Criticisms of Williams Notes for September 11

Main points

Our readings today amplified two of the criticisms that we made in our discussion of Williams’s article.

Nozick attacks Williams for looking only at consumption and not at production. His complaint was slightly different than ours. We (well, Rhett and Roger) criticized Williams for ignoring the incentives to produce health care. Nozick accuses Williams of ignoring the rights of those who would have to provide health care for those who need it, where “those who would have to provide” are, ultimately, the members of the society who would have to pay the doctors, etc..

Menzel criticizes what he calls medical egalitarianism for ignoring opportunity costs, lovingly illustrated by Prof. Brown at the beginning of our previous session. If we take those seriously, he maintains, we will see that there is a good case giving the poor less health care than the rich.

Questions about Nozick

Professor Brown asked if Nozick had substantially improved on Locke’s account of property rights, especially where scarcity is concerned. I’m uniquely positioned to answer this question, having read the whole thing. No. The main thrust of Nozick’s discussion of distributive justice is negative: no alternative to a broadly Lockean theory of rights is acceptable. He maintains that he can make his negative point without giving a positive defense of a broadly Lockean theory of rights. I don’t think he succeeded, but that’s a separate issue. I’m just trying to explain why he might have thought he could get away without improving significantly on Locke.

Scott rejected Nozick’s individualistic assumption. He thought that it makes perfect sense to say that a society should provide health care for its members even if no individuals are responsible for doing so. Max provided Nozick’s reply: what’s a society other than a collection of individual members? There’s a marvelous debate in there.

Kevin noted that we don’t treat doctors as having complete rights over their liberty. Among other things, we think they are not at liberty to avoid giving aid to someone in desperate need, as in an accident. This kicked off a discussion of where exactly we draw the line between requiring doctors to provide services and allowing them to insist on payment (or whatever) first.

In my opinion, the important point is this. The fact that we debate about where to draw the line means we think there’s a line, that is, there are at least some cases where individuals are required to provide services for others and are not at liberty to refuse to do so (without an extraordinary excuse, usually). Nozick’s argument depends on the premise that individuals have rights to do whatever they choose without engaging in force or fraud. Some libertarians think the discussion about drawing the line will not come to a definite answer and conclude that there is no line. I think that’s like saying that since there is no definite way of drawing a line exactly between orange and red that there is no such thing as the color orange. But that’s me.

Finally, just for the record, I restate my opinion that Nozick and Williams are talking past one another. Williams is talking about what a rational state of affairs would be. Nozick is talking about individual rights. It may well be that individuals have rights to do irrational things. Heck, I’m pretty sure they do.

Bernice dissented. “How can what is right be irrational?” It’s a good question that is debated in the theory of rights.

Questions about Menzel

What kind of egalitarianism was Menzel criticizing? I think he meant to criticize the view that there is a special case for medical egalitarianism. (Derek said this). That is, he’s going after something like this combination of beliefs:

  1. Health care should be equal
  2. Wealth need not be equal

Bernice stuck up for medical egalitarianism. It’s not a matter of what people want, she said, it’s what society has to provide. He’s got answers in there, but it would be interesting to see that one hashed out.

Finally, it bears repeating that if we’re going to apportion health care according to what people would chose, we need to be able to specify the circumstances under which the choice is made. A poor person with severe liver disease will want insurance to cover a transplant. Poor people looking at their lives as a whole, in advance of knowing their specific needs, would probably not want this; they would rather spend the money on something else. But describing just what those circumstances are is tricky tricky tricky.

This is one of the most important issues for Dworkin.

This page was written by Michael Green for Freedom, Markets, and Well-Being, PPE 160, Fall 2008. It was posted September 12, 2008.
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