Intolerance for the Intolerable

Nicholas Kristof highlights the latest of the “Left Behind” series, Glorious Appearing, in which the Son of God kicks serious ass. An excerpt from the book:

Jesus merely raised one hand a few inches and a yawning chasm opened in the earth, stretching far and wide enough to swallow all of them. They tumbled in, howling and screeching, but their wailing was soon quashed and all was silent when the earth closed itself again.

hell.jpgKristof rightly notes that this Jesus-as-genocidal-angel- of-vengeance theme is fairly disturbing. “In Glorious Appearing,” Kristof writes,

Jesus merely speaks and the bodies of the enemy are ripped open. Christians have to drive carefully to avoid 'hitting splayed and filleted bodies of men and women and horses.'

Jesus is knocking on your door. If you don't let him in, he will. . . fillet you! Kristof makes the point that this vulgar, brutal, and vindictive crypto-Christianity, in which non-believers are splayed and sucked into “yawning chasms”, doesn't look a whole lot better than the vulgar, brutal, and vindictive form of Islam that has us so terrified. This is, I believe, a very fair point.

However, Kristof worries about offending the delicate sensibility of sadistic Christians who thrill to “Left Behind”-style eschatological porn.

I had reservations about writing this column because I don't want to mock anyone's religious beliefs, and millions of Americans think “Glorious Appearing” describes God's will. Yet ultimately I think it's a mistake to treat religion as a taboo, either in this country or in Saudi Arabia.

That's nice, I suppose, that he had reservations. And it's true: religion is not a taboo subject. He concludes:

People have the right to believe in a racist God, or a God who throws millions of nonevangelicals into hell. I don't think we should ban books that say that. But we should be embarrassed when our best-selling books gleefully celebrate religious intolerance and violence against infidels.

That's not what America stands for, and I doubt that it's what God stands for.

hellsmall.PNGThe “right” of which Kristof speaks is ambiguous. People have a political right to think or express anything they want. No books shall be burned. Yet people have no intellectual or moral right to think or express whatever they like. “Left Behind” Christians deserve to be criticized, chastised, and mocked for their wanton violation of the demands of reason and basic decency. Reasonable people may believe false doctrine, but reasonable people may not believe savage doctrines, and those who do are owed no moral quarter.

Kristof is right: we should be embarrassed by the fact that we live in a culture where this kind of odious filth, posing as piety between covers, shoots to the top of the best-seller list. But embarrassment is not enough. Decent people should be outraged. People reading Glorious Appearing on the bus ought to be treated with the regard we reserve for the happily nodding public reader of The Protocols of the Elders of Zion. It is not all right, and people have no right whatsoever to feel that it is.

From the Left Behind website:

I'm 12 years old, and my mom got me hooked on the Left Behind series. I've read most of the kids books and all of the adult books. I think Glorious Appearing is the best one yet. It conveys the feelings of the characters so well. I just want to say thank you for starting this series, it's brought me so much closer to God. So thanks.
—Nicole, posted 5/14

That's really not all right.

  • x_trapnel

    I’m really pretty confused, too–I understand the slippery slope argument you’re making, but it just doesn’t seem like the causal mechanism is plausible. Ok: a public plan gets subsidized enough that, through a combination of that, risk-pooling economies of scale, or whatever, it becomes hugely dominant in the “basic health care insurance” segment. What is the mechanism that leads to a ban on “luxury insurance,” which is precisely what you’re talking about when you worry about bad cost/benefit-ratio treatments?

    If the worry is that no one will *perform* the treatments, that seems implausible–if nothing else, doctors would be happy to be paid out-of-pocket. The only worry here would be concerning malpractice liability–but that’s a genuinely separable debate.

    If the worry is that only the rich will be able to *afford* the high cost/benefit treatments out of pocket–well, that’s the status quo anyway.

    If the worry is that companies will only insure luxury treatments if they can cross-subsidize with basic ones, and so the govt’s dominance of the basic-insurance market will kill the luxury-insurance market … I’m just not sure what to say to you. Because for that argument to be valid, it has to be the case that, in fact, folks *don’t want* luxury insurance enough to pay actuarily-fair rates for it (not enough of them to create a market, at any rate). But then… so what?

    I get that you don’t like Canada’s system, or the NHS, but neither is on the table, and the institutional dynamics of what IS on the table seem much more likely to push towards, e.g., Germany or Australia. But how do your worries apply to these systems? The rationing in these systems is the same sort as here–by $$–but is generally restricted to the “luxury” sector.

    • OK. I think you’re right. I got myself confused. I don’t think we’re heading toward a ban on high-end spending. And the manifest demand for it is in fact why Medicare can’t cut its costs and why putting more people in a Medicare-like government-run health plan has no chance whatsoever of bringing down overall costs.

      Anyway, the thing that struck me is that I’ve never heard anyone seriously make the “human life is priceless” objection to government rationing. The objection is to a system that denies people treatment or makes them wait a long time for treatment when there are alternative systems that cover everyone but do much less of that.

  • Peter Twieg

    Good catch. I guess Singer (and probably many of his sympathizers) wants to assert that lives have a finite, calculable value… but that this value is constant between people. Singer probably has confused an averaging of individual revealed preferences by the government for some kind of collective revealed preference, the latter of which is methodologically and philosophically incoherent, like “social indifference curves”, but is extremely seductive to certain collectivist thinkers.

  • As for other countries’ systems, apparently in Britain you can be denied NHS treatment if you purchase additional care. One source for such a story, another: “Officials said that allowing Mrs. Hirst and others like her to pay for extra drugs to supplement government care would violate the philosophy of the health service by giving richer patients an unfair advantage over poorer ones.”

    But, as others have pointed out, yours is only an argument against the above sick logic, not against universal health care per se.

    • dusty

      “Officials said that allowing Mrs. Hirst and others like her to pay for extra drugs to supplement government care would violate the philosophy of the health service by giving richer patients an unfair advantage over poorer ones.” Thats just sickening. (pun not intended, but HA!)

  • Paul_G_Brown

    Of course, the government, like individuals and families, has a limited budget. So if the government is going to pay for medical care, it has to ration. And that very fact is an argument for limiting the government to only paying for the care of people who are unable to pay for a minimum of care themselves.

    And how do you propose we decide how much to spend on these people?

    All Singer is saying is that there are more or less reasonable ways to answer questions about whether a HMO should spend money on ‘treatment X’. This is precisely the same calculation that was made by car companies with respect to air bags, shoulder belts, and central gas tanks. Engineers building airliners go through the same process. It’s a methodology for deciding how to allocate resources to get ‘bang for buck’.

    In fact, it’s the same decision health insurance companies make every day about whether or not to “cancel Will’s policy”. They’re all putting a price on life. All Singer is saying is that we might as well just be explicit about it.

    On another note: When Singer says something, and it seems stupid? My working assumption is I’m the dumb one. Not him.

  • ducdenemours

    The Singer article is a very well written definition of QALYs complete with the rationale behind them which is fair enough I suppose.

    Nevertheless, I hope fellow readers will find it useful to know that in England (other bits of the UK are still to make a final decision I think) you can buy extra drugs such as sutent, avastin, herceptin and the rest to top up your NHS care. The rationing body has also adjusted its QALY calculations to allow some of these drugs to be provided on the NHS.

    In short, the social solidarity principle that governments of either stripe spent a long time upholding has been ceded – as it had already in dentistry (North American readers stop sniggering) and prescriptions among other aspects.

    I also think it is important that we should not get fixated by these expensive drugs. Sutent and the rest are very expensive but are still pretty marginal in terms of overall health spend.

    Costs of diseases such as diabetes, Chronic Obstructive Pulmonary Disease COPD, heart disease generally, dementia and all the other illnesses associated with modern developed world will dwarf the spend on these drugs.

    What is more they do not cure anything. They might keep some people alive a bit longer and often with pretty terrible side-effects.

    In short, although it raises some interesting overall issues around healthcare and risk-pooling, there is a danger, i fear of becoming fixated on the debate around these drugs that misses out the other important healthcare questions.

  • Will – please read hilzoy on the utter dishonesty of this “rationing” rhetoric. I usually like your stuff, but this is just embarrassing.

    • I think you missed the comment above where I said I was confused and admitted I had it wrong. I guess I should flag that in the post.

  • tlwest

    Actually, I’ll go out on a limb here and defend the Canadian system.

    But first, Will’s quote:
    Individuals do it all the time through their rationing–through occupational choices, consumer choices, residential choices, transportation choices, and health and medical choices, all of which reveal how much the individual is willing to pay to avoid an X% risk of death..

    The term willing is loaded. Most of the time, the term you actually mean is able. I don’t think that anyone could seriously claim that someone who has only $50 to his name really only values his life at $50.

    And that is crux of the argument. Do the wealthy value their lives say a thousand times more than the homeless? I don’t think there are many who would claim that they do. Perhaps a better way of evaluating how much you value your life is by what fraction of your overall net worth you’d sacrifice. But then the homeless would value there life *more*.

    In the end, there’s no way of easily having people value their life that *isn’t* really a proxy for how wealthy they are.

    In other words, those economists that would use value human lives by how much people are willing to spend to save them are essentially saying that a human life is valued by its wealth.

    While wealth means a lot, in many countries, like Canada, most people would be unwilling to say that the lives of the wealthy are more valuable than the lives of anyone else. Wealth may buy you more toys, and your children a more comfortable life, but it should not buy life itself.

    And that is what underlies Canadian-style health care systems to Canadians.

  • Greg Billock

    Did you read the entire article? Singer does argue that public healthcare benefits be assigned on a utilitarian basis (as would be expected). That’s what the article is about.

    The next-to-last paragraph (beginning “Rationing public health care limits free choice if private health insurance is prohibited.”) points out that this in no way needs to impede the ability of individuals to spend however much they wish on treatments which don’t seem to be proven or cost-effective enough for the public to provide. Singer points to the Australian system, with which he is familiar, as a model.

  • jamesvonderhaar

    I think the objection here is largely a result of different people that you tend to be around. The notion of putting a price on human life and preferences for reducing risk of death in the future is uncontroversial for economists, but is likely to elicit revulsion in the general populace, and especially among Singer’s detractors in the field of moral philosophy.

    What’s old hat to you has to be explained and argued painstakingly for Singer’s audience.

    None of which is to say that your argument that the government can’t read price signals effectively enough to get an “objective” value of human life isn’t valid.