Some Themes

Restating some of the themes that are the reason this blog exists, but whence I often drift....

My view is that the soundest foundation for political thought is the moral philosophy outlined by the philosopher William James in "The Moral Philosopher and the the Moral Life".

That essay is perhaps best remembered for this sentence.

"Or if the hypothesis were offered us of a world in which Messrs. Fourier's and Bellamy's and Morris's utopias should all be outdone, and millions kept permanently happy on the one simple condition that a certain lost soul on the far‑off edge of things should lead a life of lonely torture, what except a specifical and independent sort of emotion can it be which would make us immediately feel, even though an impulse arose within us to clutch at the happiness so offered, how hideous a thing would be its enjoyment when deliberately accepted as the fruit of such a bargain?"

The point is that we ought to respect that specifical and independent emotion and refrain from torturing the lost soul.

But let us continue with James' essay. For his overriding point is that we will always act under conditions of uncertainty, because "there is no such thing possible" James writes, "as an ethical philosophy dogmatically made up in advance."

There are a plurality of rights that are, in the context of our limited temporal perspective, in conflict. The only way forward is the meta-right of reconciling the first-order rights. He gives an entertainingly condensed picture of politico-moral conflicts at the end of the 19th century. "See everywhere the struggle and the squeeze; and ever-lastingly the problem of how to make them less. The anarchists, nihilists and free-lovers; the free-silverites, socialists, and single-tax men; the free-traders and civil-service reformers; the prohibitionists and anti-vivisectionists; the radical darwinians with their idea of the suppression of the weak, -- these and all the conservative sentiments of society arrayed against them are simply deciding through actual experiment by what sort of conduct the maximum amount of good can be gained and kept in this world."

In this process, we are all bound to be in the wrong in some sense. Hence the need to pray for forgiveness. But we may also hope that even in our wrongnesses we contribute to the education and development of our species, to the gradual reconciliation of the different rights. To the meta-right.

Thus much, James. I do not claim him as an anarcho-capitalist. Indeed, you'll see that he lists "anarchists" as one of the contending factions in the above exposition, part of the fray. A philosopher will be above the fray. (The "conservative sentiments of society" are part of the fray too, though arrayed against all the others.)

My own view of anarcho-capitalism, though, is that it is actually one with the meta-right. It is what I see when I seek to join James above that fray. It is where we will find ourselves heading as we work to reconcile all of our different impulses.

Josiah Royce expounded on a similar concept when he talked about "loyalty to loyalty." A meta-loyalty. He wrote about how wonderful loyalty to a group larger than one's self is. But then he took note of the obvious objection to any "philosophy of loyalty." A pirate may be loyal to his pirate captain. They may all work together quite well. But they are working to rob the honest folk who have trusted treasure to that merchant vessel so unfortunate as to sail past them! Should we celebrate the loyalty of a pirate?

Well ... yes, in a sense. But we should also note that it fails to be loyal to loyalty itself. The loyalty of the sailor on the merchant vessel to HIS captain doesn't infringe upon anyone else's loyalty. THAT sort of loyalty, then, is also meta-loyal. The pirate's loyalty only works to defeat the loyalty of others, and this is both exemplifies an ideal and undermines it.

Meta-right. Loyalties that include loyalty to loyalty. In such ideas we see the way forward, and I hold that way will turn out to be anarchic. In the meantime, we deal with the specific dilemmas we face as best we can, fumbling, and trying to keep in mind the broader goals beyond the day to day crises.

What Ails US Health Care?

I went to a movie yesterday. It was "Once," a lovely bittersweet romance set in Dublin, with a scene or two where the protagonists explore the Irish countryside on the back of a motorcycle. As my friend and I entered the cinema, a man at a table implored us to sign a petition for single-payer health insurance. This was my first clue that "Sicko" by Micheal Moore was also playing there. I declined to lend my name to his list.

We saw Once, not Sicko, and I didn't see him again on the way out. Still, the incidnt confirmed me in what had been my wavering resolution to say something about the health care market here. For it seems to me that this is one instance out of many where government, as the supposed agent of a sovereign, poses as the solution to a problem of which it is the cause. The better solution is to remove that cause. How would that work, in the health-care context?

I'll explain by treating the matter historically, mostly perhaps because I read The Microbe Hunters (1940) by the great science-history popularizer Paul de Kruif about 20 times when I was a child, until the binding fell apart. So I'm going to answer Moore in Dekruifean style.

A one-paragraph clue to where I'm heading. It is inappropriate to say that a freemarket system for the provision of and financing of modern scientific medicine (MSM) has been tried and found wanting. The fact is, it has never been tried at all. To show this, we have to go into the 19th century development of MSM.

The American Medical Association was founded in 1847, to promote what its members already considered an orthodox or conventional model of medicine against challenges from homeopaths and mesmerists. (There were no Christian Scientists yet.) This is a curiosity itself. What did "orthodox medicine" mean in 1847? This was before Pasteur's discoveries had secured the germ theory of disease. Surgeons weren't physicians of any sort, they were still anybody skilled with a blade.

The defining characteristic of a physician, in the AMA/orthodox sense, in 1847 was the administration of "allopathic" drugs. Medicines that didn't resemble the suspected disease or poison. Allopathy -- "other than the disease." Obviously, this leaves possibilities wide open, and the particular drugs that would be administered to a patient by an allopathic doc in 1847 were those that had been selected by centuries of trial and error. The gastly connotations of that expression in this context are entirely fitting.

I think it is unlikely that any school of healing in 1847 was more likely to prolong your life than to shorten it. Or that any of the three contenders I've mentioned had a much better record than the other two. But the AMA's members were placing a sort of bet -- the homeopaths and mesmerists/mind-healers were placing contrary bets -- as to what would eventually prove to be the best approach to curing.

In 1855, the AMA put into effect what was called the “consultation clause” in its code of ethics. This clause meant that an orthodox practitioner risked expulsion (which at this point didn’t have the force of law, but we can think of it as a form of ‘shunning’ by one’s peers – in some contexts an effective psychological threat) if he so much as consulted with an unorthodox practitioner, i.e. a homeopath. This, you might say, was an effort at private-sector cartelization.

Lots of exciting stuff happened in the 1860s. In the United States, a civil war gave a lot of men opportunities to hone their skills as surgeons. They gained practical skill that the AMA would co-opt after the war, allying itself with surgery at last.

Meanwhile, in Europe, Louis Pasteur and Robert Koch put the "germ theory of disease" on a sound scientific basis in the 1860s. This also gave a foundation to the idea of allopathic medicine. If each disease has its own distinctive germ than the thing to do is to inoculate or immunize against that germ, or to find an agent that will kill off that germ without killing the
surrounding tissue.

Another development of the 1860s, this time in the British isles. Joseph Lister became the great proponent of an antiseptic surgical environment, specifically popularizing carbolic acid in this connection. The germ theory was an influence upon Lister, as one might expect. And his work helped undergird the alliance between physicians and surgeons.

So (returning to the US): after Appomattox, the AMA finally had something to sell. It was no longer just making a bet on something that might work, it had some science behind it. It was becoming an organization of entrepreneurs selling MSM.

It didn't take long thereafter, though, for the AMA to decide that private-sector cartelization, via such means as shunning, wasn't going to be enough to allow them to make the kind of profits for which they lusted. They started lobbying for licensure rules, essentially criminalizing the practices of their foes, and giving themselves control of entry into non-criminal healing.

Most of the states of the US have medical licensing laws that date to the quarter century 1875 - 1900.

So, to American's who can't get the insurance they need and/or the health care they need,and who are leaving the country to seek it elsewhere, what do I as an anarcho-capitalist have to say? To begin: God's speed. I wish you the best. Second, though, I should say that such anecdotes don't and shouldn't guide us as to the proper direction of reform. The proper direction would be, at last, to give a try to something that doesn't seem ever to have been seriously attempted, the de-licensing of modern scientific medicine, a true post-Pasteur privatization of the field.

Will Wilkinson, of The Fly Bottle, has expounded upon this a bit. Here's the money quote:

"There ought to be a guy, Manny, say, who does stitches. You cut your arm and you go to Manny’s stitches joint, which flourishes because Manny is the best at stitches. Manny leaves no scar! Ever! Moreover, he’s cheaper that some guy who spend years learning about the biochemistry of the human body. What does that have to do with stitches!? Why isn’t there a Manny’s Stitches Joint! You should be able to get a degree from the University of Phoenix in knee replacements. Just knee replacements! Why can’t you?! Because the AMA is evil. M.D.s are monopolists and welfare queens, and preventing a huge infusion of high-quality low-cost health care providers from coming to market."

Here's more on Wilkinson's tack, from his blog. http://www.willwilkinson.net/flybottle/2006/03/19/health-care-fantasia/