So you are out with your friends, trying to decide which restaurant/bar etc to go to, but you are “unable to comprehend” how you could all come to a decision?

I believe that’s more aptly called the classical libertarian position.

I expect you will most strongly disagree with my next statement, but I’m taking the position that this is the only moral government.

As to what the U.S. government is maintaining now, that is not close to a market—not in health care.

As to the video you posted, respectfully, I am at a complete loss as to what is your point.

Dworkin thinks it is right for people’s access to health care to reflect their own choices. What he thinks is wrong is for it to reflect how wealthy they are. His thought experiment is an attempt to see how the market mechanism would allocate health care in a society where everybody started out in life with equal wealth in the absence of government interference. It is not intended to over-ride people’s choices—quite the reverse—but to negate the influence that unequal wealth has in the existing market for health care.

It’s fine to criticise Dworkin’s reasoning but claiming that you don’t want the government making collective decisions or to be involved at all, unless you are an anarchist, isn’t serious. The American government maintains the highly unequal distribution of wealth that gives some Americans access to expensive speculative treatments and leaves others to die of easily treatable diseases.

Er, no. ‘We’ simply means American citizens. (And that’s perfectly clear from the post and the article.)

Practically speaking, Dworkin’s central idea amounts to a small band of enlightened elites intuiting what the rest of us “want” (if we only knew it) and deciding what we’re going to live with. That’s the “we”—those anointed with the “gift” of being able to discern the General Will of Le Peuple, a la Rousseau, and the political connections to implement their vision.

What we need in this country is not one-size-fits-all collectivist decision making. That’s what people against further government involvement in health care are against. What we need is a greater variety—more choices—in health care and health insurance products. That will require less government involvement in what is presently one of the most heavily regulated industries in the U.S.

They don’t, of course – being in the right place at the right time (starting with the right uterus at the right time, the most important decision you’ll ever make) has far more influence. (It is, of course, really easy to make the fundamental attribution error about yourself and assume you earned every bit of success you enjoy, whether or not this is in fact the case, which it generally isn’t.) One hopes this point wasn’t lost on the person who posted it, but considering the atmosphere at MR, who knows.

As for the larger discussion… rational actor theories and human societies don’t mix. Isn’t Dworkin dooming his discussion to lead to, at best, a thought experiment with no bearing on reality, and at worst and probably more likely, to be mis-generalized to situations where his premises are thoroughly inapplicable? (Even if the question can be resolved at all in the toy universe, which is far from clear.)

But does it really have to be so expensive? These $2,000 biweekly shots: who priced them? Get rid of the profits, marketing, and duplications; weaken patent protection; educate enough doctors and bring their incomes in line with other professionals – and what you’ll get is probably more like $200 biweekly shots. Or maybe even $20 shots. The whole thing is, I suspect, a bit overhyped and overglamorized.

Fwiw I think that this is a very interesting problem with Dworkin’s approach but its practical consequences can be exaggerated. Notwithstanding differences in outlook between the young and old there must surely be a lot of overlap between earlier and later preference-sets among people who are sincere, rational and properly informed, and I would guess that these would be broadly supportive of the kinds of proposals outlined in the post.

Possible short answer: from taxes that you (and other people) were forced to pay when you were younger, even though you wouldn’t have agreed to them at the time.

Oh come on, Jack. That is so pre-Era of Great Financial Innovations.

Dworkin’s argument is to try to figure out what level of treatment will be paid. If you were given full knowledge of the various odds of contracting the various diseases/conditions and their costs, what level of insurance would you pay for?

What level of payments would you make vs what money would you keep for your present self for other priorities?

And the catch is that, while making this decision, you are given NO INFORMATION as to whether you specifically are going to require any of those expensive treatments. All you know is that the odds of you specifically needing it are relatively low.

Sure, we all want infinite amount of care and no expenses spared for our OWN treatments, but very few are willing to fund that for everyone else out of our own pocket. And at the same time, few of us will ever have the funds to be able to cover some of the serious possibilities of our later life on our own. So, some level of collective payment (aka insurance model, whether public or private) is needed.

Third, Dworkin’s future-looking youth is not likely to say “if I’m 80 and spry but macular degeneration might blind me, I wouldn’t want the $2,000 biweekly shots to slow it.” He would not want to go blind and so would want to spend more at a later stage.