Markets and Morals, edited by Gerald Dworkin, Gordon Bermant, and Peter Brown, New York: Halsted Press, John Wiley & Sons, 1977, 195 pp., $12.50
If you are looking for a representative sampling of what current academics will say if invited to discourse on the topic of markets and morals with special regard for the proper role of free markets in the "provision" of health care, this is the book for you. Although the essays collected here were originally written in 1974, they still provide an accurate gauge of how much libertarianism there is and isn't in the ivy halls.
One knows from the first sentence of the introduction that this anthology will be loaded with annoyingly unrecognized collectivist assumptions. For that first sentence speaks of "the appropriate criteria that should govern the production and consumption of various goods." Notice the assumption that there are such aggregative things as "the production" and "the consumption" of various goods. Then there is the more invidious assumption that there is some angelic perspective from which people (or depersonalized "criteria") can and should decide what shape and size this production and consumption is to have. Whether or not "the market" is to be allowed depends upon whether or not its operation conforms to these angelic "appropriate criteria."
The editors, no doubt, think that they're being open minded. They're prepared to consider the claims of any collective social goal that might present itself as defining "the appropriate criteria." That there may be no such goals and no use for them because the proper freedom of individuals is not to be read off from such a collective end is beyond their consideration. So, implicitly for the editors and explicitly for most of the contributors, it is in terms of conformity to some collective and angelically appreciated end that these questions, for example, are to be answered: "Should people be allowed to buy drugs or sex? Should people be allowed to sell blood or organs of the body?" Allowed by whom? By the omnipresent "we"—the mythical being who grooves on "the appropriate criteria" and exacts the fitting sacrifices from mere individuals.
Not a single essay in this collection questions that there is a right to health care—or at least a right to the means of acquiring health care. Free-market relations are, however, given some defense as useful social devices. James Buchanan's essay suggests that many complaints against the market really, from the perspective of those complaining, ought to be directed against the unequal endowments with which individuals enter market relationships. But why do we find that contemporary liberals push for inefficient market interferences instead of "efficient" direct transfers of wealth? Buchanan suggests that inefficient State interferences decoy such liberals away from direct attacks upon the underlying inequalities, and he seems to think that this is for the best. But it is unclear who is decoyed and who is decoying. Are these liberals really interested in social utility—but too stupid to opt for the efficient route? Or is their first love control and domination? See, below, the case of Lester Thurow.
Reuben Kessel's essay traces the scarcity of physicians and of medically useful blood to the absence of true markets in medicine. In their introduction the editors so expect their readers to find Kessel's claims astonishing, that they feel the need to italicize "too little free enterprise." Can you imagine? Someone actually thinks that the State might be too extensive! The editors and their anticipated readers can take solace, however, in Kessel's acceptance of the State as an instrument of forced redistribution.
In contrast to these two essays, papers by Bernard Barber and Walter Weisskopf illustrate only how much slop one can get away with if it's conventional slop. Gerald Cohen labors extensively and successfully at presenting to us, once again, the Carlylian-Marxian account of the corruption of the world by Money.
Lester Thurow's essay is a gently fascistic illustration of the principle that he who pays the piper calls the tune. Thurow is out to argue against mere cash redistribution and in favor of actual government provision of various goods and services (in-kind benefits). His essay partially reveals why modern liberals will always prefer massive welfare programs and state "social services" to Friedmanite negative income taxes. Thurow's argument is simple. Given normal assumptions, cash grants involve greater utility gains for their recipients (the "donees") than would comparably expensive grants in-kind. For cash grants allow the "donees" to purchase whatever they most prefer. But, says Thurow, we must also consider (but not too much) the utility of the "donors." Maybe they don't derive utility from the donees' utility. It could be they are only satisfied if the donees receive certain specific goods (e.g., air bags) or services (e.g., civics lessons). The donees' interests are to be advanced—but only in ways that please the donors.
What gives the donors the right to insist that their "donations" be used in ways that advance their own utility? Not the fact that the donors have a right to these resources, for they must "donate" them. Who or what, then, decides how these "donations" will be employed? You guessed it. The great we—"society" with its "social norms." Furthermore, "society" has the noble task and right of preserving itself by means of in-kind succor which promotes reverence for "society" and its mission. So we must have public schools to inculcate "the basic values of society." And drugs must be prohibited and State rehabilitative systems maintained because "society requires positive commitments to its values." People are too stupid to make the choices that Thurow with his special "individual-societal" preferences divines for them. So providing them with the cash means of implementing their choices would be foolish. "No amount of cash income redistribution can solve the value creation problem."
Peter Singer joins Thurow, Weisskopf, and Cohen in doing what Buchanan innocently disbelieves in, to wit, consciously attacking market relationships per se. The interesting part of Singer's essay consists of a recounting of Richard Titmuss's claims in The Gift Relationship. These are intriguing and well justify Singer's paper despite his too quick inferences. Roughly summarized, Titmuss seems to have found that allowing the purchase and resale of blood reduces the total amount of blood available. The explanation for this seems to go like this: (1) Many people will freely donate blood if they see it as providing others with a vital good that these recipients could get in no other way, but they will not freely give blood if they see such a donation as merely earning for themselves the standard commercial payment or as merely freeing a blood recipient from payment of some standard fee. (2) Many people will see any giving of blood in the latter way if commercial blood transactions exist in their society. So allowing the sale of blood—Singer would say: making it into a commodity—actually decreases the amount available. Moreover, it undercuts the desirable fellow-feeling connected with pure gift giving.
Charles Fried's essay offers some plausible, albeit undeveloped, criticisms of Chicago school accounts of rights and a wholly implausible argument for the right to health care. Here is the argument as far as I can make it out. (1) Rights are somehow presupposed by bargaining. (2) To be a bargaining agent one has to be a self. (3) To be a self one must have bodily integrity. (4) Therefore others are obligated to provide one with the material conditions of bodily integrity. Convinced?
Finally, the most interesting essay in this collection is Thomas Scanlon's response to one traditional libertarian line of argument. This line starts with the simple and modest demand to be left alone—Herbert Spencer's right to ignore the State (and be ignored by it!). In Robert Nozick's Anarchy, State, and Utopia this argument is presented in terms of emigration. Surely everyone acknowledges a right to move out of a given country. Why, then, not a right of internal emigration—a right to disassociate from the State in all or some respects without geographical displacement?
Scanlon's counterargument is to deny the analogy between external and internal emigration. Like the external emigre, the aspiring internal emigre wants to leave with his property intact. According to Scanlon, however, at least above some primitive level property is held as an institutional and not a natural right. One has a right to various holdings by virtue of living under certain societal-institutional rules—rules under which one's property is properly subject to taxation and regulation. Since the property rights accorded one in a Scanlonian social contract cannot be divorced from that property's being subject to taxation and regulation, one cannot opt out of these burdens and still retain one's property rights. If one ignores the State and is ignored by it, one cannot retain one's State-conferred rights. A critique of Scanlon's position is left to the reader.
I began this review by hinting that the only overall virtue of Markets and Morals is as a sample of the current academic climate. The moral of this review is not that all the contributors excepting Buchanan and Kessel are scoundrels or fools—though some certainly are. Rather, my point is to emphasize how far the defense of liberty has to go. Fried, Scanlon, and Singer are substantial and influential intellectual figures. And they are just a sample of the hundreds of individuals of equal stature whose closest approach to libertarianism is a defense of a sanitized version of the status quo. In contrast, whether one needs a second hand to count the libertarians of equal stature depends upon how loosely one uses libertarian. A reorientation in the academic-intellectual climate has, at best, only just begun.
Eric Mack teaches philosophy at Tulane University.