Comments on Arizona Case Papers

Libertarian Views of the Arizona Case

• Libertarians believe in negative rights based on respect for individuals’ capacity for rational choice

• They would oppose any state funded, tax based program as an infringement on tax payers’ property rights

• They do NOT necessarily believe markets work well—rather market choice is a RIGHT, regardless of its consequences

Some Misinterpretations of the Libertarian View

• Most Libertarians view the welfare of children as the responsibility of their parents—no health rights for those under 18

• No special responsibility of insurance companies—it would just depend on what contract the buyer and seller signed

• No special obligation to those born poor or disadvantaged—they can/should just work hard g\to improve themselves

Egalitarian LiberalViews of the Arizona Case

• Egalitarian liberals believe in providing SOME level of minimum opportunity for all as a positive right—but the content is unclear

• Are either basic pre and post natal care, or transplants, a part of that entitlement?

• Since more extensive rights cost more, your view of how high taxes can legitimately go shapes your answer.

• An entitlement to some quantity and quality of life implies age rationing.

Some Misinterpretations of theEgalitarian Liberal View

• Self harm does not necessarily imply a loss of entitlement.

• Redistributing cash only is an exceptional position.

• If you want to help to worst off you need a LIFETIME perspective.

• You don’t need to favor complete equality so not all private insurance provisions have to be matched

Utilitarian Views of the Arizona Case

• Compare transplant gains versus alternative gains—e.g. covering the notch group or non-health spending or lower taxes

• BOTH the SIZE of the gains or losses and the NUMBER of those affected are relevant

• You must discuss how/why you will measure gain (objective vs. subjective distinction).

• If you narrow the analysis to health—explain why• May lead to priority for, or limits on eligibility for,

those with the most benefit• Policy conclusions depend on specific predictions

Subjective Utilitarian Measurement in the Arizona Case

• Subjective utilitarianism is not a vote or a popularity contest. It depends on the benefits enjoyed by those who benefit.

• You need to measure gain (e.g. willingness to pay) of, for example, notch group mothers and kids versus transplant recipients.

• Users of this method need to consider income differences and how to deal with children and others with limited understanding

Optimistic versus Pessimistic Subjective Utilitarians

• Optimistic subjective utilitarians like markets because they believe they will maximize utility—as a means not a libertarian right

• Some would use market prices (e.g. what people will pay for added insurance coverage) to estimate willingness to pay.

• Pessimistic subjective utilitarians still want to produce happiness, but believe consumers need help to make happiness-enhancing choices (e.g warning labels).

Measuring Gain Objectively

• Health experts often use narrow health indexes

• A full analysis requires a comprehensive index• A person’s potential future productivity is not

a utility gain—even if it can lead to such gains• A person’s past accomplishments and actions

are also irrelevant. The issue is not blame but prediction.

Some Additional Points

• If transplants were deemed part of the minimum entitlement, egalitarians might use a lottery to allocate scarce organs among all those who would benefit

• Utilitarians give them to those who would gain most

• When dealing with a limited area it is worth noting the issue of geographic responsibility