01 July 2009
An Opt-Out Option?
Thomas Sowell argued in his book A Conflict of Visions that much contemporary political thought traces to one or another of just two conflicting worldviews. These worldviews he dubbed the "constrained" and "unconstrained" visions (Steven Pinker would later later call them the "tragic" and the "utopian" visions, respectively).
The difference, in brief, centers on what a person believes the limits of human knowledge and goodness are: If you believe humans are inherently flawed and fallen, and that, though they can make marginal improvements, imperfection and evil (even sin) will always be an abiding part of the human experience, then you subscribe to the "constrained" or the "tragic" vision. If, by contrast, you believe that humanity can be indefinitely improved, and that, with the right combination of institutions and leaders in place, most human vice can be eradicated, then you subscribe to the "unconstrained" or "utopian" vision.
I would fall into the "constrained" or "tragic" camp, both on religious and on empirical grounds.
I mention Sowell's argument here, however, because one of its implications is that disagreements between proponents of the two "visions" are intractable. They have different worldviews, and their political and economic positions are implied by those fundamentally different worldviews. That explains both why differences between the two groups can become so acrimonious, and it also predicts, unhappily, that there may be little hope for reconciliation. They will often simply have to agree to disagree.
Which brings me to today. The Obama administration is proposing to nationalize a significant portion of the health care "industry" (as it's called), and many supporters have not hidden their desire eventually to nationalize the whole ball of wax. For many of them this government takeover is required by their conception of justice. Significant numbers of detractors and critics, on the other hand, argue not only that this may increase inefficiencies and costs, but also that it violates their sense of justice to take health care choices out of the hands of individuals.
With President Obama intensifying his pressure for universal health care coverage, the debate is likely to become more heated.
So, drawing on the Sowell argument, here is my proposal for a compromise between the two sides: Pass the legislation, but include in it "opt-out option" for dissenters. Exercizing the opt-out option would mean forsaking any and all right to the care or coverage provided under the government's plan, but it would also mean no requirement to pay into it. Indeed, I would propose allowing an "opt-out option" for other government benefit programs as well, including Social Security, for example. Allow people who wish to be in charge of saving for their own retirement to opt out of the program, giving up any and all benefits, but not paying into the program either.
The biggest worry about my "opt-out option" is that such a number of people would exercise it that the program would not be able to sustain itself--and then the people who are intended to be the primary beneficiaries, the least advantaged among us, would once again be left in the lurch. I recognize and concede that worry. I have two thoughts in response.
First, my own conception of justice, which draws on the British and American liberal tradition, entails giving a tremendous deference to individual consent: if a person does not want to be part of my organization or my program, then I think I need a very strong reason to override his wishes. Imminent danger to national security, for example, might count, but the threshold should be that high.
Second, many people who could monetarily afford to leave the systems would choose not to. I have colleagues, for example, who would prefer to stay in Social Security or a nationalized health care system, if for no other reason than that way they do not have to bother with finding the "best" investment counselor or wading through myriad private health care providers and insurers. I expect many others would be moved by similar considerations.
Many people will also, out of their own sense of justice, wish to be a part of the systems even if they could afford to or would benefit from leaving, just as many people who could send their children to private schools choose for their own reasons to send them to public schools. Hence I think the number of people exercizing the "opt-out option" might not be as great as one might fear.
I confess, however, that even if I am wrong about the number of people who would exercise the option, I find the notion of respecting people's consent to be compelling nonetheless. If someone says "no, thank you, I want no part of your program," we can remonstrate with him, try to convince him otherwise, even beg, plead, or shame him; but if we insists, then I believe we must honor his wishes and let him go.