....during the run up to the establishment of the NHS, the option of banning private care was considered quite seriously, even by Bevan, and was rejected on several grounds, including that any proposal including it would get smashed by the doctors. The BMA was obviously a key force to making the NHS work, and its acquiesence had to be bought. Bevan famously responded to someone who asked how he was going to silence to opposition of doctors: “We’re going to stuff their mouths with money”.I've done this before, but HB sets it up perfectly here. Speaking in terms of an ideal of moral action it follows from the above that I shouldn't buy a bunch of grapes for myself without buying another for the homeless man outside the store. Fair enough, but following that ethic to its logical conclusion -and logic in these discussions is the point- I shouldn't cry for the death of my parents without crying for every person with an obit in the paper. My father used to talk with derision about the revolutionary in the Czar's dungeon who worried that he was getting more than his fair share of sunlight (the origin of the story is here) but to Brighouse and his ilk equal concern is equal concern. Read the introduction to "Legitimate Parental Partiality" by Brighouse and Adam Swift [pdf], and consider the absent terms: "friendship," "intimacy," "love." The piece is synecdochic of its field; as I've said before the liberalism that tries to find or form non-contradictory truths in the world of experience is perverse.
This (stuffing their mouths with money) is not an option here and now. Nor, obviously, is preventing people from buying private care. (I’m in favour, for various reasons, of allowing people to buy private care, but agree with engels that there are reasons to prohibit it; John is wrong to imply that there is nothing wrong with rich people buying care for themselves—indeed, one thing that is wrong is that they could be buying it, instead, for people who are less well off). What worries me, though, about John’s response to engels, is that his repsonse may prove too much. I don’t think there is a cost-saving and moderately fair option that is consistent with the prevailing US political consensus. All the good options are too foreign, and that is one of the reasons that reasonable reform is almost certainly out of reach.
Egalitarians believe that goods should be distributed much more equally than they are at present, but they also recognize that there are principled limits to the pursuit of distributive equality. Fully to realize a fair distribution would involve the sacrifice of other values that properly constrain egalitarian ambitions. Some barriers to the realization of equality reflect the value of respecting prerogatives people have to favor themselves. Even G.A. Cohen, whose egalitarianism is unusually pervasive and demanding, says that:
...only an extreme moral rigorist could deny that every person has a right to pursue self-interest to some reasonable extent (even when that makes things worse than they need to be for badly off people). I do not wish to reject the italicized principle, which affirms what Samuel Scheffler has called an ‘agent-centred prerogative’.....2It is also widely thought that people have morally weighty prerogatives to act partially toward particular others. Indeed, the permissibility of partial relationships between individuals is a touchstone of liberal – including egalitarian liberal - thinking. David Estlund presses the point against Cohen, developing a series of cases of incentive- demanding motives that result in inequality but draw only on altruistic concerns -- where the other whose interest is being pursued is near and dear to the incentive-demanding agent.3
These relationships appear inegalitarian in deep ways. The parties to partial relationships may exclude others from the mutual benefits their association yields and have special responsibilities to one another that give them the right, and sometimes the duty, to further one another’s interests in ways that may interrupt equality. Scheffler calls this observation (when made in an appropriately hostile manner) the ‘distributive objection’ to special responsibilities: ‘the problem with such responsibilities is ...that they may confer unfair benefit. ...special responsibilities give the participants in rewarding groups and relationships increased claims to one another’s assistance, while weakening the claims that other people have on them’.4 Indeed, participants in these protected relationships benefit twice over. They enjoy the relationship itself, and they enjoy the claims that it enables them legitimately to make on one another, to the exclusion of those outside the relationship.The standard terms of opposition are partiality and equality. But partiality is a function of proximity: this is obvious, yes? And intimacy is proximity literally up close. But Brickhouse is incapable of using the terminology of human emotion even to describe its function and therefore its value. Most of us can not love intimately a thousand people. Believe me, it's been tried. But rather than accept and understand the conflict between two powerful "goods" (even the terminology implies commodity) Brighouse following the pack tries to construct an ideal balance. He wants the "right" answer. He wants the "truth." The best way to deal with the facts as opposed to ideas -and here's where Eliot's appreciation of James comes in- would be to describe both intimacy and law as positive and opposed forces. Instead of "partiality" say "friendship" and allow for its authority.
At a certain point it becomes a question not of right or wrong, not of absolutes, but of what we as a community choose to value; the balance itself is less important than how that choice is made. Brickhouse calls himself a philosopher rather than a professor of philosophy because he views philosophy as form of logical argument, and logic is considered close to formal science (so philosophy is more like chemistry than literature). But his logic sees the individual as constrained by community when another logic, equally valid but less reductive, sees the individual by necessity not constrained but engaged, as both member and function of society. And Brickhouse can't even imagine how this could be so. He's unwilling to see friendship with all its moral weight both as constitutive and destructive of society because he has an ideological commitment to an abstraction reducible both to individual ideas and the idea of the individual. He's so full of shit his eyes are brown.