Robin Hanson, noting Ezra Klein’s challenge to libertarians on universal coverage, is, as always, a little too clever for his own good:
But a great many ill, collapsed, etc. folks in the world are largely left to die, at least if curing them costs like a US hospital stay. Ezra argues above for “decent” national care, not global care. And even libertarians wouldn’t leave family members to die. So everyone agrees that we heroically help some, and leave others to die. We only disagree on who falls into which category…
Humans clearly evolved quite different mental modes for thinking about how to treat folks with our our local tribe, vs. how to treat distant strangers. Libertarians largely accept the usual ideas about how to treat both groups. Where they disagree is who counts as a stranger.
Libertarians limit “my tribe” to close family and small chosen communities, much as did our forager ancestors, who were free to change bands at any time. Farmer culture taught farmers to think of distant strangers as “my tribe”, as long as “our elites” said so, or if “we” fought wars together. And nation-states have worked hard over the last few centuries to transfer this feeling to nations. Libertarians mostly just don’t accept this. And though I’m not strictly libertarian, on this I agree – it is far from obvious that nations must be our tribes.
Hanson is indeed onto something; he’s just onto the wrong thing. Say what you will about our movement from nomadic forager societies to rooted agricultural/industrial/commercial societies, but if it has brought any benefit progressives should agree that expanding the moral circle is foremost among them.
So if Hanson is trying to “gotcha” American progressives by saying we should care just as much about lack of proper health care in the developing world as we do about our own country, well, I agree! And so does Bill Gates, who has given the vast majority of his vast fortune to alleviating lack of proper health care in the developing world! So do the many, many Americans who give money to Doctors Without Borders, the Red Cross, etc.
But Hanson will argue that national health care mandates are compulsive and charity is voluntary. But leaving aside things like USAID, that’s a logistical issue, not a principled one. The disparities in wealth, the challenges of accountability, the lack of resources, collective action problems, etc, make the possibility of wealthy governments providing health care to the citizens of non-wealthy governments too difficult. But in a far-flung future world where most countries are wealthy and international governance is far advanced, progressives would probably support initiatives to globalize health care coverage if it meant lots of people who otherwise wouldn’t have access to health care then got access. Politics, though, is the art of the possible, and right now the “possible” solution is “funded mandates for Americans, generous aid and charity for everyone else.”