At her blog Hullabaloo, the always excellent Digby asks someone “who knows more about theology than [she does] to explain” Gary Bauer’s following remarks to her:

For Christians, intent is integral to determining whether and when certain techniques, including water-boarding, are morally permissible.

Actually, although I find Bauer unpleasant and his attempt to justify the US’s torture regime despicable, I don’t think what he says here is necessarily wrong. Nor, indeed, is it just for Christians or does it require a knowledge of theology to appreciate.

If you take a child to the dentist to have some teeth removed, just to make her suffer, you have done something morally impermissible. If you take the same child to the dentist to have some teeth removed because you reasonably think they are rotten, you have not acted impermissibly. And these judgments hold even if, in the first case, it turned out that the removed teeth just happened to be rotten; and in the second case, it turned out that the teeth were not rotten after all. So the difference in the morality of the actions in the two scenarios is exclusively a matter of intention.

Now it may be that what puzzles Digby is not the general principle that the morality of an action may be determined by the intention with which it was performed, but the idea that this extends even to such actions as waterboarding or other types of torture. Why should this be so? Perhaps Digby is thinking something like this: when we describe certain actions as torture, we are already building in to the description of what was done some element of intention on the part of the agent. Torturing someone is inflicting pain on them, with the intention of causing suffering. So perhaps one might think that it is impossible that some further element of intent could, as it were, cancel the moral impermissibility of an action of torture that derives from the inbuilt intention of causing suffering. But I don’t see why this should be so. Take an action like punishing someone. It might be thought that, like torturing, punishing someone is doing something to them with the intention of causing some suffering. But suppose, for example, one’s child rushes to take a seat on a bus ahead of an elderly person trying to occupy the same seat. Punishing one’s child (perhaps mildly) with the intention of making them aware of the error of their behavior is surely quite morally permissible. The inbuilt negative intention in the punishing, of causing some suffering in the child, is integral to one’s educational purpose and the moral impermissibility it might endow the action with in other circumstances is canceled by the further element of intention here, to educate one’s child and make them more sensitive to the needs of the elderly.

I am aware that any attempt to consider issues like torture in terms of general principles about action and morality and in terms of constructed examples that are designed to make certain things stand out more clearly, is to invite the accusation that one is ‘soft’ on torture or temporizing on behalf of torturers. So let me stress once again, these remarks do not imply that I think that the torture regime of the US is morally acceptable. I think it is morally unacceptable. But I don’t think it helps anyone to look for what makes it unacceptable in the wrong place. I have written further on this matter here.

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The fact that there have been numerous instances of people turning up to townhall meetings on health care reform armed with guns has led several commentators to see a kind of face-off between the First and Second Amendments. As David Sirota puts it, in a post at OpenLeft, our First Amendment right to free speech

is now being threatened by, of all things, the Second Amendment.”

The rise of gun-toting protesters at congressional and presidential town hall meetings has put citizens’ right to bear arms in direct conflict with citizens right to attend public political meetings without fear of physical retribution. Indeed, in bringing loaded weapons — as opposed to a sign portraying a gun, for instance — to these meetings, protesters are quite deliberately aiming to intimidate others. They are, in effect, asserting that their Second Amendment rights to bear arms should come before everyone else’s First Amendment rights.

I want to suggest that when we reflect a little on the ‘metaphysics’ of speech, the relation beween these two Amendments cannot be seen as a simple and straightforward conflict.

Usually, when we think of our right to freedom of speech, we think of being allowed to say what we want without interference. And clearly, this is incredibly important. But we must not forget that most speech that we value is not of the private kind but is rather speech that has an audience. And it is the listening end of things, not the speaking end of things, that largely determines the relation between the First and Second Amendments. In a word, the amount of attention that people have to listen is finite. There is a finite (albeit relatively large) number of listeners out there, and a mere twenty-fours a day for them to listen in. When we factor in quality of attention we come up with a much rarer commodity. Whatever it is we want to say, we want listeners who are intelligent, sympathetic, constructive and, especially in the case of political speech, powerful. The attention of such listeners is of very small quantity. Since the amount of speech that people want to produce is vastly greater than can be absorbed by this limited quantity of attention, any speaker faces a situation of acute resource scarcity. How difficult it is to find an ear into which to pour one’s personal troubles; a colleague to read and comment on a paper one is working on; an audience for one’s blog; a Congressperson or President to put one’s case to. Anybody who looks for one of these things is in serious competition with a host of others.

Which brings us to guns. In any fight over scarce resources, the threat of violence is always lurking. In the case of freedom of speech, guns don’t just silence speakers – though of course they do this as well. They are also used in the armed robbery of attention. They work partly through their actual function, in that several townhall meetings, at which powerful politicians offered their attention publicly, and thus potentially to Americans in favor of health care reform, were canceled because of worries over violence. Certain speakers were robbed thereby of an opportunity to address a desirable audience. But guns also help steal attention through their symbolic value since much of the news cycle now gets taken up by covering the incidents at which people turn up to meetings with guns, and in interviewing the people who bring them.

The ways in which the threat of violence in general, and guns in particular, impact the struggle for attention is a structural fact, something that we are likely to find in any competition for valuable things. But that doesn’t mean that the Second Amendment is somehow antithetical to the First. When and whether we see these Amendments as in conflict depends on whose quest for attention is helped or hindered by guns. In 1962, civil rights activist Robert Williams published a manifesto Negroes With Guns. Even if we don’t approve of the threat of violence Williams wanted to pose to the White establishment by encouraging Blacks to own guns, we surely must see his support for the Second Amendment quite differently from how we see that of today’s Rightwingers. At a distance of nearly two-hundred years, it is hard not to feel impatience with the ‘moral forcers’ and sympathy for the ‘physical forcers’ in the Luddite and Chartist struggles for workers’ rights in England. Examples like these could be multiplied freely.

I am certainly not suggesting that there is no objective moral difference between, say, Williams’ desire to carry a gun in the face of oppression by the racist state and the desire of those who want to bring guns to townhall meetings on health care reform. Indeed, I am suggesting just the opposite. In the struggle for scarce resources, we (liberals) tend to favor the efforts of those who have little to obtain some improvement over the efforts of those who have much to monopolize, increase, and hoard. Williams, as a Black civil rights activist in North Carolina in the early 1960s,  would certainly count as someone who was starved of the right kind of attention and whose desire to use guns to get more of it would compare with the use of guns by a starving person to get bread. Even if one thinks that it is wrong, even for the starving person, to resort to violence or its threat to get bread, we know how to distinguish such a case from those in which, say, a gangster uses violence or its threat to enrich him- or herself. Just so with Williams and the townhall vigilantes.

The bottom-line is this. We should not see an absolute conflict between the First and Second Amendments. The First Amendment guarantees us a right to speech but it does not impose on anyone a duty to listen. Attention, like any other scarce resource, must be fought over. The fight should be by peaceful means. But we cannot ignore that violence often insinuates itself into the control of and competition for, valuable resources. How we judge the threat of violence in these cases should depend on the resource in question and the needs of the people fighting for it. In the case of people showing up at townhall meeting armed with assault rifles, it is clear that the attempt to steal the resource of attention is not justified or noble. But my judgment to this effect does not rest on a blind invocation of the First Amendment. It is based on substantive political views about  the desirability of universal health care and the goals and motives of those who are acting to prevent that outcome.

(I should add that I am not saying that it is OK for people to bring guns to townhall meetings as long as they are the right people. There are good reasons for banning such a thing. My point is just about the philosophical aspect of the intersection of the First and Second Amendments. Public policy on gun control is quite another thing, as indeed is public policy on such speech-related things as obscenity and defamation.)

In a follow-up post, I will explore the commodification of attention and its impact on politics through the Supreme Court decision of Buckley v. Valeo.

In his recent piece “The GOP has become a party of nihilists,” Joe Klein, of Time Magazine, asks the question:

How can you maintain the illusion of journalistic impartiality when one of the political parties has jumped the shark?

The presuppositions of this question speak to so much that is wrong with contemporary mainstream journalism that I want to dwell on it a little.

First off, what does he mean, “the illusion of journalistic impartiality”? Is he admitting he disingenuously abjures the real thing? I really don’t know, but I’ll take him as meaning “the appearance of journalistic impartiality,” something that is not, like its illusion, inconsistent with its reality.

But the more important question is what he takes journalistic impartiality to be. Recent studies of the media (such as Jeremy Iggers’ Good News, Bad News) take such notions as impartiality and objectivity to be dangerous chimeras and might see Klein’s problem as stemming from his desire (albeit frustrated by Republican shark-jumping) for impartiality. But this seems to me itself a kind of nihilism. Impartiality and objectivity are certainly intellectual virtues and journalists should strive for them as much as they can. It is often held that it is impossible to achieve them – a view which rests on an absurdly inflated conception of what objectivity and impartiality are. What is alleged to make them impossible to achieve is the claim, which I accept, that we necessarily view the world from a certain epistemic perspective (roughly, with a certain set of assumptions and interests). Clearly, the inescapability of seeing the world from a given epistemic perspective often makes it hard for us to form beliefs free from insidious influence by our assumptions and interests. But that something is hard does not mean it is impossible. In judging a close finish in a race between A and B, the fact that I desperately want A to win does not make it impossible for me to recognize that in fact, B has won.

But Klein does not see the difficulties in keeping up the appearance of journalistic impartiality as deriving from considerations like these. It is something he thinks he has done successfully until now, when the Republicans have just made it too difficult for him. This is what is so puzzling in his position. What conception of impartiality must he be operating with for it to be made more difficult by GOP nihilism? In fact, he gives us the clue to his answer in the next paragraph:

I’ve written countless “Democrats in Disarray” stories over the years and been critical of the left on numerous issues in the past.

Klein seems to think that impartiality is simply equality of judgment. To be impartial is to say as many bad things about one side as the other and as many good things about one side as the other. To be impartial with respect to two sides, on his view, is to represent those sides as equally plausible or equally implausible.

So what is Klein worried about? He can still do this, no? But the problem, as he sees it, is that when one side becomes too outrageous, his conception of impartiality will be revealed as the sham it is. When it is just so obvious that one side is more ridiculous than the other, a journalist will look just a bit silly by carefully balancing criticism and praise. But of course, such ‘impartiality’ is just as misplaced if one of the parties is only slightly more ridiculous than the other; it’s just less obviously idiotic. Indeed, even if the two sides were exactly equally ridiculous, it would still be wrong to represent them equally just because. It would be like the stopped watch getting the time right by accident. What is really required by impartiality is representing things fairly. A fair representation of lunacy will represent it as lunatic. There is nothing partial in calling a spade a spade.

There is another deeply flawed aspect to Klein’s conception of impartiality. Just which sides is one supposed to be impartial with respect to? Evidently, Klein feels no need to extend his conception of journalistic impartiality to, say, the US versus Al Qaeda or even, lehavdil, to the US versus France (for example during the Freedom Fries Riots). Nor, within the domain of domestic policy, does he feel compelled, I imagine, to be impartial with respect to, say, the ACLU versus the KKK. So why with respect to Democrats versus Republicans? Well, obviously, those are the two parties among whom government is shared. But where does it say that government must be shared by these two parties and no others? The Founding Fathers were, like many eighteenth-century political thinkers, deeply distrustful of the whole concept of political parties. Parties have intruded themselves into the political landscape in a quasi-institutional way. This is already a pernicious fact. It is just one further pernicious consequence of Klein’s misconception of impartiality that it reinforces the distortion these parties impose on the field of political possibility. To put it in a nutshell, impartiality in Klein’s sense is an intrinsically conservative stance.  It has the effect of neutralizing genuine forces that might disrupt the shared hegemony of the Republicans and Democrats and of misrepresenting their existence as a fact of nature.

In yesterday’s Washington Post, Eugene Robinson suggests that one reason why health care reform is stalling is lack of passion on the Democratic side:

How could this happen? The Pew survey suggests, basically, that Republicans are more passionate about the health-care issue than Democrats.

According to Pew, those who would be “pleased” if health-care reforms proposed by Obama and Congress are enacted outnumber those who would be “disappointed.” But when you look at those who feel most passionately about the issue, just 15 percent say they would be “very happy” if the reforms go through, while 18 percent say they would be “angry.” Among Republicans, a full 38 percent would be angry if health-care reform finally passes — but among Democrats, just 13 percent would be angered if it doesn’t.

But percentages might not be as important as absolute numbers here. I don’t know what the current levels of party affiliation are right now, but right after the last election, many more people considered themselves Democrats than Republicans. Republican affiliation has shrunk down to a much more dedicated, wing-nuttier core than ever before.

If a whole lot of lukewarm Republicans became lukewarm Democrats, and Sarah Palin were the only Republican left, then a 100% of Republicans would be angry if there were health care reform and the percentage of Democrats who would be angry if there were no health care reform would be much lower than it currently is. But obviously, one would hardly expect health care reform to stall on account of that (though of course, the reasons why it is stalling would be operative then too, and the Dems would still be trying to reach a bipartisan solution in which Palin got two thirds of what she wanted and the rest of the country got one third of what it wanted).

If one factors in Independents, although the percentage of the enlarged Democratic-Independent group that would be angry if there were no health care reform would probably go down, there would very likely be a larger number of people absolutely who were passionate about getting real reform than of people who will be angry if there is real reform.

Of course, if Robinson were just talking about Democrats and Republicans in government, then he might be on to something. The real cause of the stalling of health care reform lies with the failure of almost every elected official involved in leading the fight for reform to show some backbone.

I’ve now gotten round to reading John Mackey’s op-ed in the WSJ on health care reform, the one that had me boycotting Whole Foods and all that. Here are some thoughts.

There are two big philosophical issues that underlie his piece and I’ll comment mostly on these. The first serious point is this. Mackey writes:

Health care is a service that we all need, but just like food and shelter it is best provided through voluntary and mutually beneficial market exchanges.

This suggests a dichotomy between things provided by “voluntary and mutually beneficial market exchanges” and things doled out in rations by the government like cups of rice from the government storehouse. But almost everything we need and consume comes to us under conditions that are intermediate between these extremes. As things stand in the US, food and shelter are not traded solely through voluntary market exchanges. Government subsidies affect what farmers grow; foreign policy affects what is imported and exported, as do currency and trade politics; the government’s control and maintenance of roads and airspace affects what gets sent where; government-backed scientific research affects agricultural technology and husbandry; the military’s development of the internet, of course, has affected everything; zoning laws, often made on political grounds, affect the availability and nature of housing; and so on. One way or another, then, government, policy and politics are pretty well intertwined with the market in food and housing.

Nor is the current ubiquitous provision of health care via insurance, whether government-backed or for profit, a pure voluntary market exchange. With respect to the provision of insurance itself, as Mackey notes, there are all sorts of regulations in place. Furthermore, something like 80% of the insurance market is “heavily concentrated,” that is, close to being monopolistic. Those who get their insurance through their employers usually have a single plan, or a choice of plans from a single provider, pre-chosen for them. Those who buy insurance in the individual market have few and unsatisfactory choices.

With respect to the relation between patients and health care providers (doctors, hospitals, etc.), things are complicated. In theory, this is supposed to be a voluntary market exchange and its terms should be quite independent of whether the users happen to have agreements with third parties for reimbursement through insurance. (And of course, when insurers fail to pay, the health care providers certainly don’t forget who actually is responsible for payment – the patient.) But in practice, things are quite different. Providers often bill insurers directly. This is, of course, often a great service to patients since medical billing is a field in which, literally, you can now get a  higher degree. But the service also creates a situation in which it often seems as if the patient in not financially interested. Thus, doctors frequently order unnecessary tests without asking the patient first if they want to pay for it. Their reasoning is, undoubtedly, “why do you care? your insurance will pay anyway”. But whether or not the patient has insurance should not, in a pure market exchange between provider and patient, be any of their business. Nor is the patient well-placed to complain about unnecessary tests since the patient may never even see the bill, or it may be mixed in in some very complicated way, with a whole lot of other billing. So, if nothing else, the behavior of providers is greatly affected by their knowledge of the theoretically-irrelevant factor that the patient has a side agreement with a third party. It’s as if a teenager were to go to a car dealer and had to disclose ahead of time that their absent parent would foot the bill, whatever it is. This surely undermines the teen’s role as a party to a voluntary market exchange. What we often find now in health care is an almost institutionalized version of this situation.

So, to sum up this point: Rather than imposing an artificial dichotomy onto a fluid and messy situation that does not really fit, we should be asking where, from the point of view of social policy and overall well-being, we want to be on the continuum between lining up at the government storehouse and bargaining in a state of nature. All the proposals on the table lie in this intermediate area.

The second major point I take exception to in Mackey’s piece is this. He writes:

we need to address the root causes of poor health. This begins with the realization that every American adult is responsible for his or her own health.

If this just means that some of the things it is in our power to do or refrain from doing can affect our health, it is true but irrelevant. If it means, as it surely must for the logic of his piece to make any sense, that it is in our power to prevent ourselves from getting sick and hence, if anyone does get sick, it is his or her fault, it is so obviously false as to be laughable.

We cannot divide our ailments into the willfully self-caused, like those that result from smoking, and those that drop on us from above, like a girder falling from a crane.  Many people, for example, in poor areas, may suffer from the results of bad nutrition but live without any access to affordable and healthy food, a fact that is at least partly the result of urban planning decisions, zoning laws, policing and education resources, and so on. Governments can regulate, or not, the toxins poured into our soil, air and water. We can set up, or not, needle exchanges for intravenous drgu users, a policy question that routinely gets decided on grounds that have nothing to do with public health considerations. Until government and the body politic have done everything they can to allow people to be healthy, they bear some responsibility for our ill-health.

I close with two smaller points. First, waiting lists. 1.8 million in the UK, Mackey tells us. That statistic means nothing, by itself. First, we need to know what the average wait time is. But then, we also have to compute the average wait time in the US for comparison. We may not have ‘waiting lists’ but anyone knows that if you call a specialist, you might not get an appointment for six months. In Massachusetts, the average wait time for a new patient to see a primary care doctor is 50 days. How do we compute the average wait time in the US? If we simply take all patients who are seen and divide that into the total number of days they have to wait to be seen, we omit one of the most salient facts: that millions of people don’t have to wait at all – because they have no doctors to wait for! Somehow, all the people who have no access to medical care need to be factored in, or the comparison of wait times will tell us nothing. (Obvious, right? If doctors just cut their patient-lists in half, the average wait time should be cut in half. But you’d have all those people with no doctor to go to.) I don’t have any idea how they should be factored in to computing the average wait time in the US, but the point is obvious: better to wait than to die.

Finally, just a quick response to the quote from Margaret Thatcher that Mackey begins his piece with:

The problem with socialism is that eventually you run out of other people’s money.

Maybe so. But it takes a lot longer than it does to run out of your own money!

Who gets sick or injured is a lottery. (We may exclude from consideration all those medical problems that people have a role in bringing on themselves through their own behavior. So, we’ll exclude a smoker’s getting lung-cancer, etc. In practice it is often impossible to judge what contribution a person’s behavior makes to their illness, but this is a thought-experiment we’re engaged in.) If you’re born with a bad set of genes, you’re unlucky. If you happen to be in a car that gets hit by a bus, you’re unlucky. If you happen to get colon cancer, you’re unlucky. None of these things is your fault. So, like I said, it’s basically a lottery.

But tied to this lottery is another feature, being financially responsible for the necessary medical care to treat these misfortunes. Since having the misfortunes in the first place is a lottery, so is being financially responsible for them. But because the two lotteries are tied in this way, if you lose, you lose twice. Not only do you get sick; you have to pay for the treatment too (or your insurance has to).

So, here’s a proposal. Uncouple the two lotteries. When someone gets sick (through no fault of their own), somebody else is picked at random to pay for it (or to have their insurance pay for it).  Everybody’s total risk stays the same but it would be spread more evenly. And if you got sick, you wouldn’t also have the misfortune of being financially responsible. (People who get sick should be excluded from the random process employed to chose who will pay for them.)

As is already the case, one can buy health insurance or not, as one chooses, and buy better or worse grades of insurance with higher or lower premiums, co-payments, etc. If you buy insurance which is cheaper because it excludes organ transplants, for example (a common exclusion), you’ll be fine if you get stuck paying for someone else, unless you get stuck paying for an organ transplantation. And so on.

My proposal is (if we iron out a few inevitable kinks) just a fairer version of the current system of insurance. But I’m guessing no-body will like it. The alternative? A national health care system.

ec-results-map

Not sure what to make of this, but note that the red states on the map are topologically connected while the blue states are not. That is, you could travel through all the red states without ever having to go through a blue one, but not vice versa. (This will remain true however Missouri and Nebraska 02 go.)