One thing I like about the study of economics is that it fosters compassion. When part of your job is to predict human behavior, you quickly learn the value of understanding other people’s problems. When the other part of your job is ferreting out the unseen global consequences of our choices, you’ve taken the first step toward caring about those consequences.
For example: Suppose a guy with no health insurance and no assets shows up at a hospital emergency room with an urgent life-threatening condition. Should you let him die? Ordinary compassion says no. The heightened compassion of the economist says, at the very least, maybe.
First, a policy of providing emergency health care to everyone is pretty much the same thing as a policy of providing emergency health insurance to everyone. It was specified here that this was a guy who didn’t want health insurance. So let’s recognize for starters that such a policy runs counter to — I am tempted to say runs roughshod over — the guy’s own revealed preference. It’s an odd sort of compassion that forces people to buy things they don’t want.
Now you might object that nobody’s forcing this guy to buy emergency health care; we’re trying to give him emergency health care. Not so fast. Here’s the first place where a little economic training goes to hone one’s sense of compassion: The emergency health insurance we’re foisting on this guy has a cost. We can spend that money on emergency rooms or we can spend it on a myriad of other things the guy might prefer. How is it compassionate to give him one thing when he prefers another?
This is particularly true if the guy happens to be very poor. Poor people have a lot of problems, and emergency health care is only one of them. They need better education, they need better transportation, and they need a little help buying groceries.
There is room for lots of debate and lots of disagreement about how much we as a society should be spending to help poor people. That’s not the issue here. The issue here is: Given that you’ve decided to spend an extra such-and-such many dollars a year helping poor people, why would you spend it in this particular way rather than one of the many other ways they could use it? For God’s sake, why not at least ask them if they’d rather have the cash?
There are many good economic arguments for subsidizing health care (there are also many good counter-arguments). That’s yet another important debate that’s largely off-topic here. I want to focus attention on the narrower question of what compassion demands.
Here’s my answer: If your compassion is constrained, blind or posturing, you’ll say “Of course we should save lives at the emergency room”. If your compassion is broad, perceptive and genuine — if you grasp and care about the underlying trade-offs — and if you believe you’re being baited by a constrained, blind, posturing journalist — you might very well burst forth with a (com)passionate “Let him die”.
There’s yet another facet to this compassion business, which I’ll mention only briefly because Robin Hanson got there first: Of the many commentators who have jumped in to decry the “lack of compassion” among the debate audience, I’ll wager that nearly all are perfectly comfortable with the American government’s current policy of providing American style health care only to Americans, as opposed to, say, Kazakhs. In other words, they too are perfectly fine with a policy of “let him die”, as long as he dies far enough away. At this point, we’re not arguing about principle; we’re arguing about where to draw an arbitrary line. Once you’ve admitted that there are limits to compassion, it’s fair to ask: Why is it okay for Americans to ignore the plight of Kazakhs, but not okay for Texans to ignore the plight of New Yorkers, or for rural Pennsylvanians to ignore the plight of Philadephians? Maybe there are answers to those questions, but if so, those answers are surely not to be found in the mindless cry of “compassion”.
There are deep and troubling issues here that deserve to be addressed, and economics has a lot to contribute to that discussion. That’s why it’s so very disappointing to see Paul Krugman, yet again, using his platform in the New York Times to bray with the yahoos instead of calling attention to deep and difficult trade-offs. None of us have all the answers, but that’s no excuse for pretending there are no hard questions.
There’s another side to compassion, and that’s a willingness to admit that your adversaries might occasionally have legitimate or even lofty motives, and that their positions are sometimes worthy to be engaged, not simply pilloried. In pursuit of a narrow political agenda, Krugman betrays a failure of compassion not just toward those he disagrees with, but, more importantly, to the many Americans (including many of the desperately poor Americans for whom he so often and so self-righteously claims to speak) who stand to benefit from the wiser policies that just might follow from the more informed public discussion to which I know Paul Krugman could contribute brilliantly if he so chose. Instead we have the sad irony of an embittered polemicist wasting his talent by spewing vitriol against everyone who dares to struggle with the difficult policy choices that he has decided are beneath his notice — all in the name of compassion.
Note: You’ll find more on the economics of compassion in Chapter 15 of my book More Sex is Safer Sex.