Criticisms of Williams Notes for September 19

Main points

Williams’s treatment of health care is uneconomic in two ways: it pays little attention to both the production of goods and the preferences of those who consume them.

Nozick and Menzel, respectively, attack these points. Their basic positions are laid out in the handout.

Societies vs. individuals

Lindsay and Michael objected to Menzel’s position on the grounds that there is something wrong with a society that refuses to treat a desperately sick or injured person regardless of what that person had chosen.

I think that is a powerful point.

Here’s a question that Menzel would put to them. There are limits to what a society is willing to do for people, even when their lives are at stake. We have decided not to fund every possible way of prolonging life and we don’t provide all the treatments for prolonging life to all people.

How do we decide when a treatment should be provided and when it can be withheld? It would be wrong to allow someone to bleed to death in the hospital waiting room. But is it wrong to allow someone to die of heart failure in the same hospital because that person didn’t sign on for a heart transplant (assuming there is an available heart, of course)?

The general question is whether there is any treatment that it would be OK to withhold. If so, how do we decide what it is? If not, well, we’d better get used to spending a lot on health care.

A question about Rawls

This is a bit out of left field since we aren’t reading Rawls. But he came up, so that’s my excuse.

Rawls argues that the parties in the original position would use the “maximin” rule in deciding on principles of justice. The parties in the original position do not know who they are or what their society is like but are nonetheless given the task of choosing basic principles to govern that society. In saying that they would follow the maximin rule, Rawls meant that they would choose the option with the best lowest possible outcome for them. So, for instance, he argues they would choose a distribution of wealth in which those who have the least are wealthier than they would be under any alternative distribution of wealth.

Here’s my question. Suppose that the parties in the original position were asked to allocate funds between health care and other goods. Wouldn’t they spend as much on health care as possible, leaving only enough left over to cover other necessities like food and shelter?

Suppose I were one of those parties and was comparing a system like that with one that spent a little less on health care and spent the rest on, say, education. Call them systems A and B, respectively. In system B, the worst possible outcome is that I’ll die from the lack of care that was foregone. In system A, the worst possible outcome is that I’ll be ignorant from the lack of education that was foregone. Since death is worse than ignorance, I would choose system A.

Repeat these comparisons a few times and you’ll come to the conclusion that health care almost always wins.

Does that show there’s something odd about the maximin rule, even for the specialized purposes that Rawls puts it to, namely, choosing the basic institutions of a society?

This page was written by Eleanor Brown and Michael Green for Freedom, Markets, and Well-Being, PPE 160, Fall 2007.
Freedom, Markets, and Well-Being