Fifteen years ago I wrote a paper on universal service in telephony. I compared the Rawslian system with the Utilitarian school and the Benthamites. In the paper I was commenting on the Baumol-Willig theorem, a tautoligical proposition crafted by a few economists at the beckon call of AT&T to justify the incumbents control over the network. I stated:
" The Baumol Willig theorem states that we want to maximize the welfare of the populace while keeping the profits of the monopolies high. This is a classical example of an ad hoc propiter hoc theorem. Clearly the result is that we tax the people and subsidize the monopoly.
The other issue is how do we measure welfare.
If we are a Rawlsian then we measure welfare as the welfare of the least of us and not the average welfare. Rawls states that if we maximize average welfare then we disadvantage the least of us and this is not just.
Thus as a Rawlsian we demand Universal Service. We must insist that all people have access to all service elements, whether it makes economic senses or not, we do so via wealth transfer. Hopefully, this political theory should now not seem too foreign. Ralwsians favor the implementation of access fees and the implementation of Universal Service. Indeed, the true Rawlsian would impute Universal Service to even computer terminals as has been stated by Vice President Gore.
In contrast is the classic liberal, now called libertarian view. It is more a combination of minimal government involvement and maximizing utility to the consumer. This is the philosophy of the utilitarian. Here we assume that government has a de minimis role and that the market follows of its own accord and that the market, in an Adam Smith fashion, will clear any inefficiencies of distribution and pricing mechanisms.
It assumes that each business should stand on its own stead and that utility is maximized on average. The result from the libertarian school, as opposed to the contractarians or Rawlsians, is the elimination of access fees and the elimination of universal Service."
I then went and described the Rawlsian approach, one which I thought would never raise its head again. I stated:
"Rawls has proposed a theory of justice that is a statement of what many proponents of antitrust theory ion the mid-fifties and sixties promulgated. The essence of Rawls’ theory has three elements;
Original Proposition: There exists a means and method for a society to establish a Contract amongst and between themselves. This Contract thus created in this society of the just is one that maximizes the return on every transaction to the least of the individuals in the society.This approach to contractarianism is one related to individuals in a non-bargaining environment establishing between and amongst themselves a “contract” to govern their society.
There are two elements contained herein.
The first is the essence of a contract, and in fact a form of social contract between the members of society and amongst them as a whole.
The second element is that of a view towards man as a constrained and unconstrained view of
human nature.
The unconstrained view states that man, individually and in concert, has the capabilities of feeling other people’s needs as more important than his own, and therefore we all act impartially, even when the individuals own interest are at stake.
The constrained view is to make the best of the possibilities which exist within the constraint.
For example, the constrained view of universal service is one which would state that if it costs a certain amount to provide the service, an there is a portion of the society not able to purchase the service, then there is no overriding need to provide it if such a provision is uneconomical and places a significant burden on the other member of society.
The unconstrained view, as a form of socialism, states that if there is the least of us in want for whatever the telecommunications revolution has in store, then they should have access to it at whatever cost. One can see that the current trend in Universal Service is such an unconstrained view, especially as viewed by the current Vice President in his actions over the past four years.
Rawls approach to this contract is one wherein the individuals in the society collect themselves as individuals, and agree to a plan for the operations of that society.
First Principle of Justice: each person shall have equal rights and access to the greatest set of equal fundamental personal liberties.
Second Principle of Justice: social and economic inequalities are to be arranged so that they both, (i) provide the greatest benefit to the least advantaged., and (ii) attached to positions available to each individual under conditions of fair equality of opportunity."
Thus to my surprise I read in this weeks JAMA an article entitled, The Ethical Foundation of American Medicine, In Search of Social Justice. In their view the Rawslian approach is key to the way in which health care should be provided. They state:
"Rawls’ theory of justice, often referred to as social justice, has gained prominence since the 1970s as a dominant theory of justice. This theory has 2 major principles. The first, that “people should have maximal liberty compatible with the same degree of liberty for everyone,” defines limits of individual liberty by focusing on the liberty of others. The second, that “deliberate inequalities [a]re unjust unless they work to the advantage of the least well off,” focuses on social consequence and responsibility for actions.
Considering the body of research and news reports that describe inequalities in US health care access and quality,10 and the fact that these inequalities do not work to the advantage of the least fortunate, it is clear that the US health system does not meet these criteria for being just. It seems that the structure of incentives in the current health system stimulates behavior that marginalizes considerations of social justice, leaving it seldom emphasized, relative to the other 3 core principles of medical ethics."
Unlike other theories of society, the Rawlsians argue that there exists a social contract with all so that all should receive what the least receive and no more. Thus if I have the financial resources to seek medical care for the prevention of colon cancer by annual colonoscopies and the law permits payment only for five year colonoscopies, the Rawlsian would either deny me my annual choice or make it annual for all, and then have all people pay the added costs. The Rawlsians establish "rights" extra those Constitutionally and legally established and then take the position that if the least of a society do not have them fully then none shall have them. It states that those who have been successful should not in any way use that wealth to disenfranchise those who do not.
The Rawlsian school also removes burdens from people. If you happen to be one of the 30% who are morbidly obese in the US and most likely suffering from Type 2 Diabetes, so be it, it is not your fault, despite the fact that you consume well in excess of 2000 cal per day, you must be dealt with as a faultless and blameless victim. Those who struggle to maintain health must therefore pay for the victems who out of total abject neglect do not.
The article in JAMA continues:
"For example, physicians attempt to maximize income while caring for the needs of their individual patients, but this means that some physicians choose to accept fewer, if any, Medicare and Medicaid recipients, as well as self-pay patients. Some physicians argue that to keep their practice financially viable, they have to see fewer patients for whom they are inadequately reimbursed.
Yet for each of the physicians who decide they can no longer care for these patients, the responsibility of care falls to another clinician. This increases the burden on those other clinicians and exacerbates the income disparities among them. In circular fashion, this increases the focus on revenue and reimbursement, rather than on social justice.
A second factor that may contribute to the imbalance of medical ethics in practice involves the cost of education and level of student debt....
A third important factor is the US culture of “individualism.” While general western philosophy has shaped US culture, the unique history of the United States has created a special emphasis on individualism, entrepreneurial capitalism, and personal responsibility. Specifically regarding health care, many other western nations have some form of universal coverage supported by their government and treat health care as a public good. In the United States, health care only intermittently has been treated as a public good and an intense debate regarding the promotion of government health programs vs the philosophy of individual responsibility and allowing market forces to work is ongoing."
The authors recognize the unique character of the United States and then as classic Rawlsians they reject it in a backhanded manner. The US has not only created the special emphasis on individualism, entrepreneurial capitalism, and personal responsibility but has built its culture, society and success on those pillars. They are at the core of our society and they are what make us what we are, they are the success of the United States. The authors as true Rawlsians, are vehemently opposed to those core principles. That should be a terrifying thought.
" The Baumol Willig theorem states that we want to maximize the welfare of the populace while keeping the profits of the monopolies high. This is a classical example of an ad hoc propiter hoc theorem. Clearly the result is that we tax the people and subsidize the monopoly.
The other issue is how do we measure welfare.
If we are a Rawlsian then we measure welfare as the welfare of the least of us and not the average welfare. Rawls states that if we maximize average welfare then we disadvantage the least of us and this is not just.
Thus as a Rawlsian we demand Universal Service. We must insist that all people have access to all service elements, whether it makes economic senses or not, we do so via wealth transfer. Hopefully, this political theory should now not seem too foreign. Ralwsians favor the implementation of access fees and the implementation of Universal Service. Indeed, the true Rawlsian would impute Universal Service to even computer terminals as has been stated by Vice President Gore.
In contrast is the classic liberal, now called libertarian view. It is more a combination of minimal government involvement and maximizing utility to the consumer. This is the philosophy of the utilitarian. Here we assume that government has a de minimis role and that the market follows of its own accord and that the market, in an Adam Smith fashion, will clear any inefficiencies of distribution and pricing mechanisms.
It assumes that each business should stand on its own stead and that utility is maximized on average. The result from the libertarian school, as opposed to the contractarians or Rawlsians, is the elimination of access fees and the elimination of universal Service."
I then went and described the Rawlsian approach, one which I thought would never raise its head again. I stated:
"Rawls has proposed a theory of justice that is a statement of what many proponents of antitrust theory ion the mid-fifties and sixties promulgated. The essence of Rawls’ theory has three elements;
Original Proposition: There exists a means and method for a society to establish a Contract amongst and between themselves. This Contract thus created in this society of the just is one that maximizes the return on every transaction to the least of the individuals in the society.This approach to contractarianism is one related to individuals in a non-bargaining environment establishing between and amongst themselves a “contract” to govern their society.
There are two elements contained herein.
The first is the essence of a contract, and in fact a form of social contract between the members of society and amongst them as a whole.
The second element is that of a view towards man as a constrained and unconstrained view of
human nature.
The unconstrained view states that man, individually and in concert, has the capabilities of feeling other people’s needs as more important than his own, and therefore we all act impartially, even when the individuals own interest are at stake.
The constrained view is to make the best of the possibilities which exist within the constraint.
For example, the constrained view of universal service is one which would state that if it costs a certain amount to provide the service, an there is a portion of the society not able to purchase the service, then there is no overriding need to provide it if such a provision is uneconomical and places a significant burden on the other member of society.
The unconstrained view, as a form of socialism, states that if there is the least of us in want for whatever the telecommunications revolution has in store, then they should have access to it at whatever cost. One can see that the current trend in Universal Service is such an unconstrained view, especially as viewed by the current Vice President in his actions over the past four years.
Rawls approach to this contract is one wherein the individuals in the society collect themselves as individuals, and agree to a plan for the operations of that society.
First Principle of Justice: each person shall have equal rights and access to the greatest set of equal fundamental personal liberties.
Second Principle of Justice: social and economic inequalities are to be arranged so that they both, (i) provide the greatest benefit to the least advantaged., and (ii) attached to positions available to each individual under conditions of fair equality of opportunity."
Thus to my surprise I read in this weeks JAMA an article entitled, The Ethical Foundation of American Medicine, In Search of Social Justice. In their view the Rawslian approach is key to the way in which health care should be provided. They state:
"Rawls’ theory of justice, often referred to as social justice, has gained prominence since the 1970s as a dominant theory of justice. This theory has 2 major principles. The first, that “people should have maximal liberty compatible with the same degree of liberty for everyone,” defines limits of individual liberty by focusing on the liberty of others. The second, that “deliberate inequalities [a]re unjust unless they work to the advantage of the least well off,” focuses on social consequence and responsibility for actions.
Considering the body of research and news reports that describe inequalities in US health care access and quality,10 and the fact that these inequalities do not work to the advantage of the least fortunate, it is clear that the US health system does not meet these criteria for being just. It seems that the structure of incentives in the current health system stimulates behavior that marginalizes considerations of social justice, leaving it seldom emphasized, relative to the other 3 core principles of medical ethics."
Unlike other theories of society, the Rawlsians argue that there exists a social contract with all so that all should receive what the least receive and no more. Thus if I have the financial resources to seek medical care for the prevention of colon cancer by annual colonoscopies and the law permits payment only for five year colonoscopies, the Rawlsian would either deny me my annual choice or make it annual for all, and then have all people pay the added costs. The Rawlsians establish "rights" extra those Constitutionally and legally established and then take the position that if the least of a society do not have them fully then none shall have them. It states that those who have been successful should not in any way use that wealth to disenfranchise those who do not.
The Rawlsian school also removes burdens from people. If you happen to be one of the 30% who are morbidly obese in the US and most likely suffering from Type 2 Diabetes, so be it, it is not your fault, despite the fact that you consume well in excess of 2000 cal per day, you must be dealt with as a faultless and blameless victim. Those who struggle to maintain health must therefore pay for the victems who out of total abject neglect do not.
The article in JAMA continues:
"For example, physicians attempt to maximize income while caring for the needs of their individual patients, but this means that some physicians choose to accept fewer, if any, Medicare and Medicaid recipients, as well as self-pay patients. Some physicians argue that to keep their practice financially viable, they have to see fewer patients for whom they are inadequately reimbursed.
Yet for each of the physicians who decide they can no longer care for these patients, the responsibility of care falls to another clinician. This increases the burden on those other clinicians and exacerbates the income disparities among them. In circular fashion, this increases the focus on revenue and reimbursement, rather than on social justice.
A second factor that may contribute to the imbalance of medical ethics in practice involves the cost of education and level of student debt....
A third important factor is the US culture of “individualism.” While general western philosophy has shaped US culture, the unique history of the United States has created a special emphasis on individualism, entrepreneurial capitalism, and personal responsibility. Specifically regarding health care, many other western nations have some form of universal coverage supported by their government and treat health care as a public good. In the United States, health care only intermittently has been treated as a public good and an intense debate regarding the promotion of government health programs vs the philosophy of individual responsibility and allowing market forces to work is ongoing."
The authors recognize the unique character of the United States and then as classic Rawlsians they reject it in a backhanded manner. The US has not only created the special emphasis on individualism, entrepreneurial capitalism, and personal responsibility but has built its culture, society and success on those pillars. They are at the core of our society and they are what make us what we are, they are the success of the United States. The authors as true Rawlsians, are vehemently opposed to those core principles. That should be a terrifying thought.
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