This article sets out the moral failure of single-tier basic healthcare. Single-tier basic healthcare has been advocated on the grounds that the provision of healthcare should be divorced from ability to pay and unequal access to basic healthcare is morally intolerable. However, single-tier basic healthcare encounters a host of catastrophic moral failings. Given the fact of human pluralism it is impossible to objectively define “basic” healthcare. Attempts to provide single-tier healthcare therefore become political processes in which interest groups compete for (...) control of scarce resources with the most privileged possessing an inherent advantage. The focus on outputs in arguments for single-tier provision neglects the question of justice between individuals when some people provide resources for others without reciprocal benefits. The principle that only healthcare that can be provided to everyone should be provided at all leads to a leveling-down problem in which advocates of single-tier provision must prefer a situation where some individuals are made worse-off without any individual being made better-off compared to plausible multi-tier alternatives. Contemporary single-tier systems require the exclusion of noncitizens, meaning that their universalism is a myth. In the light of these pathologies, it is judged that multi-tier healthcare is morally required. (shrink)

This article examines the consequences of the politicization of health care in the United Kingdom following the creation of the National Health Service (NHS) in 1948. The NHS is founded on the principle of universal access to health care free at the point of use but in reality charges exist for some services and other services are rationed. Not to charge and/or ration would create a common-pool resource with no means of conserving scarce resources. Taking rationing decisions in the political (...) realm means that the values and priorities of individual patients are marginalized and the preferences of powerful organized groups able to capture the political process dominate. The key lesson for international health care reform is that the politicization of health care via the NHS has not led to the realization of egalitarian ends but rather has empowered vested and organized interests at the expense of individual patients. (shrink)

The "Socialist Calculation Debate" is little known outside the economics profession, yet this inter-war debate between liberal and socialist economists on the practical feasibility of socialism has important implications for all contemporary public sector bureaucracies. This article applies the Mises-Hayek critique of central planning that emerged from this debate to the crisis presently facing the British National Health Service. The Mises-Hayek critique suggests that the UK government's plan for a renewal of the National Health Service will fail because of the (...) epistemological pathologies that face any centrally planned system. It is argued that the key lesson of the Socialist Calculation Debate is that market prices and private property rights are essential for the efficient allocation of resources and the attainment of the best possible health outcomes. (shrink)

Robert Nozick's Anarchy, State, and Utopia (1974) is recognised as a classic of modern political philosophy. Along with John Rawls's A Theory of Justice (1971), it is widely credited with breathing new life into the discipline in the second half of the twentieth century. This Companion presents a balanced and comprehensive assessment of Nozick's contribution to political philosophy. In engaging and accessible chapters, the contributors analyse Nozick's ideas from a variety of perspectives and explore neglected areas of the work such (...) as his discussion of anarchism and his theory of utopia. Their detailed and illuminating picture of Anarchy, State, and Utopia, its impact and its enduring influence will be invaluable to students and scholars in both political philosophy and political theory. (shrink)

Most deontologists find bedrock in the Pauline doctrine that it is morally objectionable to do evil in order that good will come of it. Uncontroversially, this doctrine condemns the killing of an innocent person simply in order to maximize the sum total of happiness. It rules out the conscription of a worker to his or her certain death in order to repair a fault that is interfering with the live broadcast of a World Cup match that a billion spectators have (...) been enjoying. It rules out such sacrifice even if it would maximize the sum total of everyone's happiness. An act utilitarian, by contrast, would require the sacrifice of the one whenever this latter condition obtains, since such a utilitarian is committed to the view that one ought always to act so as to bring about the greatest sum total of happiness. An act utilitarian might, however, consistently hold that a large number of rather insignificant pleasures, such as that which a spectator derives from witnessing men in shorts running around and kicking a ball, is never sufficient to justify the infliction of a great harm on a single individual. 4 He might take such a position without abandoning utilitarianism by denying that the sum total of such minor pleasures could ever be sufficiently great to outweigh the harm of death to the one. Under the inspiration of John Stuart Mill, a utilitarian might draw a more general distinction between serious and trivial harms and pleasures and maintain that no amount of a trivial pleasure could ever amount to a sum of happiness that is greater than the disutility of a serious harm. (shrink)

In a number of works, James M. Buchanan set out a proposal for a ‘demogrant’— a form of universal basic income that applied the principles of generality and non discrimination to the tax and the transfer sides of the scheme and was to be implemented as a constitutional rule outside the realm of day-to-day politics. The demogrant has received surprisingly little scholarly attention, but this article locates it in Buchanan’s broader constitutional political economy project and shows it was a logical (...) application of his theoretical framework to the problem of inefficient and unfair welfare systems when reform to the basic institutions of majoritarian democracy was not forthcoming. The demogrant aims to end the problems of majority cycling and rent seeking that plague contemporary welfare states and therefore offers a model of welfare without rent seeking—a constitutional welfare state. We compare Buchanan’s demogrant model to other universal basic income and negative income tax models and consider the most important criticisms. We conclude that rescuing the demogrant model from relative obscurity would be a fruitful future task of applied constitutional political economy and public choice. (shrink)

Most deontologists find bedrock in the Pauline doctrine that it is morally objectionable to do evil in order that good will come of it. Uncontroversially, this doctrine condemns the killing of an innocent person simply in order to maximize the sum total of happiness. It rules out the conscription of a worker to his or her certain death in order to repair a fault that is interfering with the live broadcast of a World Cup match that a billion spectators have (...) been enjoying. It rules out such sacrifice even if it would maximize the sum total of everyone's happiness. An act utilitarian, by contrast, would require the sacrifice of the one whenever this latter condition obtains, since such a utilitarian is committed to the view that one ought always to act so as to bring about the greatest sum total of happiness. An act utilitarian might, however, consistently hold that a large number of rather insignificant pleasures, such as that which a spectator derives from witnessing men in shorts running around and kicking a ball, is never sufficient to justify the infliction of a great harm on a single individual. 4 He might take such a position without abandoning utilitarianism by denying that the sum total of such minor pleasures could ever be sufficiently great to outweigh the harm of death to the one. Under the inspiration of John Stuart Mill, a utilitarian might draw a more general distinction between serious and trivial harms and pleasures and maintain that no amount of a trivial pleasure could ever amount to a sum of happiness that is greater than the disutility of a serious harm. (shrink)

This essay explains the prevalence of egalitarian beliefs among academic philosophers, individuals who enjoy significant wealth and privilege. I argue that their egalitarianism does not present a “paradox of conviction,” as G. A. Cohen contends, but follows logically from the institutional structure of academic philosophy. This structure creates a “veil of insignificance” wherein philosophy is a moral performance that incentivizes the adoption of egalitarian beliefs. Philosophers also view the world from behind what is termed a “veil of privilege” that incentivizes (...) a public commitment to egalitarianism as a means of distancing themselves from the role of privilege in their life and encourages the hubristic assumption that the practical problems of socialism can be easily overcome with effort or ingenuity. Identity-protective motivated reasoning means that evidence conflicting with egalitarian beliefs is avoided, ignored, or dismissed. These dynamics are reinforced by established actors who gatekeep the profession. (shrink)