Samuel Brittain: On Liberty and Choice

Samuel Brittain of the Financial Times argues that choice in decisions such as health care and education is a fundamental value in a free society:

On liberty and choice, by Samuel Brittan, Financial Times:  A commonsense view is that personal choice is desirable, so long as it does not inflict harm on other people. Nevertheless, there are periodic attacks on the idea. This is an appropriate time to consider the subject as May 20 is the 200th anniversary of the birth of John Stuart Mill, the philosopher whose classic book On Liberty is still the best treatment.

The issue became topical in the 1980s because of the invocation of choice by the Thatcher government in defence of its economic and social policies. At the mere mention of Margaret Thatcher too many otherwise level-headed commentators lost all sense of proportion ... One object of their anger is his emphasis on extending personal choice in services such as health and education. ...

Some people will attach the greatest value to the availability of qualified consultants. Others will attach importance to privacy. Further objectives include the reduction of waiting times or hospitals being nearby. Patients will attach different weights to these objectives and also to the tax cost of trying to achieve them. A spartan patient may regard a quick high-tech in-and-out job as the most efficient treatment. A sybarite might attach almost equal importance to a cheerful room and easy visiting hours.

It is worth emphasising, however, that if the dogma of providing services “free at the point of delivery” is upheld, choice must remain limited. With zero prices there can be no limit to what is demanded. So some rationing and selection are inevitable. ...

There is a wider issue. Choice is worthwhile, whether or not it promotes some concept of efficiency. Its value lies in the absence of coercion or man-made obstacles to the exercise of people’s powers and capacities. ...

Economic growth ought to increase choice. ... Here we come to a parting of the ways. It is, in my view, presumptuous of legislators or social scientists to tell us how to promote our happiness. Their objective should be to promote conditions in which people have the maximum of options. What they make of these opportunities is their business...

It is necessary to go even further. The bedrock value on which classical liberals ought to rest is freedom. Someone who attaches importance to freedom is committed to attaching importance to choice, but it does not necessarily work the other way round. You can have a lot of choice but be fundamentally unfree. What matters is freedom of action and speech among consenting adults. A society is unfree if your income has increased but you can be put in jail for expressing beliefs contrary to the prevailing political or religious ideology. It is also unfree if you are prevented from travelling abroad either by edict or by an exiguous official travel allowance. Choice among hospitals, or even among varieties of cereals, may not have the same importance, but it is still part of a free society.

The markets for cereal and health care are different. When there is market failure, as in health care, some people may have no choice at all and be forced to do without, and we may not be completely comfortable with the equity of the price allocation mechanism in any case. There are other values to consider.

Comments

[anne]

Choice is lovely and I do adore my shoes, but Blue Cross was kind enough to send me the cost of a health care policy which is a stunning $567 a month, plus a $400 deductible, plus co-payments for anything and everything, plus a 10% charge above the deductible for niceties beyond shoes. As far as we can tell, the Massachusetts health care plan will do nothing to make helath care more affordable such as pooling applicants. I love choice, and happily I have it.

[spencer]

The problem is that choice is a function of income.

The law forbids the wealthy as well as the poor from sleeping under bridges.

Coming out of the hills of Appalachia in the 1950s where I had a teacher that taught us that zero times a number was the number I did not have the same choices as an affluent kid coming out of a private school. That is where your analogy of free choice breaks down.

[anne]

http://www.calvorn.com/gallery/photo.php?photo=6319&exhibition=7&u=99|5|...

Eastern Meadowlark Taking Flight
New York City--Central Park, Great Lawn.

There are however always shoes :)

[algernon]

Yes, medical care is too expensive. So you have a right to hold a gun to someone else's head & force them to pay for it.

[billy]

Everything is a curtailment of freedom. Civilized society is a curtailment of natural freedom. The natural state of human affairs is kill or be killed.

Most of the petty rentiers want government intervention for protection of property, law and order, copyright and patents and what not. All government inventions.

Those who have no property do not benefit from any of this. So why should those things be done by the government?

Those who say that government should do X,Y and Z have already agreed government should do things - the only difference is about what X,Y and Z should be.

And 99.9999% of the people who complain about government would be worse off in a world without government. What they are complaining about is that A,B and C does not benefit them so government should not do it. But since X,Y and Z benefits them, it automatically benefits everyone else also! And hence government should do it.

[anne]

Ah, but Massachusetts has chosen to force people to buy medical insurance if they can afford it, but there is no provision for affordable insurance beyond what already exists for those who would qualify for Medicaid. I am not pleased in the least.

[Movie Guy]

Give it time, anne. They are setting the stage for a bigger national action.

[save_the_rustbelt]

Only $567 per month?

The Mass rule theoretically will reduce upward pressure on your premiums by eliminating some of the cost shifting required to treat uninsured and underinsured patients.

We shall see.

[algernon]

Billy,

Each of us should have a right to life, liberty, & property. In this country we instituted gov't to secure those things. As students of history, many in the founding generation understood that going beyond that purpose would lead to tyranny. Today the tyranny of the majority is the norm, as John Adams & others predicted.

Your equating of gov't protecting what people have worked to create(law & order, patent protection, etc.) to coercing taxpayers to pay for all manner of goodies, most of which end up in the pockets of the politically-well-connected rather than the needy--well, you're greasing the skids.

[Russ Hicks]

“Each of us should have a right to life, liberty, & property. In this country we instituted gov't to secure those things.”

Most of the civilized world understands that life, liberty & property are best secured in a regime encompassing socialized medical insurance of some form or fashion.

America’s high percentage of GDP consigned to health costs is the result of mid-twentieth century rent-seeking on the part of medical special interests which bore responsibility for the failure of the Truman administration’s national health insurance proposal.

The only “needy” involved in this argument is the poor-centric implication of bread and circuses which bears no resemblance to rich, modern, middle-class-centric social democracy which is our best safeguard against any tyrannical threat from the politics of rich and poor.

As founders like Benjamin Franklin understood, property is the social product of collective coercion:Private property . . . is a Creature of Society, and is subject to the Calls of that Society, whenever its Necessities shall require it, even to its last Farthing, its contributors therefore to the public Exingencies are not to be considered a Benefit on the Public, entitling the Contributors to the Distinctions of Honor and Power, but as the Return of an Obligation previously received, or as payment for a just Debt.Thus all rights enjoyed individually are performed collectively, with the result that we are each born in social debt.

In determining how we discharge this debt, separating security welfare and social welfare fails because it is unprincipled to require others to perform societally ratified values expedient to you while precluding your own performance of societally ratified values expedient to others.

What moral weight does the productive results of coercive social conduct – our socialized private property – carry against…Itself?If we don’t fight this creeping, knuckle-dragging pre-social democracy here in the U.S., aren’t we not only continually hammering ourselves with constantly rising medical costs (Thank you, sir, can I have some more?) but also greasing the skids for such ideas to spread to places like Sweden where levels of productivity, opportunity and freedom might be reduced to that of America in the 1780s?

[dissappointed]

Having only an undergraduate degree in economics, I wish I were a brillliant economist with a PhD and that I could add something to this discussion.

Where are those brilliant economists who I assumed would be alert and manning the guard tower for us all? Frankly, I am alarmed.

I see and hear talk of this great Mass health care plan and about health care being a "right" -- on par with free speech! To me, it is an Income Transfer, pure and simple; and sadly one that removes useful personal incentives from society.

Where are economists with the courage to demonstrate and to say that these programs misuse the power of the state and usurp people's individual liberties -- most often the liberties of those people who behave in the most 'productive' ways for society!

I've yet to do the math, but it wouldn't be difficult to prove -- would it -- that a young person that saves a LITTLE in a retirement account, in a health savings account (HSA), and makes simple, prudent decisions for the most part regarding their health and lifestyle, wouldn't need a paternal state to bail them out! Why should healthy, well-behaved, savers be coerced into "pools" to bail out the "less fortunate"!?

It is even more shameful in a society in which technology (computer databases, genetic profiling, etc.) can granulize personal risks and measure the results of human behavior as never before! A misguided mob -- using the power of the state -- wants to ignore this science and "pool" us all, as if we were born with the same endowments and later behave the same!

Where is an economist with guts that will say, "Mr. and Mrs. Jones, you have a high risk health profile; you need to save more for potential health problems, consider curtailing your family size -- or adopting instead, and make a number of other modifications to your lifestyle."

It is sad fact of life that some will have lessor endowments and that bad things will happen to others -- BUT, nonetheless, they can still make prudent choices with their behavior if the market is free to give them some signals!

Shamefully, I so often hear "market failure" thrown out as a way for some to advance their pet social cause, however noble, say feeding the poor or tending the sick. We do need structures to help the less endowed and less fortunate -- but it is dangerous to embed all these Income Transfers in places that eliminate good incentives and create new bad ones. We must all fight to make income transfers simple and transparent!

(How many people know, for instance, that the tax on their phone bill subsidizes rural phone lines and therefore rural living? Maybe this "noble idea" isn't such a good one when we think about $100/barrel oil ...maybe people should live in cities!)

At least, we need the markets to be FREE to do some cajoling -- peoples' parents, advisors, and government seem unwilling to do it for them.

[algernon]

Well said, 'dissappointed'.

Russ Hicks, you must really be a fan of coersion to go through such contortions to justify it. The health system is a mess, but that is probably more the result of the way it is already ~40% socialized rather than that isn't completely socialized. Have patience; I'm sure you'll get your way.

[Russ Hicks]

“Why should healthy, well-behaved, savers be coerced into "pools" to bail out the "less fortunate"!?”

Because living standards will improve with the reduction of health costs as a % of GDP and the reduction of the threat of end-of-life loss of savings that the lack of which constitutes a detriment to “life, liberty & property” along with the relief of knowing that “health savings accounts” offered by rent-seeking special interests with a stake in maintaining high health-to-GDP-costs have been defeated.

Because all of our freedoms emanate from “income transfers” of one sort or another, whether it be the sons that families send to war or the tax dollars which collectively subsidize the collectively performed freedom of speech endowment.

No credible freedom exists which isn’t ultimately performed by others.

It is unprincipled to highlight the coercion which goes into one without highlighting the coercion which goes into the other.

It is unprincipled to require the performance of one while precluding performance of the other.

It is unprincipled to speak of “coercion” as if there is no debt involved.

…Or is there a free freedom lunch?