Tuesday, April 05, 2011

Decision and choice

It's a bird! It's a plane! Whatever it is, the point whooshes over Tyler Cowen's head.
Let’s say it’s 2027 and I’ve just turned 65. I fill out a Medicare application on-line and opt for a plan with superior heart coverage (my father died of a heart attack), not too much knee coverage and physical therapy (my job doesn’t require heavy lifting), no cancer heroics (my mother turned them down and I wish to follow her example), and lots of long-term disability.

Is that so terrible an approach? Is it obviously worse than having the Medicare Advisory Board make all of those choices for me?
Yes, it's a terrible approach. Cowen conflates decision and choice. It is definitely possible (and probably true) that people can rationally decide between preferred forms of treatment. The problem is that, unlike Cowen, most people are not a tenured university professor with a guaranteed income in retirement. They can't choose anything. In a similar sense, I might be able to rationally decide to colonize Europa rather than Titan, but I cannot choose between the two: I lack the ability to do either. The whole point of Medicare is to provide medical treatment for people without the means to make the choice, whether or not they can rationally make the underlying decision.

If Cowen wants to say that people without the means to make the choice shouldn't get medical care in their old age, let him say so directly, and we can debate the issue on the merits.

No comments:

Post a Comment

Please pick a handle or moniker for your comment. It's much easier to address someone by a name or pseudonym than simply "hey you". I have the option of requiring a "hard" identity, but I don't want to turn that on... yet.

With few exceptions, I will not respond or reply to anonymous comments, and I may delete them. I keep a copy of all comments; if you want the text of your comment to repost with something vaguely resembling an identity, email me.

No spam, pr0n, commercial advertising, insanity, lies, repetition or off-topic comments. Creationists, Global Warming deniers, anti-vaxers, Randians, and Libertarians are automatically presumed to be idiots; Christians and Muslims might get the benefit of the doubt, if I'm in a good mood.

See the Debate Flowchart for some basic rules.

Sourced factual corrections are always published and acknowledged.

I will respond or not respond to comments as the mood takes me. See my latest comment policy for details. I am not a pseudonomous-American: my real name is Larry.

Comments may be moderated from time to time. When I do moderate comments, anonymous comments are far more likely to be rejected.

I've already answered some typical comments.

I have jqMath enabled for the blog. If you have a dollar sign (\$) in your comment, put a \\ in front of it: \\\$, unless you want to include a formula in your comment.