Have you ever been tempted to buy a beggar a cup of coffee or a sandwich instead of giving money? If so, you have, like a young Anakin Skywalker, taken your first step to the dark side of altruism. Don’t get me wrong, I’ve been there too. The reason I offered food instead of (money for) vodka is because I wanted to “help” the beggar. From my lofty perch (that is, sober, housed, and employed), I wanted to impose my values on him. Like a father choosing broccoli instead of ice cream for his kids, I thought I knew better what was good for the beggar — what he really wanted if only his thought processes were rational.
At some level, this is sensible. If I am paying, either directly in the form of the handout or indirectly in the form of the obvious externalities from the beggar (e.g., crime, stink, etc.), then it makes sense for me to try to reduce these costs.
But the dark side of caring is the perversity of this control. Once we start thinking this way, the creep towards totalitarian nannyism is hard to resist. Once I am paying for your health insurance, I suddenly care a lot whether you get an abortion, have that gender-switching surgery you’ve always wanted, or, most ominously, eat that Big Mac for lunch instead of the salmon salad. In today’s new America, I suddenly really care how much junk food the people making less than $88,000 eat — I pay for every Dorito that crosses their lips. And, for the record, I hate this about me and about New America. (Evidence this is our future comes from the UK, where 75% of people in a recent survey supported greater government control over individuals’ food choices.)
The problems with altruism are well documented. The IMF for years tried to control the internal policies of countries that it bailed out or loaned money to. These attempts were failures, both because the experts don’t always know what they think they know and because the meddling inevitably involves backlash, power grabs, corruption, and so on. (The IMF has abandoned these policies.) This instinct was also a source of the eugenics movement. Once we think of people as cost centers instead of autonomous individuals, the cost-benefit calculations can lead to some disturbing results. German posters from the eugenics era provide a nice example.
The battles ahead for New America are likely to be just as dirty. The battle over abortion in the Stupak Incident is just a preview of what is to come as every interest group wanting to feed at the trough, remake America, press for rights they hold dear, and so on, head for Washington to convince our dear leaders why the rest of the country should or should not pay for their pet project.Whatever the negative impact of me acting as a control freak is on my neighbor the beggar will be dwarfed by the nation as control freak. At the individual level, the control we try to exercise might actually be a good thing. But multiply it by 300 million, centralize it in Washington, and unleash the forces of public choice on it, and watch the beginning of the end of our freedom.
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Joey — “antitrust guy” beat me to it. Why is he wrong?
Joey: I don’t think the analogy to social security is very good, because there is a defined benefit. Health care is different–you get care based on need. If social security benefits were doled out based on each person’s needs (car, housing, etc.) we would have to ration it in some way (you can only buy american, no McMansions, etc.)
Health care has to control costs–indeed, one reason for the bill (at least coming from some of its supporters) was to reduce the runaway costs of medicare. That can be accomplished only by placing some set of limits on care. Sure, rationing can be done rationally (cost-benefit), but can also be done politically–just look at the uproar over the recommendation that breast cancer screening occur less frequently and only later in life. That’s innocuous compared to abortion, but those decisions will inevitably be lodged in some government agency.
I really enjoyed this article and I’ve been spreading it around to some of my fellow students. Greater and greater government intervention would seem to follow as natural consequence of some of the areas that this bill, now law, touches on. Looking over a summary, we may see a national dietary regulatory body (among other things) somewhere on the horizon to control ballooning costs.
The attitude of “we know best” seems to be at the root of more than health care legislation though. Once something like this plan is enshrined in law it institutionalizes that totalitarian mentality which can readily spread.
Again, I really enjoyed the article. Giving to the homeless won’t exactly be the same anymore.
Geoffrey,
I think I agree more with you and Todd than I disagree. And I have steadfastly avoided commenting on healthcare because it is a total mess of an issue. But since you mention it…
Haven’t uninsured people in this country felt entitled to health care for a long time? I have friends who work in emergency medicine. Emergency rooms are a total mess thanks to the way that uninsured people use them today.
I don’t pretend to know whether or how the law just passed is going to solve those kinds of problems. And probably like you and Todd I get a very sick feeling in my stomach whenever I hear the law compared to Social Security or Medicare/Medicaid. But I do like the fact that a lot of uninsured people who have nonetheless been a burden on the system are going to be forced to go legit.
I want to see how some of the law plays out. Given the circumstances, I’m looking this as a grand experiment. If it succeeds, wonderful. If it fails, there’s always Vanuatu.
First, apologies for confusing Todd and Thom.
But to the point that centralized distribution of healthcare will turn out badly– really? Because we centralized care for the aged with Social Security, and such fears never materialized there. We give the elderly a stipend, but we don’t tell them how to live or where to go on vacation or otherwise how to spend their money, and we’ve had Social Security for 70 years now. We already centralize payment of healthcare for the poor, the elderly, the veterans, the military, and we don’t interfere in their healthcare choices anywhere near as much as the Tea Party wing of the GOP fears will happen now. (Certainly to no greater extent than private insurers interfere with my choices.)
I’ve never thought much rationing of care will come about because of reform. Costs will soar, yes, but they were going to soar anyway. Our choices will be either to raise taxes considerably, or– more likely, in my view– we’ll need to increase new immigration into this country on a vast scale in the 2020s and 2030s to support our aging population.
But the idea that we should leave every individual to cope with his problems via the private market, when they are problems he did nothing to bring upon himself *and he has no reasonable way of handling himself*– well, that’s a hard sell.
I agree with you, Todd. I think the people behind the legislation likely view its centralizing tendencies as a feature, not a bug.
MFM: Your comment may have been meant wholly tongue in cheek, but I think Todd’s point is not that there’s a slippery slope from buying sandwiches for the homeless to health care legislation (although there may be a connection), but rather that the same incentive that makes a beggar’s benefactor care about what the beggar does with the largesse will make taxpayers care about what the recipients of taxpayer-supported health care do with the entitlement. And for Todd (as well as for me) that “caring” is a real part of the problem with health “care” “reform.” Whatever else this law does, it will necessitate, justify, aggregate, magnify, institutionalize, warp and politicize the incentive to care about others’ otherwise independent choices about a huge range of things. This can only turn out badly.
I don’t know. This seems like more of a sticky staircase than a slippery slope to me. That is unless you’re representing the government and offering to buy all the homeless people in NY a sandwich.
Joey,
(Todd, not Thom, wrote this post, although we are a lot alike. I wouldn’t want to taint Thom with my musings.)
My post wasn’t really about the beggar. I think the right thing to do is to either give the beggar nothing or to give him an apple. My point is that this type of perfectly sensible thinking can be extremely dangerous when taken to the national level. In other words, there are diseconomies of scale, so to speak, in the benefits of altruism because of these negative effects that will inevitably arise. After all, altruism is generally regarded as a good thing. I’m just pointing out a potential downside.
As for the abortion point, I agree with you. I’m not in favor of governmental involvement in any of this stuff. You may care about abortion, sodomy, or the like, others may care about drinking, smoking, overeating, and so on. We all have stuff we care passionately about, and want to either protect or impose on others. This is very dangerous when turned into politics. As I’ve posted before, Hayek obtains — our heterogeneous preferences make centralization of power over our choices doomed to failure.
Thom,
What would you recommend someone do with the beggar, then? Give him the dollar, or give him no money at all? I do see the logic in your thinking, that the beggar should have the freedom to do what he chooses– but that assumes the beggar is reasonably rational, when empirical evidence shows a large number of homeless beggars aren’t; they are mentally ill, or alcoholic, or drug-addicted. If you give him the dollar, he is more likely to waste it on a self-destructive purpose. So your choices are to give him a cup of coffee, ignore him completely, or give him the $1 to spend as he pleases and risk the taxpayers spending $100 to scrape him off the street when he wanders into traffic in a drunken stupor.
That’s why I don’t give them any money– which I hate, but I know that to give them more power over their own fate increases the odds that they’ll do something destructive rather than productive; so I leave them as powerless as possible. At worst, they’ll do no harm.
I do, however, wholly agree about the Stupak incident and government increasingly trying to exert control over you. The more conservatives try to exert control over what reproductive choices my wife and I might want to make, or what marriage choices my neighbor and his boyfriend might want, or what experimental stem-cell research might benefit my relative with Parkinson’s– that’s exactly the sort of intrusiveness we need to stop.
Hear! hear! Words of wisdom. Unfortunately, not everyone has heeded them, and things are bound to get very messy indeed.