamous relationships, but couldn’t get there, because they weren’t allowed to marry.
* Ho Chi Minh was an agrarian reformer and all-around good guy.
* Anyone who questions whether human activity is a significant cause of climate change should be sued into submission and, possibly, imprisoned.
* Health care in the United States is all about capitalist dog-eat-dog competition, with the government nowhere in sight – in contrast to the socialist nirvana of Canada or France.
P.S. – well before Obamacare, the USA already had the second or third highest per capita public spending on healthcare in the world.
Please understand – that’s not public + private spending (where, obviously, we’re #1) – that’s public spending alone.
The USG has long spent way more per capita on healthcare than France.
But, for some reason or other, France manages to provide universal coverage, while the USG…doesn’t.
And yet, we’re told, if only we turn our entire healthcare system over to the USG, and let it run it the way it currently runs Medicare & Medicaid…all will be well.
I live in Chile with a per capita income (badly distributed) of 22,760 dollars, less than half of the U.S., with 55, 760 dollars per capita income.
Chile has an infant mortality rate of 6.7, the U.S. of 5.8. Chile has a life expectancy of
80.5 compared to 79.3 for the U.S.
Chile has a public health service, which is slow and bureaucratic. There are also private health insurance plans. However, even though it is bureaucratic and far from perfect, the public health service provides free universal healthcare to those who cannot afford to pay for private health insurance or to use a voucher program (which allows you to chose your own doctor and the state pays about half of the medical fees). Everyone, rich or poor, thus has access to healthcare and to medication provided by the public health service. I’m not proposing the Chilean system as a model for others, but guaranteeing public healthcare for all does seem to provide decent results, even in a country which is much less wealthy than the U.S. The problems of bureaucracy in the public healthcare system can be solved by re-engineering the system, as Chile has done with other public services such as the tax services.
s.wallerstein: the USG already spends more than twice as much per capita on healthcare, compared to Chile. So why are you getting “decent results,” while we aren’t? And why would you think that handling over still more wealth & power to the USG would improve matters?
I have no idea how efficient or inefficient the U.S. government is, but I don’t see any way for the poor to receive decent quality health care, including dental work and prescription medication, than for the government to subsidize it through general tax revenue. A voucher system may work better than a public health service such as the NHS in the U.K.
For me, decent quality health care for everyone is a human right: everyone has a right to decent quality health just as they have a right to a fair trial.
What we mean by “decent quality healthcare” varies according to how wealthy and developed a society is, but a society as wealthy and developed as the U.S. is should be one of the best in the world according to health care indicators (for everyone), but that is not currently the case.
Another way, I just realized, for the poor to recent decent quality healthcare is for doctors, dentists, and drug companies to lower their prices.
To Robert Gressis:
a couple of things.
1. One thing that I wanted to say was that sociologically, the debate is differently framed in the US than in other economically advanced democracracies. In these other societies, it is taken as a baseline for political debate that health care is a right. In the US, that’s not the baseline. I am genuinely curious whether I am right about this. (I live in Canada, and though I think I am right, I am far from sure.)
2. You’re certainly right that health care being a right doesn’t imply that government should provide it. As Philippe pointed out, Germany and some other countries have mandated private insurance, not Government-paid health care. It’s also true that it doesn’t imply that it should be mandated, but mandated coverage is part of the baseline political assumption that I am talking about.
Great post, thank you!
As a non-progressive academic in a subject area that tends to be fairly militantly progressive I agree wholeheartedly that there are many areas of research that would benefit from not shaming away non-orthodox viewpoints. One area that stands out here in the side-debate about healthcare in your comments is the question of what precisely it entails for something to be a human right.
An ever growing list of things are said to be basic human rights (health care, clean water, birth control, etc.), but does something being a human right mean that (a) everyone has the right to access that right, or (b) every one has the right to access that right *free of charge*? In my experience the progressive viewpoint tends towards (b), and discussions of the practicality of free stuff for everyone are difficult to have without being called a “one-percenter” or a bigot of one form or another.
I’m having trouble not quoting Heinlein at this point…. TANSTAAFL. If human rights become not just the right to the pursuit of life, liberty and happiness, but the guarantee of services free of charge, where will that money come from?