Bernard Williams and Robert Nozick are two philosophers I really enjoy reading. Seeing one directly address the other in print is strangely amusing, like finding out that two good friends you had met at different places and times in your life actually know each other (I had assumed, I suppose, that although Williams and Nozick were contemporaries, and certainly knew of each other’s work, they worked in different areas and thus probably never ‘squared off’ over any particular issue). That’s Williams on the left, and Nozick on the right. Pretty dashing–and downright Adonises by philosophical standards.
So let’s hear from Williams first. In a well-known essay titled “The Idea of Equality,” published in 1962, Williams writes:
Leaving aside preventive medicine, the proper ground of distribution of medical care is ill health: this is a necessary truth. Now in very many societies, while ill health may work as a necessary condition of receiving treatment, it does not work as a sufficient condition, since such treatment costs money, and not all who are ill have the money; hence the possession of sufficient money becomes in fact an additional necessary condition of actually receiving treatment….When we have a situation in which…wealth is a further necessary condition of the receipt of medical treatment, we can once more apply the notions of equality and inequality…since we have straightforwardly the situation of those whose needs are the same not receiving the same treatment, though the needs are the ground of the treatment [my emphasis]. This is an irrational state of affairs…it is a situation in which reasons are insufficiently operative; it is a situation insufficiently controlled by reasons–and hence by reason itself.
Now, here’s Nozick, responding to this passage in a section of his well-known book Anarchy, State, and Utopia:
Williams seems to be arguing that if among the different descriptions applying to an activity, there is one that contains an “internal goal” of the activity, then (it is a necessary truth that) the only proper grounds for the performance of the activity, or its allocation if it is scarce, are connected with the effective achievement of the internal goal. If the activity is done upon others, the only proper criterion for distributing the activity is their need for it, if any….But why must the internal goal of the activity take precedence over, for example, the person’s particular purpose in performing the activity?….[Is it the case that] the only proper criterion for the distribution of barbering services is barbering need[?]….Need a gardner allocate his services to those laws which need him most?
Nozick anticipates the reader’s objection to his comparison between doctors, barbers, and gardners–viz., medical care, unlike hair-cuts and mowed laws, is something human beings need very much. Nozick agrees, but continues:
What we arrive at is the claim that society (that is, each of us acting together in some organized fashion) should make provision for the important needs of all of its members. This claim, of course, has been stated many times before. Despite appearances, Williams presents no argument for it. Like other, Williams looks only to questions of allocation. He ignores the question of where the things or actions to be allocated and distributed come from.
This seems to me a pretty shoddy criticism of the argument Williams puts forth in the passage I cited above–certainly beneath Nozick’s standards, which, I think, are generally quite high. For starters, anybody who reads the passage from Williams in the context of Williams essay–which, of course, is how it should be read–will know exactly how Williams would answer Nozick’s rhetorical question concerning why the ‘internal goal’ of an activity should take precedence over other considerations when determining who should become practitioners of the activity in question and how the scarce goods/services produced by/associated with the activity should be allocated. Williams is arguing the broader point that giving precedence to the internal goal of the activity is a way to distribute opportunity and resources unequally in a way that does not violate a political society’s commitment to equal treatment and equal respect for all citizens. It’s a way of giving any and all citizens a reason for an unequal distribution that they should each be able to accept as relevant–roughly, an unequal distribution is called for insofar as it is the most effective way of achieving/realizing the internal aims of the practice. More roughly still, the unequal distribution ‘follows,’ as it were, from the raison d’etre of the practice: nobody should complain that it’s unfair that only the sick get medical care, but in a political society that pays lip-service to egalitarian principles one could with full justification complain if only the sick and relatively wealthy get medical care, for ‘wealth’ is manifestly irrelevant to the central purpose or ‘internal aim’ of the practice of health care.
Also, as Nozick himself seems to sense, the comparisons to barbering and gardening are totally specious. Nozick seems to be implying that society cannot legitimately tell providers of some good/service, G, the basis on which they may provide G. Just how radical this claim is might be missed when we’re focusing on barbers and gardeners (even in these cases, though, we do not allow barbers to distribute barbering services on the basis of race).
But its radicality isn’t its main defect–rather, it just seems so uncompelling (I’m afraid maybe I’ve begun to internalize some lessons that Josh has been trying to teach me on this blog. Perish the thought!) We do not have natural rights to become doctors, barbers, gardeners, or whatever–these options are available to us because we are members of a system of social cooperation (a political society), and in this case membership has its costs as well as its privileges. We don’t get to barber, for example, however the hell we want to barber and with whomever the hell we want to barber. Along with making it possible for one to earn a living as a barber, our society lays down some guidelines and laws. Any individual unwilling to follow these guidelines and laws should not become a barber. Mutatis mutandis for doctoring. There’s just no compelling complaint against those who would say that as a doctor in our society, you will have to provide medical care to people independently of their ability to pay. If you don’t want to do that, don’t become a doctor–become, I don’t know, a barber, where allocating services on the basis of ability to pay is allowed and even enforced by the law!
One way to see that Williams is on higher ground here, I think, is to imagine the disagreement being about legal defense services instead of health care. What is the internal aim of our punishment practice? That’s not obvious, I know, but it seems plausible to conceive of our punishment practice as related to guilt in something like the way health care is related to illness. In each case, the social institution arises in direct response to a clearly identifiable problem–people get sick, and people break the laws. Society should have a plan for dealing with these inevitabilities. Now notice that in our society–the one we actually live in, hardly an egalitarian paradise, we do not treat ability to pay as a necessary condition for obtaining a legal defense. If you cannot afford an attorney, one will be provided to you. Why do we do this? Per Williams’s argument, we could say that we do this because we recognize that the amount of money a person has is clearly irrelevant to questions concerning his guilt or innocence, which questions explain why we have a social practice called ‘lawyering’ in the first place, and so considerations of wealth should not factor into whether or not one is able to get a lawyer.
I’ll close with a question I’ve been mulling over recently: why is Universal Health Coverage supposedly ‘controversial,’ while ‘Universal Legal Coverage’ is not?