OP-ED

The Libertarian Mind

“It is an eternal obligation toward the human being not to let him suffer from hunger when one has a chance of coming to his assistance.” –Simone Weil

Libertarianism is much in the news these days, as the political divide in the U.S. seems to widen almost before our eyes. Before providing a rough, notional definition of “libertarianism”, I should offer readers some caveats. First, I am not a political scientist, professional philosopher, or economist, though scholars in these fields have offered many pointed critiques of what is loosely called libertarianism (see references). Furthermore, as a psychiatrist, I am trained to diagnose individuals whom I have professionally examined. I am not in the habit of “diagnosing” movements, ideologies, or political groups; indeed, the idea of doing so is clearly outside the purview of medical or psychiatric practice.

Nonetheless, as a lecturer on bioethics and humanities, it is impossible for me to read the platform and proclamations of the Libertarian Party without drawing some tentative conclusions as regards the nature of this movement; its psychological underpinnings; and its ethical implications for the poorest and sickest among us—those sometimes referred to as “the destitute sick.”

I do not propose to “psychoanalyze” particular individuals, or to speculate on the motives of political figures who figure prominently in American politics. And, because the term “libertarian” has such a wide range of meanings, I will focus my attention on the official platform of the Libertarian party, which is very lucidly spelled out in a publicly-available venue (http://www.lp.org/platform). For the most part, I will deal with the Libertarian party’s position on health care and social support systems, while offering some tentative impressions on the “psychology” of libertarian theory.

I do not pretend to offer an “objective” analysis of these issues. As a psychiatric physician and bioethicist, I am committed to certain ethical principles which put me squarely and starkly at odds with certain libertarian positions. This is not to say that psychiatrists are of one opinion on these matters—far from it. Moreover, I recognize that physicians and ethicists of good will may support the very positions I will castigate. I also recognize that, whatever the ethical failings of the Libertarian party’s views, there are undoubtedly many self-identified libertarians whose ethical impulses are humane and compassionate. Nonetheless, I will argue that this is simply not true of the Libertarian party’s position on health care and social support systems. At the same time, as a psychiatrist, I recognize that some positive elements of libertarianism—such as its emphasis on personal autonomy, personal responsibility, and self-discipline—are in accord with general principles of mental health and with the goals of many schools of psychotherapy.

The varying definitions of “libertarianism”

It is a mistake to consider libertarianism a monolithic entity or ideology. Indeed, some strains of libertarianism seem to contradict the basic tenets of other strains. As the philosopher Prof. Peter Vallentyne has noted, libertarianism is neither a “right wing” nor a “left wing” philosophy, but varies according to the particular issue in question. For example, as Vallentyne notes, “…on social—rather than economic—issues, libertarianism tends to be “left-wing”…” whereas many libertarian views on taxation, health care, and the economy gravitate toward “the right”.

For purposes of my argument, the preamble from the Libertarian Party website adequately describes the libertarian philosophy, as follows:

“We hold that all individuals have the right to exercise sole dominion over their own lives, and have the right to live in whatever manner they choose, so long as they do not forcibly interfere with the equal right of others to live in whatever manner they choose… Governments throughout history have regularly operated on the opposite principle, that the State has the right to dispose of the lives of individuals and the fruits of their labor. Even within the United States, all political parties other than our own grant to government the right to regulate the lives of individuals and seize the fruits of their labor without their consent. We, on the contrary, deny the right of any government to do these things, and hold that where governments exist, they must not violate the rights of any individual…”

The Libertarian Party Platform on Healthcare and Social Support Programs

The Libertarian Party platform states,

“We favor restoring and reviving a free market health care system. We recognize the freedom of individuals to determine the level of health insurance they want, the level of health care they want, the care providers they want, the medicines and treatments they will use and all other aspects of their medical care, including end-of-life decisions. People should be free to purchase health insurance across state lines.” [italics added]

Similarly, with respect to retirement and “income security”, the Libertarian party position states,

“Retirement and Income Security Retirement planning is the responsibility of the individual, not the government. Libertarians would phase out the current government-sponsored Social Security system and transition to a private voluntary system. The proper and most effective source of help for the poor is the voluntary efforts of private groups and individuals. We believe members of society will become more charitable and civil society will be strengthened as government reduces its activity in this realm.[italics added]

The same basic stance is taken in the Libertarian position on what they term “the social welfare system”:

“We should eliminate the entire social welfare system. This includes eliminating AFDC, food stamps, subsidized housing, and all the rest. Individuals who are unable to fully support themselves and their families through the job market must, once again, learn to rely on supportive family, church, community, or private charity to bridge the gap.” [italics added]

It is striking that no empirical evidence is proffered to support the claim that the “most effective” source of help for the poor is the “voluntary efforts of private groups and individuals”; much less that society “will become more charitable and civil” as government reduces its activity in this realm. It is probably difficult for the Libertarian party to cite empirical case examples, since no industrialized nation has ever adopted a strictly libertarian position on retirement and income security—or, for that matter, on health care delivery.

Indeed, the research of economist Prof. Jeffrey Sachs argues against the libertarian position on health care and social supports, albeit indirectly. Sachs compared  a group of “…relatively free-market economies that have low to moderate rates of taxation and social outlays with a group of social-welfare states that have high rates of taxation and social outlays.”  He refers to the first group (including the U.S., U.K, Canada and Ireland) as the “Anglo-Saxon countries,”  and the second group (including Denmark, Finland, Norway and Sweden) as “the Nordic countries.” Sachs notes that  “…budgetary outlays for social purposes average around 27 percent of gross domestic product (GDP) in the Nordic countries and just 17 percent of GDP in the English-speaking countries.” Sachs’s research found that

“On average, the Nordic countries outperform the Anglo-Saxon ones on most measures of economic performance. Poverty rates are much lower there, and national income per working-age population is on average higher. .. [Furthermore]…the results for the households at the bottom of the income distribution are astoundingly good, especially in contrast to the mean-spirited neglect that now passes for American social policy. The U.S. spends less than almost all rich countries on social services for the poor and disabled, and it gets what it pays for: the highest poverty rate among the rich countries and an exploding prison population. Actually, by shunning public spending on health, the U.S. gets much less than it pays for, because its dependence on private health care has led to a ramshackle system that yields mediocre results at very high costs.”

And even within the so-called “Anglo-Saxon” countries, the U.S. health care system compares unfavorably, in several respects, with that of Canada. In what is arguably the definitive study of US/Canadian administrative health care costs, published in the New England Journal of Medicine, Woolhandler et al (2003) analyzed the costs of insurers, employers, doctors,  hospitals, nursing homes and home-care agencies in both the U.S. and Canada. They found that administration consumes 31.0 percent of U.S. health spending, double the proportion of Canada (16.7 percent).Average overhead among private U.S. insurers was 11.7 percent, compared with 1.3 percent for Canada’s single-payer system and 3.6 percent for Medicare.  Furthermore, the authors concluded that “…excess administrative overhead can be attributed to the highly complex private health insurance system in the United States.”

Woolhandler  et al argued that, if streamlined to Canadian levels, enough administrative waste could be saved in the U.S. to provide comprehensive health insurance to all Americans. The website of Physicians for a National Health Program  (http://www.pnhp.org) makes a comprehensive case for a publicly-funded, single-payer insurance plan.

Moral Implications of the Libertarian Stance

For those among the destitute sick who have been unable to afford any health insurance at all, it will be of small consolation that the Libertarian party wants them to have the “freedom” to “determine” the level of health insurance and to purchase it across state lines. If these were even remotely practicable ideas, it would follow that all who wanted full health insurance coverage for serious chronic illness would have the “freedom” to obtain it. Of course, this is simply not possible in the real world, much less in our present economic environment.  Indeed, the libertarian’s position is a bit like strongly supporting the individual’s “freedom” to flap his arms and fly.

The Libertarian party platform seems quite content to claim that if the government pulls back from aiding the poor, “society” will somehow take up the slack—while carefully avoiding any implication that each of us, including members of the Libertarian party, has an affirmative  moral duty to aid the poor. And, predictably, the platform is silent on what the sick and destitute are to do if “the voluntary efforts of private groups and individuals” fail to materialize.

Libertarians aver that “A compassionate society will find other ways to help people who need temporary assistance.” (http://www.lp.org/platform) Yes–and if we lived in a reliably “compassionate” society, the libertarian agenda might work out quite well. Unfortunately, in hard economic times, the ability of private charities and philanthropic organizations to help the needy is drastically reduced.  For example, in 2008, the Rocky Mountain News reported that

“Wall Street’s troubles and the faltering economy are delivering a one-two punch to Colorado’s food banks, animal shelters and other nonprofits such as the Salvation Army and the American Red Cross. These organizations are experiencing greater demand for their services from people in need. But the increased demand is coming just as these groups are bracing for a cutback in financial contributions from their donors – if the cutbacks haven’t already occurred because of the economy. (http://www.rockymountainnews.com/news/2008/oct/09/donations-to-charities-decline/)

More recently, according to the Oct. 18, 2010, Charlotte Observer,

“A new ranking of the nation’s 400 biggest charities shows donations dropped by 11 percent overall last year as the recession ended – the worst decline in 20 years since the Chronicle of Philanthropy began keeping a tally… An earlier report by the Giving USA Foundation found overall charitable giving declined 3.6 percent last year. That report included giving to private foundations and to smaller charities, while the Chronicle’s survey only includes top charities raising money from the public.”

(http://www.charlotteobserver.com/2010/10/18/1769542/charity-donations-fall-11-the.html)

Notice that in the Libertarian platform, there is little or nothing as regards the moral responsibilities of anyone in particular, such as members of the Libertarian party.  (One exception: libertarians must abjure the violent coercion of others). The task of aiding the sick and destitute is left, nebulously, to “society” which, in the worldview of libertarianism, will naturally and inevitably produce a sufficient number of “compassionate” members.  To be sure: some libertarian proposals for improving access to health care are worth considering, such as establishing tax-free medical savings accounts, or making health care expenditures fully tax-deductible. But these would benefit primarily those steadily employed and able to put money aside on a regular basis—not those who have been unemployed for months or years, much less the homeless or destitute.

Perhaps members of the Libertarian party are afraid that if they dare invoke the moral responsibilities of their own membership in assisting the destitute poor, busy-body “liberals” will inevitably turn this into a legal obligation to help others, which is clearly anathema to libertarians. For my part, it is hard to read the Libertarian party’s philosophy of health care and social welfare without feeling the icy wind of indifference to the destitute sick.

Libertarianism as Inverted Narcissism

In psychological terms, narcissism may be either “healthy” or “pathological” in nature and degree. A certain amount of positive self-regard is essential for self-preservation and the pursuit of one’s prudential interests. But beyond a certain point, self-regard can become a kind of grandiose self-worship, characterized by an inordinate sense of “entitlement.” It may seem paradoxical, even perverse, to accuse libertarians of an overweening sense of entitlement. After all, isn’t the cardinal tenet of libertarianism the claim that individuals must stand on their own two feet, without expecting “handouts” from the government? Indeed, a libertarian might well object that, “It’s the liberals and socialists who have an exaggerated sense of entitlement! They are the ones who are constantly demanding that the government take care of them, furnish them with health care, retirement income, and social welfare programs.”

It is true that the narcissism of the libertarian movement is not always evident on first inspection of its claims. The sense of entitlement among libertarians is not straightforward, and appears in some curiously “inverted” forms. And yet, the grandiosity of the libertarian position is hard to miss. In effect, the libertarian proclaims, “I’m such a tough, self-reliant hombre—not like you simpering, teat-sucking wimps!—that I don’t need or expect any help from anybody, and the rest of you should live the same way I do, no matter what your capabilities or disabilities, and no matter how poor or sick you may be.” Indeed, as Robert Locke has put it,

“Libertarianism itself is based on the conviction that it is the one true political philosophy and all others are false. It entails imposing a certain kind of society, with all its attendant pluses and minuses, which the inhabitants thereof will not be free to opt out of except by leaving.”

Locke further points to libertarianism’s “…genius for making its followers feel like an elect unbound by the moral rules of their society.”

More charitably, the libertarian stance may be viewed as a highly rationalized variation on the “rags to riches” theme popularized by the 19th century novelist, Horatio Alger. Although there is plenty to admire in the figure of the “self-made man” who succeeds through a combination of pluck and luck, libertarianism takes the Alger mythos to cruel extremes. It exhorts the individual to “Pull yourself up by your bootstraps!” even when the unfortunate person in question has no boots–and perhaps, no feet. Thus, when libertarians insist that “Individuals who are unable to fully support themselves and their families through the job market must… learn to rely on supportive family, church, community, or private charity to bridge the gap…” they are proffering a perverse mirror-image of the infamous line popularly attributed to Marie Antoinette: “Let them eat cake!”  For the libertarian, this becomes, “Let the poor and destitute find charity somewhere!” The not-so-covert implication seems to be, “If you were fool enough to get yourself into this mess—for example, by not saving up $20,000 to pay for this year’s chemotherapy—you’ll just have to find somebody to take care of you.”

Nowhere is there any discussion of what should be done to help the sick and destitute when “supportive” family, friends, or private charities are unwilling or unable to step in.  Should the government do nothing, and let the sick and destitute die of hunger or chronic illness? The Libertarian platform is silent on this matter—for this is a troubling question, and, from my perspective, many libertarians show little interest in being troubled. For them, life would really be no problem at all, if only government would get off our backs and let the strong and the free prosper. There is a kind of adolescent naivete in this, but also a strong whiff of elitist hypocrisy. As Gabriel Winant recently wrote,

“Libertarians…are walking around with the idea that the world could just snap back to a naturally-occurring benign order if the government stopped interfering…this is the belief system of people who have been the unwitting recipients of massive government backing for their entire lives. To borrow a phrase, they were born on third base, and think they hit a triple… [furthermore]…they’re thoroughly out of touch with reality. It’s a worldview that prospers only so long as nobody tries it, and is too unreflective and self-absorbed to realize this.”

To be sure, there are positive elements within the libertarian world-view. No American who grew up reading Ralph Waldo Emerson’s essay on “self-reliance” could doubt that this is a virtue. Nor would most Americans deny the value of protecting civil liberties and the blessings of freedom. But as Robert Locke observes,

“Empirically, most people don’t actually want absolute freedom, which is why democracies don’t elect libertarian governments. Irony of ironies, people don’t choose absolute freedom. But this refutes libertarianism by its own premise, as libertarianism defines the good as the freely chosen, yet people do not choose it. Paradoxically, people exercise their freedom not to be libertarians.”

And when it comes to Libertarian party views on health care and social welfare, this physician finds only a shallow ethos of callousness, cloaked in the populist rhetoric of “freedom” and “responsibility”.  The Libertarian view on these matters seems to me little more than grandiose and jejune utopianism, masquerading as high-minded respect for individual rights. Surely, a humane society that cares about its sickest and poorest citizens must do better than that.

References

Libertarian Party Platform  http://www.lp.org/platform

Peter Vallentyne, “Libertarianism”, Stanford Encyclopedia of Philosophy, accessed at: http://plato.stanford.edu/entries/libertarianism/

Jeffrey D. Sachs, The Social Welfare State, beyond Ideology

Scientific American Magazine November 2006

Gabriel Winant, The lesson of Rand Paul: libertarianism is juvenile. Salon, accessed at http://www.salon.com/news/politics/war_room/2010/05/21/libertarianism_who_needs_it

Robert Locke, Marxism of the Right, in The American Conservative, March 14, 2005.  Accessed at: http://www.amconmag.com/article/2005/mar/14/00017/

Woolhandler S, Campbell T, Himmelstein DU.  Costs of health care administration in the United States and Canada. N Engl J Med. 2003 Aug 21;349(8):768-75.

Ronald Pies, MD, is Professor of Psychiatry and Lecturer on Bioethics & Humanities, SUNY Upstate Medical University, Syracuse, NY, and Clinical Professor of Psychiatry, Tufts University School of Medicine. He is the author of several psychiatric textbooks, as well as several books on religious ethics (“Ethics of the Sages,” “Everything Has Two Handles”). His most recent book, “Becoming a Mensch”, has just been released by Hamilton Books/Rowman & Littlefield.

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9 replies »

  1. There are too many people in positions of power and influence have the mind set and say outwardly, who as the Jack Nicholson Character in “A Few Good Men” tersely says:

    “You (the American Public) can’t handle the truth!”

    Libertarians, in my humble opinion, really scare the hell out of Democrats and Republicans, because this political mind set does not genuflect inherently to a political partisan cause either side of the real Republocrat party as a single entity is selling daily.

    Independence, really is the antithesis of what our alleged representation wants for its’ servants, er, constituents.

    Oh, and I think too many doctors also abhor patients asking for choice…

  2. Well, most libertarians are not anarchists. Most libertarians believe that one of the few roles government should play is to protect people and markets from force and fraud. If someone commits fraud against you, you should be able to go to the government to seek justice.

  3. There is one fundamental flaw in your argument:

    Assuming other people will not use force or fraud to get what they want.

    Evidence:

    Human history

  4. It really comes down to economics, the price system, profit and loss system, and mutually beneficial exchange.

    I am not going to read the article because only 1 of 3 things is likely:
    1. He is absolutely correct and totally understands libertarians and economics and agrees with them (not likely)
    2. He thinks he understands libertarians and economics and shows you why they are wrong (likely)
    3. He fully understands libertarians and economics but lives in a dream world where economics doesn’t matter and tugs on your heart strings about grandma with cancer and that if only someone were taxed 50% on a BMW purchase, grandma could get chemo. (very likely, I notice he is an MD)

    So instead I will skip to a brief and accurate explanation of my thoughts on the subject.

    Profit and Loss
    The only way to create profit in a free market economy without violating someone else’s rights (ie, theft), is to take inputs (cost), add value to them (work), and sell them at a higher price (profit). When an entity is creating needed and desired value and able to sell the final product for more than the input costs, they are creating profit. For example, when 3M builds an MRI machine, they: buy a few thousand dollars worth of materials, do work on those materials (labor), and produce a machine that is worth far more than the materials and labor were separately. They sell it at a higher price than they paid for the inputs.

    If an entity is unable to sell the finished product at a higher price than the input costs, they have destroyed value. They have made an error and done something that should not have been done. An easy example would be if McDonalds made a bunch of cheeseburgers expecting customers, but the customers never came and the cheeseburgers rotted. They had the cost of input but no profit at time of sale. They had a loss. Obviously, it would be bad for them to keep doing this.

    In a market that is free of subsidies, tarriffs, artificial monopoly grants, or other artificial support or barriers to entry, the profit and loss system leads to the prudent (profitable) decision makers gaining control of more resources and the bad (unprofitable) decision makers losing control of resources or going out of business entirely.

    In other words, it self corrects. The people who create value thrive and those who destroy value perish and forfeit their right to choose how to use our scarce resources.

    Profit Signal
    When one firm makes outsized profits, it is a signal to other firms that the profitable firm has figured out a process to add value in a new or better way. Other firms then attempt to replicate this as long as there are no artificial barriers to entry. In other words, if McDonalds comes up with a new sandwich that the public really likes, they are first to the market with that sandwich and make big profits. One simple example was the Double Cheeseburger, aka McDouble that was only $1. Burger King saw McDonalds’ success with this and chose to copy it with the “Buck Double”. Before the buck double, BK could not really compete with MCD at the $1 level. This expanded the options for eating for $1 and has forced the price to stay down at $1 due to fierce competition in spite of years of inflation.

    Mutually Beneficial Exchange
    Doctors, medical researchers, etc are generally intelligent and have to go to years of schooling at large expense. While that is a cost, and prices have nothing to do with costs, it is relevant to point out. All people are profit seekers, other than those who wish to spend other people’s money. A person who is willing to go through a lot of school and potentially a lot of debt has many choices in life. Many of them could just as easily be a petroleum engineer and bank $100-150k right out of school with less debt (cheaper degree). They could go work on Wall Street and make $80k right out of school with the potential of making millions in a few years if they do well.

    Like it or not, if you pay these people less or force their wages down, you absolutely will get fewer people willing to enter the field. This absolutely will reduce supply. When you artificially reduce price, you create shortages, all things equal. Fact. This is easily observed in countries that have wage controls on medical industries. They leave those countries and come here or other countries at great expense to the original country.

    The truth is that they provide an absolutely critical product. If a doctor saves your life or your quality of life, you owe them. Plain and simple. Yes, in many cases it is an inelastic good. I mean if a car hits you, you don’t really have a choice. But any restitution should be sufferred by the person who hit you and their insurance, not the doctor.

    Any scheme that involves “reducing cost” based on subsidies or price controls instead of actually improving the manufacturing or delivery process will lead to misues of resources or shortages. If tomorrow the government said “Ok, anyone who does not have insurance now can use medicare instead, and to make sure that no one gouges the system, we are going to freeze prices to where they are today,” you would have lines stretched outside the hospitals and doctor’s offices and it would be years (5-10) before more supply could be brought online. Quality would decline significantly and there would be little incentive to expand supply (why bother if its a money loser?).

    Summary
    Applied to medicine, the profit and loss system ensures that quality researchers, manufacturers, and practitioners of health care goods and services gain market share and that those who squander resources go out of business. Those that go out of business may have some quality employees or facilities that can then be absorbed by the better firms.

    When a firm is highly profitable with a product, it is a signal that other firms should copy that product or improve upon it. Unfortunately, thanks to the government, this is highly restricted.

    Virtually all problems with our current health system are traced back to government:
    1. Patent law prevents competition. There is a reason why generics aren’t allowed to copy name brand drugs quickly; government.
    2. State and local level government monopoly grants prevent insurance companies from competing.
    3. Licensing requirements tend to require doctors know more than they may really need to depending on the field they want to go into. While it is nice for all doctors to understand cancer at an intermediate level, it may not always be necessary. For example, maybe a cheap doctor who would work at Wal-Mart stores could focus on just being able to diagnose when an anti-biotic is probably appropriate and if it doesn’t work, refer the patient to a better doctor.
    4. Prescription laws that restrict certain things that really should be over the counter. IE, birth control pills. Forcing women to get a new prescription every 3-6 months simply generates an extra trip to the doctor and huge waste of money.
    5. Subsidies for research can prop up bad researchers. In a free market, researchers who don’t produce real results would lose their jobs. Companies that continue to hire bad researchers would go out of business. It is actually quite possible that we would have more cures and treatments if we did not subsidize research, as strange as that may sound.
    6. Government requires all people be treated if they go to an emergency room. Many of those people don’t pay. Hospitals should be allowed to garnish wages of non-payers. When millions of people don’t pay, how else are you supposed to replace the medical supplies and keep doctors on staff? If the government is going to require hospitals to treat everyone, they should also require patients to pay their bill just like back taxes. If not, then hospitals should be allowed to not treat people.

    In summary, if you allow free competition and eliminate market warping subsidies and artificial monopolies, supply of health care will expand, improve in quality, and be lower in price (and cost). Buying health insurance should be as easy as buying term life insurance and the cost should be comparable to car insurance for most people. That won’t happen as the result of government intervention.

    Libertarians understand this. Those who don’t understand it think we are heartless.

  5. Dr Pies, what are you doing here? I thought this was Psych Central for a second, and then realized I was at TheHealthCareBlog after all.
    Let me offer you my opinion about going on at blog sites and commenting as you do. People sometimes have the unfortunate impression that someone of your stature, until proven otherwise, is a Key Opinion Leader (which you are as a psychiatrist and wrote wonderful columns at the Psychiatric Times in the past) and thus has some validity and representation of the group you mention partnership to, and that is dangerous. Dangerous, because in the end, by writing this piece, you give said impression you offer an expertise in a domain I don’t think you really do, and that could be a great disservice to colleagues.
    I have plenty of opinions about politics, simply because I am an American Citizen and pay attention to politics. It does not give me the authority to present a piece of this nature and not risk serious belittling at the very least.
    I suggest you do a lit search on someone I find very offensive who comments on psychiatry, who is as a far from having an expertise in psychiatric circles as one can get to make the comments he does in pubic venues like this, and tries to do great harm to the psychiatric profession, and that person is Richard Vatz, a professor of political rhetoric at Towson University in Baltimore, MD.
    Read what he says, and then try to compare it to what you have just done. I am disappointed to read this from you. And I have some backround to say this, albeit I have an alias here to minimize hassles. You will disagree with me now, but I hope you will give some pause and reflection to what you have written here today.
    Hey, as Dennis Miller says so aptly, “It’s just my opinion, I could be wrong.” But, I don’t do this under the guise of an expert. Think about it!

  6. I appreciate THCB’s publishing my commentary on the Libertarian Party platform, and I understand that this is a complicated and emotional issue. Before any further comments come in, I’d like to state my usual policy re:
    “internet etiquette”. I do not respond to anonymous postings, with very rare exceptions (e.g., someone’s life or limb is endangered by giving his/her full name). My view is that if I or any of my colleagues are putting our names and reputations on the line, the same should be the case for those who respond to the posting. I will also not respond to personalized attacks. I am happy to respond to a civil exchange of views by those willing to identify themselves. Thanks to all THCB readers for their understanding. –Regards, Ron Pies MD

  7. My favorite line:
    “I am not in the habit of “diagnosing” movements, ideologies, or political groups; indeed, the idea of doing so is clearly outside the purview of medical or psychiatric practice.”
    I’d be kinda of interested to read your professional take on, say, the Tea Party movement. ; )

  8. That was a lot of words to say that if you think charity should be only voluntary you are demented.

  9. Hmm, well you seem intent on making sure everyone understands the core assumptions of libertarians. Lets make sure that everyone understands your core assumptions as well.
    The core of libertarianism is that humans should not deal with each other using force or fraud. Everything flows from that single point.
    So, in our example of free health care for the poor (or free anything to anyone), libertarians will say they oppose government action to achieve it because the only way to do so is through the use of force — either a doctor must provide his time for free or a citizen must have money taken from him in the form of taxes to pay the doctor. Either way involves the threat of physical force – ie if you don’t pay your taxes or provide the services for free, agents of the state will eventually show up at your house with a gun to force compliance or throw you in jail.
    Most folks who support government coercion try to dress this use of force up in pretty clothes, but you yourself have expressed skepticism that people will provide voluntary gifts or service in sufficient quantities to achieve whatever your goals are. So force is required. In effect, you lament that the vast majority of people won’t do as you wish them to do, so rather than trying to convince them or do these things yourself, you are going to get the government to force people to achieve your objective.
    So, you must ask yourself, is Goal X (whether it be reduction in obesity or services for the poor or whatever) so important that it ethically justifies that we accomplish it by forcing people to do our will at the point of a gun?
    If your answer is “yes,” then fine, we agree to disagree. At least I give you credit for clear thinking and honesty.
    If your answer is “no,” then welcome to libertarianism.
    If your answer is to promote these government programs but deny that you are advocating herding people to your will at gunpoint, then you are engaging in a lie.
    The fact that some other people choose to be milche cows does not in any way change the ethical issues when you come to take away my freedoms. It may help to assuage your conscience somewhat so you can convince yourself you are ethically clean, but you are still forcing me to act against my own will as surely as the pharaohs did with the slaves building their pyramids.
    By the way, for someone who claims to have some knowledge of psychology, you sure have not thought through the psychology of voters much. I would contend that the vast majority of people who vote for reductions in freedom are doing so in a way that they perceive does not affect themselves much. They vote for taxes and restrictions on someone else, not on themselves.
    The appeal of socialism is that everyone looks up the ladder and imagines it will allow him to pick the pocket of the guy above him. What he forgets is that it also allows the guys below him to pick his pocket. People vote thinking they will get a free lunch, only to find that rather than getting something for free, they end up paying for someone else’s lunch.

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