Life Is Scarce
Simon (i.e., plenty) for capital and Malthus (i.e., subsistence) for labor. That, of course, is Karl Marx’s vision of long-term economic development. And while I don’t have a strong opinion as to whether or not this is accurate over the long term, it’s certainly a plausible story about the future, and Marx’s solution—socialism—unquestionably seems to me to be the correct one. … If the “robots” are really mere machines, then it should be easy to peacefully divide up the surplus more-or-less equitably, we’ll transition to socialism and everyone will be happy—it’ll be like Star Trek. If the robots are sentient beings, then we’d presumably be looking at an eventual slave revolt and Communist revolution.
Is it possible that Health Care is 160% of GDP? What this is telling us, is one way or another health care costs will not continue to rise faster than the overall economy. … The question before you is, do you want the world where health care is limited only by our collective ability to pay for it. What many elites don’t face up to is that if you asked this question to the person on the street he or she might very well say yes. I am constantly aware of this because a persistent source of tension between myself and my family is their feeling that it is not just ok but morally imperative that personal budget constraints be hit in the purchase of medicine. … Making the case for less health care spending is making the case for abandoning the sick and the needy. If you want a world that does not proceed on autopilot you need to be gearing up to make that case. Slight of hand about cost-savings or market efficiencies is not going to do the trick.
When I describe a Malthusian future where most (robot) people wouldn’t live much longer than they were near the best in a very competitive labor market, many readers react like Yglesias, and talk of revolution. Surely, they suggest, no moral person would accept a society where how long folks lived depended greatly on how much they could pay.
Like Karl Smith above, a month ago I tried to make the point that even without robots we are heading toward such a world:
A fountain of youth pill whose required dosage doubled every decade would either have to be banned, or given to everyone over thirty with insurance. … Eventually we’d run out of money to pay for these pills; we’d have to say no to some people, and then they’d quickly die. … Good thing we don’t have a fountain of youth pill, right? Actually, our real situation is worse. Per capita medical spending in the US doubles about every fifteen years, which is still much higher than our economic growth rate. Yet we struggle to see any substantial correlation between health and medical spending – our medicine is mostly useless on the margin. Its nothing like a fountain of youth pill. Our refusal to say no to any medical treatment that seems to our wishful-thinking eyes like it might help will also bankrupt us. And we won’t even get a fountain of youth in the bargain.
One way or another we will find a way to exclude seen-to-be useful medicine from people in our society. The only question will be: what will be acceptable criteria for such exclusion? I’ve argued that the ability to produce enough wealth to pay for your added life is a decent criteria for such a choice, and it can be implemented in an admirably flexible and decentralized way. If you reject that criteria, what other criteria will you substitute, and what price are you willing to pay in centralized regulation and lessened innovation and competitiveness with the rest of the world?