Friday, October 28, 2011

Free Education and Health Care

Brian Sapient at Atheism wants to know if atheists agree with the claim that education and health care should be free.

Of course, nothing is ever free. Somebody has to pay for it. So the real question is whether education and health care are things for which people have a right to force other people to pay for, threatening violence up to death on those who refuse.

As it turns out, these are two different types of goods and, as such, they require two different answers.

Education is a public good. It provides benefits to people - not just the person being educated. We are all better off in a community of well-educated, reasonable people. Whereas those who are stupid and irrational create all sorts if problems, not only for themselves, but for others.

We find this in climate change denial, where people who cannot reason their way out of a wet paper sack provide a significant barrier to policy options that could prevent a great deal of global harm and suffering. I am not saying that I know what the best options are. I am saying that it would be nice to have this discussion with people who can at least put aside the poor arguments that currently dominate global warming denial.

A public good is something that other people have a reason to pay for (there is some sum of money less valuable to a person than the benefits they obtain). However, they can not be blocked from these benefits when others pay for them. Free riders who seek to obtain the good without paying cause the good to be under funded.

National defense, a police and court system to fight crime, pollution control, and flood control, all produce public goods. They also are things that it is reasonable to ask the public to fund.

Health care, on the other hand, is a mostly private good. It's benefits are almost exclusively to be had by the person whose health is being cared for.

There are exceptions. Immunization against communicable diseases provide a public good by creating firewalls against the spread of those diseases, for example. This provides an argument for government subsidies for immunizations.

It is also true that we would all be better off surrounded by people who are generally healthy and fit. However, a government health and fitness program is a different sort of thing compared to free health care.

In fact, in one important way, free health care might work against overall public health and fitness. Free health care means, "We are going to cover the costs of personal decisions detrimental to health and fitness."

Smoking. Obesity. Lack of exercise. Drug and alcohol abuse. Unprotected sex. Use of alternative medicines (e.g., prayer). These all decrease health and fitness, and increase health care costs.

For all practical purposes, free health care is actually a subsidy for these types of activities. A subsidy invites people to take up an activity by saying that the government will pick up part of the tab - cover some of the expenses - associated with smoking, obesity, sexual promiscuity, and the like. It is a subsidy for unfit and unhealthy living.

It is also important to recognize that many of the activities useful for maintaining health and fitness are free. It costs no money to get exercise, not smoke, not over eat, not abuse alcohol and drugs, and not have unprotected sex. People can also save a lot of money by avoiding quack medicines and other nonsense - another potential benefit of a quality education.

Where people are choosing to risk their health, I do not see any particularly strong reason to want to compel others to bail them out when they suffer the results of their own choices.

Having said this, there is a certain amount of medical care that qualifies as a welfare good. It goes in the same category as having food to eat, water to drink, air to breathe, and a basic freedom of movement. You are not going to survive without it. Even a fit and healthy person will have health care costs necessary to maintain a minimum quality of life. Others lose health and fitness through no fault of their own. To state the obvious, we all lose health and fitness eventually, no matter what we do.

If a civilization has a lot of resources being spent fulfilling few and weak desires, there are many and strong reasons to direct some of those resources to fulfilling more and stronger desires. Methods would naturally include praise and condomnation - to promote an aversion to wasting resources on trivial things and a desire to help those in need. Other tools available to obtain these ends include rewards (for those who make these kinds of contributions) and punishment (for those who do not).

However, this is a far more limited option than would fit in the category of "free health care".

So, to answer the question.

The state should heavily subsidize education - real education; the acquisition of reasoning skills and true beliefs. The subsidy should respect the degree to which education is a public good.

If a society has people spending resources on fulfilling few, weak, and trivial desires, then it should redirect some of those resources to fulfilling more and stronger desires of basic health care. It should also work to promote health and fitness. However, subsidizing poor lifestyle choices is not a useful way to spend government funds.


Eric Noren said...

I'm with you the whole way except that I don't think you adequately explain why education is a public good. I don't see the similarity with police, pollution control, military... other public goods you mention.

Additionally, it seems to have the same attributes as the private goods you list: "the benefits are almost exclusively to be had by the person" being educated.

Second question, where do you make the leap to "free." (Obviously we mean free to the end user/consumer.) Can't public goods simply be made freely available, but not free in price? In the case of education, if we define it as a public good, how much education should be free? Secondary school, undergraduate, graduate, post-graduate?

Tim said...

You present a logical, consistent opinion. And one that follows sensible economic principles.

But unfortunately this misses one key crucial factor. There is not just the ill health directly caused by the decisions of the individual. There is significant random aspect to health and disease. Both inherited conditions, environmental factors, accidents and plain old bad luck. it is not about being equal, but about pooling the risk. If nothing else, we should ensure adequate health cover for children and caps for catastrophic illness.

Also, a minor disagreement is the extent you give people credit for being rational. Unfortunately, many of the unhealthy behaviours you rightful criticise are established early and can often be as much the fault of the parent and community as the individual. This is parallel to a key argument for education being publically funded, as otherwise an individual's educational attainment would be particularly, or perhaps significantly, limited by their parent's wealth.

Both education and health are vital in letting people be productive members of society and, even beyond the risk of spreading infectious diseases, that makes each at least partially a public good. My good continued health and education befit the whole country to some extent.

Purbrookian said...

You are completely wrong about healthcare, for many reasons; the waste, fragmentation, corruption, fraud, and incompetence inherent in a for-profit pay-or-die non-health non-care non-system should be apparent even to the most barmy right-winger. Every other country uses a tax-supported, state-regulated scheme. Are they all wrong?

Emu Sam said...

Where does charity fall on the spectrum of public-to-private goods? It seems private in the sense of satisfaction that the giver receives and the more solid benefit the receiver receives. Ways it could be public: preventing riots; a variant of insurance if ANYONE could need charity; reducing the need of a person to scrounge for food can ultimately make them more productive in some cases (instead of dumpster diving for the rest of their life, they spend a year on welfare then finally find a job).

We need numbers to make these decisions. Quantify everything!

Kristopher said...

If charity ( a lack of charity has always been condemened and giving has always been socially rewarded)were covering the costs of healthcare adequetly i would agree that we should leave it at that, but quite frankly it isn't

healthcare for children and accidents might subsidize some bad activities for others... but that is a small portion of the pie. a portion that could be excluded with a few rules. (no free lung or cancer treatments for smokers, the obese have to pay out of pocket for bypass surgery, not paying for injuries resluting from sky diving, or drunk driving (if you were drunk), etc)

since your argument seems to rely on not subsidising bad activities, if these activities were excluded from the free health care system or miniscule in comparison to the whole, would you want to make it otherwise free? or do you still think it should be largely private? if so why? furthermore if the costs for the military to protect everyone from invaders is legit, how about a healthcare to protect us all from accidents (assuming a healthcare that only funded accident related medicine)?

Kristopher said...

@ HR

freely available implies that it is affordable for all. expensive things being affordable to all requires government subsidies. so freely available but not free only works if it is less than 20 bucks or so per person.

next education helps society in that there are doctors, engineers, and what not, building things and curing people. something that makes the entire society prosper not just the recepient of education. take the literacy rate for example we all prosper if everyone can read road signs and safety instructions. (a key argument for making schools public in the late 1800's when the literacy rate was not super high)

Scout said...

Very well-written article, but I rather agree with Purbrookian about the problems with leaving healthcare to the free market. Maybe I have a particular perspective on this because I come from the UK where we have the National Health Service...but I really believe that in a decent society, everybody should be entitled to a minimum standard of quality healthcare. Yes, people do need to be encouraged to take care of their health, but that does not mean abandoning them when they are sick - or indeed they make themselves sick. Look at America. Healthcare is much harder to get hold of there, and yet there are still plenty of obese people, smokers, people who drink too much etc..

mojo.rhythm said...

"I'm with you the whole way except that I don't think you adequately explain why education is a public good. I don't see the similarity with police, pollution control, military... other public goods you mention."

It's so obvious that it isn't even worth mentioning. You personally will be much better off growing up in a community of smart, educated, civilized people. You benefit from the knowledge that other people get from their educations.

Eric Noren said...

"freely available implies that it is affordable for all"

Perhaps to you. "Freely available" to me means accessible to all. The iPhone is "freely available" to all, but is not free (and some might say not even affordable). (I'm not trying to call an iPhone a private/public good, just explaining one definition of "freely available.")

"expensive things being affordable to all requires government subsidies"

Not necessarily. On what principle do we decide that any expensive thing should be affordable to all? The most expensive luxury sedans are also the safest and most reliable. Wouldn't it benefit society if we all drove in them? Should government make an $80,000 Lexus more affordable?

"so freely available but not free only works if it is less than 20 bucks or so per person"

$20 is quite arbitrary.

"education helps society in that there are doctors, engineers..."

No doubt education helps society, but as I said above, it more closely resembles Mr Fyfe's definition of a private good. The primary benefit is to the individual. Education also has positive externalities. Positive externalities don't automatically make something a public good.

"It's so obvious that it isn't even worth mentioning."

I guess only if you're as smart as you are. When you're ignorant like me, you expect people to justify their assertions through reason and logic. The logic from Mr Fyfe did not sufficiently distinguish education from other private goods. So I asked for clarification.

"You personally will be much better off growing up in a community of smart, educated, civilized people. You benefit from the knowledge that other people get from their educations."

I 100% agree with you. The fact that society also benefits from something does not automatically make it a public good.

Emu Sam said...

One way in which education assists you is by making services which require a higher education less expensive. How much more would health care cost if the education fees tripled? How much more would everything cost if we had fewer accountants, managers, supply chain analysts? What would we pay for internet if every computer scientist was laboring under five times the debt?

I'm making up numbers, of course.

Another common benefit that people mention here is that people have the right to vote - educated or not. An educated person, one who is used to research and has some training in different types of reasoning, who has some experience thinking about civic matters over a period of months; that is a person who will make better and more rational choices in a voting booth. This is not the only way in which an educated populace will, as a group, make choices that affect all of our lives.

Doug S. said...

Much of the value of education is signaling. the person with the better credentials get hired, so we compete to see who can get the most impressive credentials.

If you doubt this, allow me to propose a simple thought experiment: What would do more for the average 21-year-old's career prospects: having a Princeton University liberal arts education but no diploma (or transcript, etc), or having a Princeton University diploma but no actual education beyond high school?

Having a high school diploma used to be a much bigger deal when it was less common. Other people's degrees make your own less valuable. Rather than subsidizing liberal arts education, governments should be taxing it, so that fewer people would be obliged to spend four years doing meaningless busywork in order to get a certification that says that they can do meaningless busywork.