2. A rejection of health care egalitarianism, namely a recognition that the wealthy will purchase more and better health care than the poor. Trying to equalize health care consumption hurts the poor, since most feasible policies to do this take away cash from the poor, either directly or through the operation of tax incidence. We need to accept the principle that sometimes poor people will die just because they are poor. Some of you don’t like the sound of that, but we already let the wealthy enjoy all sorts of other goods — most importantly status — which lengthen their lives and which the poor enjoy to a much lesser degree. We shouldn’t screw up our health care institutions by being determined to fight inegalitarian principles for one very select set of factors which determine health care outcomes.

Breathe deeply and try to summon your inner peace before reading this description, from economist Tyler Cowen, of what conservatives and libertarians should put in health care policy . You're going to need every drop of calm and sanity you can muster.I'm going to repeat that: "We need to accept the principle that sometimes poor people will die just because they are poor."

There's some little danger in addressing this kind of "pure, sociopathic callousness," as Freddie deBoer describes it. As deBoer continues:



Elias Isquith is right to say that the post demonstrates what we’ve been saying plainly for years, which is that conservatives and libertarians actually are opposed in principled to sick poor people going to doctors and getting healed. (Tyler Cowen can come right out and say it, and that’s just adult political discourse; if I accuse Tyler Cowen of it, Andrew Sullivan and the rest of the Very Serious People will spit out their gum.)

But whatever. Gum-spit away. Because it's fact that poor people do die just because they are poor, all the time. But there's a difference, a giant fucking difference, between understanding that it is a fact that something happens and saying "because it does happen, we should write it into our policy in a way that makes it more likely, because, hey, it happens." And while we're at it, sometimes black people are discriminated against just because they are black—let's accept that principle and quit trying to use the law to bring a stop to it. We shouldn't screw up our free market by being determined to fight inegalitarian principles for one very select set of factors which determine career, educational, criminal justice and health care outcomes.

Tyler Cowen may well believe himself above crude racism like that; I don't know his life. But his line of thinking about intentionally creating a health care system around the notion that it's fine and dandy to let poor people die because they are poor is monstrous. In the direct sense that you have to be a monster to think it, never mind publicly advocating it as policy. His equation of health care with "all sorts of other goods" that the wealthy have and the poor don't is a moral and ethical failing, not a logical one—he's simply suggesting that the right to have treatment for asthma or diabetes is a moral equivalent with the right to have a gold-plated Rolls Royce, and both should be wholly determined by your bank account, without government involvement in either case.

This is the Right's project. Create an economy in which more and more people are poor or just one personal disaster away from poverty, and then assert that the government can't be expected to have any interest in the fact that people die because they are poor. Even if we're not allowed to say so if we're going to present it as a bad thing, this is a mainstream Republican position, something Cowen is not alone in cheering on.