This first sentence is just here for all the bloggers who want to read the first sentence of the post and then go write an angry rebuttal of my claim that poor Americans should have to torture puppies in order to be eligible for Bandaids.
The rest of the post will be for people who want to, well, read the rest of my post.
Anyway, so when we last left off, we had established that I do not believe that people who can afford to pay for their own health care have a right to have other people pay for their health care. We may decide, for various political, economic, or practical reasons, to pay for that health care anyway; but they do not have a right to have that health care paid for by others. To illustrate the point: trash removal is a cornerstone of civilization, and no one should have to wallow in their own refuse. However, given the negative externalities of failing to police one's own garbage while living in close quarters with others, it seems to be more practical, not to mention sanitary, to have the government haul everyone's garbage away. But that doesn't mean that I have a right to have taxpayers pay someone to haul my garbage, when I am perfectly capable of paying for the thing out of my own pocket. There is no generalized "right to garbage removal".
However, there may be other rights which convey the right to garbage removal, or health care. (Indeed, in the case of garbage, I might have a right to have my neighbour's trash hauled away, even if I don't have a right to free removal of my own. This being approximately the root of most libertarian-approved public health measures.)
The right that I see as most likely to convey a right to health care is what I will term, inexactly, "the right to a minimum decent standard of living".
Is there such a thing? The hardcore libertarian/anarchocapitalist answer is "nope". If you didn't cause a problem, says that logic, you aren't responsible for it, even if you have it in your power to avert it. Note that we all believe this in some measure--if you didn't, you would have sold everything you own until you were living at the level of the poorest African, and sent any money that you made above that level to poorer people abroad. Indeed, you'd be urging poor people in America to do the same. But most of us aren't that ruthlessly consistent.
If you do believe that there is no right to a decent standard of living, then I won't argue with you. That doesn't mean I think you're right; I disagree rather vehemently. But I'm pretty sure I'm not going to persuade you that you have moral obligations you don't feel, and you're not going to persuade me that the American taxpayer should let babies die because they made the mistake of having the wrong parents. How about wandering over to the music thread and making some suggestions? Some of my favourite bands have come via anarchocapitalists.
But what decent minimum standard of living? Liberals, it is safe to say, believe that this should be much more generous than do libertarians; I lean closer to the P.J. O'Rourke axiom that "the biblical injunction is to clothe the poor, not style them".
The question is easiest in the case of children. They have a right to good schools, nutritious and tasty food, safe neighbourhoods, a home where they are not terrorized by crazy or drug-addled parents, top-notch health care, and any social services they need to overcome whatever familial handicaps they started out with. I am not under the delusion that they will get all of these things, but I think they ought to, and would be willing to plow in pretty much any amount of tax money to cover the cost.
Disabled adults are the next easiest. If you can't work, for reasons of physical or cognitive handicap, you are entitled to a warm dry abode, decent food and clothes, excellent health care, such occupational therapy as may make you able to lead a fuller, more participatory life, and premium cable if you're bedridden. No, I'm serious. If you have to lie in bed all day, you should get the deluxe cable package at the taxpayer's expense.
If you're an able-bodied adult, I think a minimum decent standard of living involves making your work pay enough to support a warm dry abode, adequate food, basic clothing, electricity and gas, and the other basic accouterments of a basic life. Cable television is your own responsibility. However, I think you are also entitled not to die or become crippled from lack of health care.
Yes, I'm sorry, my libertarian brethren just started screaming at the monitor. Yes, I'll turn in my membership card and secret decoder ring at the Cato Institute. But there you are: I think along with crime prevention and courts and public health, society should keep people from dying.
How can I believe this, and not support the welfare state? My liberal readers are thinking. Well, several reasons. For one, I think government is, on average, a more comprehensive but less efficient provider of social services than private charity; fewer people slip through the cracks, but government agencies generally do a worse job with their clients than private ones, for a variety of reasons that I will elaborate elsewhere. Because of that, I want to see private charity bear as much of the burden for social service provision as possible, while realizing that the government will nonetheless have to provide fallback services.
The second is that I prefer a system which interferes as little in the lives of the poor as possible. I don't think the government should be providing vouchers for food and housing; I think the government should be giving poor people money, and letting them decide what they want to spend it on. I support the elimination of almost all government benefit programs, except those targeted at children and the disabled, and a more comprehensive version of the earned income tax credit. In fact, I'd like to see a tax system which has positive and negative rates in a continuously increasing function, zeroing out somewhere around $28,000 a year.
However, I think that schools and health care will be important exceptions to that general rule. Schools, because not all parents are responsible, and the state has a compelling interest in seeing that children are well educated even if their parents would rather spend the money on cigarettes; and health care, because of high variance in costs, and moral hazard.
You can't just give people money and say "Buy the health care you need to make sure you don't suffer and die", because unlike the other items in the package of basic goods--food, shelter, clothing, maybe a car--the costs each person will bear can vary from $0 to several hundred thousand dollars. And you can't just tell them to buy insurance, first, because their insurance costs may also vary much more widely than those of the other basic goods; and second, because many of them won't do it, relying on the fact that we will not let them die. Unless you can make a credible committment to not treat someone who shows up at the emergency room without insurance (and I certainly hope we can't make that kind of committment credible), relying on remedies that work very well for the other basic goods will not work.
I think--I think--that single-payer advocates and I share basically the same moral intuition, which is that society should not let people die from hunger, cold, or lack of medicine. They would go on to argue that for various reasons of administrative efficiency, social failure, or political difficulty, we should realize these intuitions by having the government provide massive amounts of these services. I disagree even in cases that I regard as special, such as health care and educatio, for reasons that I will lay out in future posts. But I find the moral intuition that they are trying to realize correct. And having finished describing which moral intuitions I don't find compelling as a rationale for single payer, I wanted to go on record elaborating the ends that I support, even if we disagree about the means.
I think you made a typo... the worlds in bold should probably be removed.
EI
Megan, I understand that you don't support a single payer system. Do you support a plan of the type proposed by Senators Clinton, Edwards, and Obama?
Megan,
You bring up children, but don't mention the extent to which children can be (and are) used as conduits for government largess to irresponsible parents. Mightn't the solution be to care for the children separately, e.g. in an orphanage? Before everyone starts screaming, think this through: The orphanage need not be Dickensian, and, if properly regulated and staffed, it would probably offer a much better quality of care and a safer environment than that of the average welfare mother's home.
The moral intuition has always been about means and not ends.
It's this thing called means, when tempers flair.
The orphanage need not be Dickensian
Where's the fun in that?
I hate the idea of a government agency that is in charge of determining a "fit" parent. But I also see far too many instances of complete drug addict parents who send their kids to school in rags and hungry while they're passed out on the couch.
Government probably isn't the answer to this, but I certainly would like to see those kids taken away from their parents if/until they can get back on their feet.
Back to the right to health care, the difficulty comes in once you claim there is a "right" people will find a way to expand upon it and extend it to others. How can you tell a guy that pays 300% more in health care taxes than the poor dude across town that he has no right to the health care services that his money bought for the poor guy. That is just? "We'll take your money to pay for his services, but you still have to pay for your own. Just be happy your successful and keep your mouth shut".
Maybe I can agree with your suggestions at the very very very far fringes of society. .05% are elibigle for this care? But I'm pretty bummed that my brother, who makes only 30% less than me gets a free ride with health care while I pay $5-10k (depending on services used) every year. That certainly is not just!
Maybe we need to decide what rights can infringe on others. You have a right to health care. Providing someone else is willing to give you that right. Does your right to go to the doctor does not superscede my right to not have people come into my house or bank account and take my property?
The only reason why all this crap is even possible is the ridiculous witholding tax....just take an extra few % out of their paycheck at a time. Fare tax, flat tax, progressive tax, I don't care so much what we have if we would only make people right their big check at the end of the year, rather than picking it from their pockets every two weeks at a time.
"society should keep people from dying."
Until what age?
My dearest Megan, you are neither an anarchocapitalistic libertarian nor classic liberal, as wikipedia classifies you. No, you are hopelessly confused.
I find it amazing how the left will expand government on the assumption that every program will achieve its goals, by its very existence. I am equally amazed by the quasi-libertarian approach of extreme selfishness poorly disguised as ideology prepares them to throw out the baby because the bathwater has no soap.
The fact that you don't think basic cable is part of a minimum standard of living tells me you've been reading Michael Cannon's blog at the Cato. It doesn't inform a discussion on standards of living. Most of my patients (I take care of poor uninsured Hispanics) have cell phones, without which they could not get to day labor jobs. Maybe cell phones are not part of a minimum standard of living?
I think people have gotten lost in the health care debate. Why do we want it covered in the first place. I have asked that question a thousand times before (on my blog and elsewhere) and never gotten a satisfactory response. We need expanded coverage, but without answering that fundamental question, we'll end up with a Canadian style system made worse by American polarization of politics.
I think--I think--that single-payer advocates and I share basically the same moral intuition, which is that society should not let people die from hunger, cold, or lack of medicine.
The first two are easy--food and basic shelter are relatively cheap. But that last is problematic. From lack of how much medicine? I agree that we shouldn't let people die for lack of, say, a vaccine, or medicine, or a tooth extraction or appendectomy.
But as medical technology improves, we find more and more really expensive things we can do to save lives that we couldn't do before. And I don't think we should force taxpayers to pay for the indigent to receive these treatments. Ideally, there should be some kind of sliding scale based on age that specifies the maximum the government can spend on treatment for the indigents that might start at, say, a million dollars for children under 18, and then go down to $10,000 for people over 70.
Zagreus Ammon wrote: The fact that you don't think basic cable is part of a minimum standard of living tells me you've been reading Michael Cannon's blog at the Cato. It doesn't inform a discussion on standards of living.
Voluntary entertainment choices aren't part of a standard of living? If you can afford $__/mo for a luxury item, then it follows that to a reasonable third-party observer, your minimum standard of living has been met, and nobody else is under obligation to pay for your medical expenses -- even if your priorities were misplaced and you should, in fact, have been setting that money aside for the rainy day. That's what personal responsibility is (or at least, used to be) about. Obviously it complexifies when depednent entities (notably children are involved), but if that logic isn't at least the basis of policy, be prepared to shovel large amounts of money into a rat hole.
Zagreus Ammon wrote: Most of my patients (I take care of poor uninsured Hispanics) have cell phones, without which they could not get to day labor jobs. Maybe cell phones are not part of a minimum standard of living?
Then how did they do it before cell phones, I wonder? There is such a thing as a business expense, and when that is not the case, it is also reasonable to observe that unnecessary items can very quickly become useful to necessary ends. Unfortunately, that doens't really address the root problem among many low-income classes, which is a complete ignorance to responsible money management.
In my limited experience, it is possible for many low-income people to accept responsibility if someone woould show them that (1) this is how money is budgeted and saved against uncertainty and (2) nobody is going to step up to bat for you if you don't, and given your present circumstances, you will almost certainly suffer the following unpleasant consequences: ______.
Unfortunately, the unrestrained generosity of persons with access to other people's money quickly destroys (2), in which case a person has no need to pay attention to (1), even if someone else shows it to them. Well-managed private charities sometimes pull it off by making limitations to suffering dependent upon demonstrated milestones of (1), but government handouts? Forget it. The Clinton administration actually took a step in the right direction with welfare reform, and got lots of howls from well-meaning, but misguided, left-of-Clinton liberals in exchange.
"Yes, I'm sorry, my libertarian brethren just started screaming at the monitor. Yes, I'll turn in my membership card and secret decoder ring at the Cato Institute. But there you are: I think along with crime prevention and courts and public health, society should keep people from dying.
I want to see private charity bear as much of the burden for social service provision as possible, while realizing that the government will nonetheless have to provide fallback services."
I'm not sure whether you're simply being sarcastic here, or whether you actually believe that you differ that much from the typical libertarian view. Either that, or maybe my views differ more than I think from the standard Libertarian.
I'd like to think that we all believe that there is a necessary amount of social responsibility towards each other required in life. I think the only difference between any of the major world views is who and how it should be provided. My view has always been that private charity given willing by others, and accepted willingly by others is the most efficient, and also the most likely to be accepted, and I think most of those who consider themselves to be libertarians would agree.
I'd also go one further. It's not just that private charity should shoulder more responsibility, but also extended families on their other family members. We've lost that entire concept in this country. The government has become our extended family.
The U.S. is not a socialist state (see http://tinyurl.com/2znnvl). No one is entitled to be given a house, car, food or health care, etc. If we want these things, we have to earn them. The government does not earn money. Perhaps some of us should take a civics class and learn about America. We all have to labor for what we want. For those who need help there are the charities and state programs. We need to fix the health care issue but we cannot fix it unless we know how it is broken. For the answer, please see http://www.InteliOrg.com/
society should not let people die from hunger, cold, or lack of medicine.
Society is not government. And based on my work with various charitable organizations, society doen't turn away from people in such dire straights, though frequently such people aren't interested in help since it means a loss of autonomy.
"society doen't turn away from people in such dire straights, though frequently such people aren't interested in help since it means a loss of autonomy."
Is this why we've finally cleared up that pesky homeless problem? Seriously, this is just flat-out false. Here, for instance, is a National Academies study estimating 18,000 excess deaths/year because of lack of health insurance. Now you can argue that this is an acceptable price to pay or that other outcomes would be worse if we instituted a national health care system. But to say that private charity is sufficient to make sure that nobody dies from hunger, cold or lack of medicine is provably wrong.
What does "excellent health care" mean? It could be the doctor-defined "standard of care". It could be government-defined, ala the FDA. It could be insurance-company defined.
Each of these institutions has biases and irrationalities, which in our case lead smart guys like Robin Hanson to conclude we're wasting upwards of half our health care money.
Or it could be individually defined, based on what one is willing to spring for, like most other things in our lives. That, like most other autonomy-oriented policies, doesn't work for children...
The system you propose, not so different than the one we actually have, places the responsibility for my health care on every American but one: myself. I decide what I eat, what care to seek and whether to follow doctor's instructions, what to do or not do. Some economists claim that such a system will be plagued by the cost inflation that we have seen.
If we think that the everyone-else-pays system is good for health care, I think we should extend it to gasoline purchases. Most people, including the poor, use cars to go to work. Therefore, we should have national gas insurance. Some economists may predict runaway increases in fuel consumption and prices as a result, but I don't think it's right to quibble about costs when people's livelihoods are at stake.
So, I have a moral responsibility to pay for the well being of people who can't afford it. When do they acquire the moral responsibility to take care of their own well being? If there was a good answer to that, it would be easier to convince people like me.
Megan,
Hardcore libertarians, I am sure, have always considered you at best a friend. I think you are the closest thing I have found to a 'liberal-itarian'.
Regarding private charity: Why in the world would anyone provide those services if the government is guaranteed to step in and make the difference?? It would only make sense to provide the service if it would go unfulfilled otherwise. For example, if someone handed you $100 and put you in front of two people. You have to choose who to give it to. If you don't give it to the first person, they can go around the corner and get a voucher for the equivalent amount of money. The other person has no recourse. It would make sense to give it to the person (or cause) that would have to do without if you did not fund them (or it).
I read the posting thru the lens of the S-CHIP debate. And (committed lefty that I am) can agree that in a pure, detached moral argument there is much that is reasonable and even 'ethical' in Bush's argument--and Megan's. If I understand it, getting to practical terms, if you can afford a nice car, a full screen HD TV and nice clothes, you do not have the 'right' to gov't provided Health Insurance.
OK. I concede the point. I've paid my own insurance premiums. They were roughly the same cost as the advertisements clain is the monthly lease charge for a damn fine car. I drove my old car and covered my family. It was the 'right' thing to do.
Now...lets take that to the voters. As it seems we are likely to do. And the Dems are going to hand the Repubs their head. Smiling.
Once again the Right proudly proclaims: "In your heart, you know we're right". Worked really well in '64.
"For one, I think government is, on average, a more comprehensive but less efficient provider of social services than private charity; fewer people slip through the cracks, but government agencies generally do a worse job with their clients than private ones, for a variety of reasons that I will elaborate elsewhere."
I look forward to reading that.
Private charities are woefully inefficient (not to mention nearly insignificant). The United Way, which is now one of the more efficient charities after their scandalous behaviour became public, has administrative costs of over 25%. This is about the same as food stamps. SSI, has administrative costs of about 7%. In general, about 10% of private charitable donations make it to the poor as goods, services or grants.
I have an entirely different view of how we should handle welfare. I would like to see the government build apartments for the homeless. The apartments would be small, one-room efficiencies with basic amenities (a bed, bathroom, table, chairs, etc... maybe a TV). You would be fed from a communal cafeteria that provided free, nutritious but not particularly tasty food. You would be permitted to bring whatever you wanted with you and keep it in your room that you lived in.
I wouldn't means test, I'd let anyone who wanted to stay there. But they couldn't alter the units or occupy more than one. There would be some basic rules of behavior strictly enforced. They would give up some privacy and freedom to live there, but living there would be entirely optional.
The idea is that we would be able to guarantee that the homeless/poor/whatever got basic shelter and food. If someone was happy living there, then fine. If they wanted to improve their lot, they'd have to get a job, make some money, and move.
I'm not certain this would work and I've not worked out all the details (and won't, it's not like anything like this would actually be implemented).
EI
Putting aside that parents essentially leech off of benefits given for their children...
I'm libertarian as they come - when it comes to adults that have been given a fair chance. For children, I'm a socialist. State services should be expanded for children through high school (perhaps normal college age) drastically - all three meals a day and not the crap that passes for many school lunches, better teachers, better adter-school activities, money for clothes if their family can't afford it.
But at a given age, you get cut off. Totally. You've had the chance to develop marketable skills and get a real job. So if you don't, you starve and die. If you're not valuable enough to command a health care package as part of your salary, you'll get turned away at emergency rooms.
Essentially, give everyone a far better chance to compete. Then hold them really responsible. Private charity can fill in the gaps.
That said, I'm not willing to go this route until we really are giving a fair chance to everyone. So it will take 20 years or so to achieve.
Earnest: NYC tried something very similar. The homeless didn't want to live there.
Njorl - That's a measure of efficiency that doesn't concern itself with effectiveness. What percentage of the money actually gets spent on or given to the the target should not be the only measure of efficiency. I could get $1000 of cash and hand it to some homeless person. My efficiency might be near 100% by your measurement, but its very likely that the donation will not accomplish all that much.
Njorl is correct. There is a familiar and well-defined explanation of why private charities are less efficient than government agencies. Basically, private charities mainly serve the interests of their donors. They do not have contracts with their beneficiaries; their beneficiaries have no enforceable claims on them, and are usually expected to be grateful for whatever they get. Donors, on the other hand, do have enforceable claims, along the lines of "it's my money and I expect it to be spent in accordance with my preferences". If donors are displeased with a charity's actions, they will cut off funding.
As a result, charities tend to spend an enormous amount of time and money pleasing their donors, rather than serving their beneficiaries. They spend a huge amount on soliciting new donations, through advertising and fundraising. They conduct tours of their operations for powerful donors, and print up reports to show donors how marvellously their money is being spent. More and more, they are required to conduct constant "monitoring and evaluation" of their programs, with program activities slotted arbitrarily into dozens of pre-determined categories and reports filed monthly on how many beneficiaries have received what. Monitoring and evaluation is in principle a good idea, but these kinds of paperwork evaluations often lead to the manufacturing of bogus statistics, or they lead NGOs to reorient their activities in order to churn out the kinds of statistics that look good on the M&E reports.
Because they are simply paperwork evaluations filed to keep donors happy. Real evaluations would be evaluations conducted by the BENEFICIARIES. But beneficiaries of NGOs have no means of exercising power on the NGOs' activities, of indicating their dissatisfaction in a way that would lead to improvements.
Government agencies, on the other hand, serve their citizens. Their beneficiaries have enforceable claims on them: Medicare, the CDC and the FDA are obligated to the promises they make to the citizens they serve. Complaints by beneficiaries can be enforced through the political system. It's a kludgey means of enforcement, but it exists; it has its incentives lined up right. With NGOs, the incentives are lined up all wrong. I mean, I love NGOs, I love the people who work for them. But they all suffer from this systematic problem of being more responsive to their donors than to their beneficiaries. And that makes them too often less efficient and less effective than government agencies.
Dan Miller said: Here, for instance, is a National Academies study estimating 18,000 excess deaths/year because of lack of health insurance.
Total deaths in the US in 2004 (the latest number I could find easily) were 2398343, so 18000 excess deaths is a tiny number. How much money should we be willing to spend to prevent 7/10ths of 1% of deaths from happening?
Plus if the 18000 number is right, that's the number of deaths out of 46,600,000 uninsured. So really we'd have to insure 46 million people to keep 18000 alive per year.
Hardly seems worth it to me. How much is it worth to you? Real dollars now, $100 each for the 46 million so 18000 stay alive? That's $255,555 for every non-death. $1000? $5000?
Yeah I know, I'm heartless.
To anonymouse:
About Personal responsibility: NOT without context. People make good or bad choices based on the choices presented to them. Poverty limits those choices to begin with, so don't waste my time or anyone else's time without mentioning in the same breath God's Grace without which you could not be judging so all-powerfully.
To say anything about the "root problem among many low-income classes, which is a complete ignorance to responsible money management" is about as circular an argument as anyone can make.
Please, let's start over: what is health care supposed to accomplish:
1. Help level the playing field for the poorest 10, 15 or 25% of the population (which end you favor is political, to favor 0% is immoral)
2. Improve the standard of living for the majority of the population. (If you don't think that subsidized health care for low income persons is important, you must not let the old guy at the supermarket to bag your tomatoes...)
brooksfoe wrote: Government agencies, on the other hand, serve their citizens. Their beneficiaries have enforceable claims on them
That's the pie-in-the-sky view that they teach in high school civics.
The real world, meanwhile, has agencies such as the DMV and various Departments of Revenue -- some offices of which are admittedly run better than others, but layer up enough bureacracy and take away the amount of discretion that the employees have in dealing with marginal cases, and the inevitable result is that the agency doesn't "serve" in any meaningful sense; it simply has to process enough people in any given day to justify continued funding, no matter how ridiculous the processing method becomes.
That's what happens when there is no competition for an alternative provder of a service, and no risk of a competitor arising. In time, even the dedicated civil servants are completely hamstrung by layers of arcane rules and the byzantine methods those rules create and enforce; and those civil servants who aren't service-minded either devolve to mindless chair warming, or begin creating personal power trips by enforcing every infuriating scintilla of the rules that they can find.
Njorl and brooksfoe are on the right track. I am not sure that government is inherently any more or less efficient than the private sector. I do know that I don't trust politicians who have undue influence over government (?!?!) and that you can't ever fire an incompetent public sector employee. But I can think of a couple of examples where they were farmed out to a private not-for-profit.
It is possible to develop a system by which we measure specific outcomes and use data to make policy changes. This is the way successful businesses make changes.
On second thought, name calling and ideological head bashing is much more fun.
Zagreus Ammon wrote: Poverty limits those choices to begin with, so don't waste my time or anyone else's time without mentioning in the same breath God's Grace without which you could not be judging so all-powerfully.
Sounds like you've got enough of that to three or four of us, so I'll leave it to you to judge God's Grace. I was talking about practical realities, based on my own experiences, thanks. Maybe your experiences are different, or maybe your analyses of those experiences are just as biased as mine.
Zagreus Ammon wrote: To say anything about the "root problem among many low-income classes, which is a complete ignorance to responsible money management" is about as circular an argument as anyone can make.
It's not a circular argument; it's a circular problem, which I have obseved first-hand among some former hispanic acquaintances and various other experiences which are also both relevant, and unnecessary for you to know the details of.
At any rate, the circle is obvious: No experience with money means no experience with money management; no experience with money management means no knowledge of how to budget and save; no knowledge of budgeting and saving means any surplus at all, when it does come along, gets dissipated; and when all money is spent as soon as it comes in, there is obviously no opportunity to gain experience with money. Wash, rinse, and repeat until something bad falls on your plate, and now society has a problem because you have nothing in reserve to counter it.
Or do you deny that this occurs among a large portion of low-income earners?
That's the pie-in-the-sky view that they teach in high school civics. The real world, meanwhile, has agencies such as the DMV and various Departments of Revenue
anony-mouse: compare the performance of either of these two agencies to that of any NGO in the world and you will see that both accomplish something which no NGO can do. The DMV registers every single vehicle in the United States. The IRS processes taxes and returns the appropriate refund to every single taxpayer within a reasonable period. If the IRS makes an error, you can take it to court. If the DMV makes an error, you can take it court.
If the Red Cross makes an error, you can't do jack. Because the Red Cross never promised you anything; so take what you get and be grateful. I am not aware of a single NGO which subjects itself to a legally enforceable contract with its beneficiaries about the level of service they will receive.
My observations on this subject are not based on high school civics classes. They are based on observing the performance of (mainly American) NGOs in Africa and South-East Asia.
brooksfoe - Re: "their beneficiaries have no enforceable claims on them"
Thats a point in favor of private charities.
Re: "The DMV registers every single vehicle in the United States. The IRS processes taxes and returns the appropriate refund to every single taxpayer within a reasonable period."
The DMV registers almost every vehicle because they force people to register. That's not an argument that the DMV is better, its an argument that they (or the people enforcing the applicable laws) are more powerful.
The IRS doesn't process every return in a reasonable period.
In some ways perhaps the IRS is efficient, but when you consider the tax system as a whole. With all its complexity (at times with even the IRS not knowing the right way to deal with certain tax situations), and dead weight losses, its far from efficient.
"Government agencies, on the other hand, serve their citizens... ...it has its incentives lined up right."
Brooksfoe, thanks, I haven't laughed that hard in a while.
Brooksfoe,
The added social benefit of charity -- aside from helping people -- is that it has the power to influence the behavior of recipients in productive directions. Because those who receive charity aren't entitled to it, they don't have an entitlement mentality, and are more often willing to do other things the charity requires of them (e.g., participating in a substance abuse program, etc.).
Thus religious charities are often more successful in rehabilitating ex-cons and the like than government agencies that throw money at someone regardless of their behavior.
brooksfoe - Re: "their beneficiaries have no enforceable claims on them"
Thats a point in favor of private charities. - Tim Fowlder
See, this is exactly what I'm talking about. What you just wrote doesn't make any sense. What is the point of a charity supposed to be? To serve the beneficiaries, or to make the donors happy? If a charity wants to serve its beneficiaries, why won't it commit to guaranteeing them the benefits it's supposed to deliver? Only because it wants to protect itself in case its own incompetence causes it to fail to deliver, or in case donors change their minds and don't provide the funds. Such behavior would never be tolerated in the business sector; there, you contract to deliver the goods, period. So why should charities, NGOs, whatever, be held to a lower standard? Whose interests does that serve? Not the beneficiaries, that's for sure.
The ideological bias of libertarians towards anything with the words "private" attached to it prevents you from understanding what is in front of your noses. The whole rationale for private over state-run economies has to do with the superior way incentives are distributed in the private economy. What too the libertarians here seem incapable of recognizing is that with charities, which are not motivated by self-interest, those private-sector incentives do not exist. So the superior efficiency of a private organization over a public one simply vanishes.
You can sue the fire department; you can sue the police department; you can sue the IRS, for failing to deliver the level of service they are legally bound to provide. You can't sue the Red Cross unless you're a DONOR, not a beneficiary; they aren't legally bound to provide anything to their beneficiaries, only to donors. Who does a business serve? Its customers. Who does a charity serve? Its donors. Who does a government serve? Its citizens. Maybe you disagree with that last statement, but in that case it would seem to me you sort of disagree with the Constitution, if you see what I'm saying. "Of, by, and for the people"?
Bambi - I would make it the only option... their choice whether to live there or not.
brooksfoe - I regularly fail to register my car in time. In fact, I probably miss a month or two every year. In addition, I don't always get my car inspected on time. So far, I've gotten a ticket once for that. They're not very efficient. And their rules were only enforced by the police and the courts. If NGOs could call on the police and the courts, they might operate differently...
EI
The 18,000 factoid is bulls***. The advocacy group who put out this “study” is basically taking people who were in situations like car accidents and didn’t go to the ER even though the ER won’t turn anyone away for lack of ability to pay or who were eligible for taxpayer-funded care like Medicaid but didn’t enroll. Which pretty much proves Christina’s point that “society doe[s]n't turn away from people in such dire straights, though frequently such people aren't interested in help since it means a loss of autonomy” because we’ve already provided a safety net for these people and they chose not to use it to their detriment.
You can sue the fire department; you can sue the police department; you can sue the IRS, for failing to deliver the level of service they are legally bound to provide.
I hate to break this to you, but, no, you can't.
Re: Private charities and efficiency. How hard would it have been, Megan, to have done the research before you posted?
How hard would it be, Atlantic, to hire journalists who are willing to do work before they make claims?
Kevin:Total deaths in the US in 2004 (the latest number I could find easily) were 2398343, so 18000 excess deaths is a tiny number. How much money should we be willing to spend to prevent 7/10ths of 1% of deaths from happening?
9/11 killed around 3000 people. We've spent upwards of $500 billion (and counting) as a result.
Evaluated purely as an economic problem, our response to 9/11 has to be seen as an incredibly inefficient and wasteful misuse of resources. That's why such things aren't evaluated as economic problems. But people keep coming back and making economic/efficiency arguments. These are probably the same people who keep railing against the billions in foreign aid the US hands out every year, completely ignoring the fact that as a percentage of the budget foreign aid barely registers.
It's interesting how discussions work, isn't it; if you are arguing against something people support for emotional reasons, make an appeal to economics, and if you are arguing against something people support based on economics, make an emotional appeal. I've done it myself. And in the end it always comes back to a question I posed before: what is the purpose of government? Your answer to that question leads to all the rest.
Megan: And having finished describing which moral intuitions I don't find compelling as a rationale for single payer, I wanted to go on record elaborating the ends that I support, even if we disagree about the means.
Our disagreement is that I think your means won't bring about our ends.
Christina: Society is not government.
No, but government is the most powerful expression of society's collective will, wouldn't you agree? When there's a flood or a hurricane, we don't call on the local Baptist church to respond to the disaster; we expect local, State, and ultimately the Federal government to intervene to protect life and property. Local charities can help at the margins but the lion's share of the effort is best handled by a larger organization that is dedicated to that kind of service- and that's right up government's alley. There are also other issues with relying on local charities (what if I'm uncomfortable receiving aid from a religious institution, or they are unwilling to provide to me because I'm not a believer; nevertheless I still need the aid) that can reduce their effectiveness, never mind the likely limits in terms of resources a smaller institution such as a charity would face that a government organization would not (given competent management and planning).
The same is true when you start looking at non-natural disaster situations such as health care. I sincerely doubt my local Baptist church would be willing to sponsor my health care given my opposition to their beliefs. Expecting local charities to efficiently provide services to all citizens given their various agendas just seems unreasonable to me; but a government can provide such services on a much more egalitarian basis, as its agenda (theoretically) is helping all citizens.
Juan: The added social benefit of charity -- aside from helping people -- is that it has the power to influence the behavior of recipients in productive directions.
I happen to think that aid should be given without preconditions. You shouldn't have to accept Jesus as your personal savior in order to receive aid.
Bambi: Earnest: NYC tried something very similar. The homeless didn't want to live there.
It appears they are nevertheless still trying it. And I know Dallas is trying it too.
http://www.knowledgeplex.org/news/754131.html
To get back to the healthcare question.
No matter what, the basic question is economics. What resources are to be allocated to healthcare.
In the wonderful world of single-payer systems (i.e., Great Britain) you cannot have a kidney transplant if you are over 55. Imagine implementing that rule for Medicaid.
If I remember correctly, Oregon tried to guarantee healthcare for everyone by budgeting $X per year. Then they calculated the effectiveness of each medical procedure and paid for the most effective going down the list until the buget ran out. That lasted until a woman with a sick child got on TV and blasted the "heartless" politicians until her child had an expensive but low-return procedure. I don't know the long term results and I don't fault the woman. I would have done the same.
Here in Georgia, the state pays for nursing home care if you don't have liquid assets to cover the care yourself. If you have a house, the state gets a lien on it and when you die they sell it and recover costs, leaving $25k for the heirs. Some heirs have complained. They think the exemption should be $100k. After all the state owes it to their mother, or whoever, to give the care. The house is the "family home." The heirs should get that. So every taxpayer in the state of Georgia needs to give them a penny ($100k) because the state owes mom medical care.
Do we owe Mickey Mantle a new liver and all the associated costs because he drank his away?
In the current SCHIP debate do we owe a family that makes $75k free insurance, taken from the single mother that makes $30k, but has health insurance provided by her employer?
Suppose there is a child dying of some cancer and the oncologist says "I have a theory that the child might be helped by this new untested treatment. Just give me $100k and I'll try it out." Does that get covered?
It sounds nice to say that everyone should have excellent health care, but what specifically does that mean and how much does it cost?
EI:
I would like to see the government build apartments for the homeless. The apartments would be small, one-room efficiencies with basic amenities (a bed, bathroom, table, chairs, etc... maybe a TV). You would be fed from a communal cafeteria that provided free, nutritious but not particularly tasty food.
Sounds like Pruitt-Igoe with a soup kitchen. I'm skeptical.
liberalrob:
I know the exact Dallas project you're talking about. Central Dallas Ministries wants to renovate a 15-story high-rise in downtown Dallas to include 50 units for the homeless and another 150 units for low-income tenants. Apparently the units will start at 300 sq. ft.
I was surprised to hear about the project, because it was my understanding that the trends in low-income and homeless housing were moving away from high-rise apartment blocks to low-rise apartments, townhomes, and bungalows. Hopefully it will turn out better than past high-rise public housing efforts.
Referring to charities, brooksfoe said, "More and more, they are required to conduct constant "monitoring and evaluation" of their programs, with program activities slotted arbitrarily into dozens of pre-determined categories and reports filed monthly on how many beneficiaries have received what."
And if you don't think that this burden is also laid upon government agencies, you have never worked for the government. I estimate that over 10% of my local school district's budget is taken up in providing just this sort of monitoring and evaluation.
Government is the expression of the collective will if by collective will you mean those in power forcing the rest of us to do their will.
Government is coercion. Some coercion may be a good thing, but I'd rather not dress it up in fancy language and worship it.
"I happen to think that aid should be given without preconditions. You shouldn't have to accept Jesus as your personal savior in order to receive aid."
But you should have to accept the responsibility to try to help yourself at the very least (and eventually help others if possible) in return for the help you have been given. That's the implied obligation of accepting charity, whether it's from a religious or a secular organization. When aid comes with no expectations and with a sense of entitlement, as it often does from the government, it can have disasterous consequences for the recipient.
You can sue the fire department; you can sue the police department; you can sue the IRS, for failing to deliver the level of service they are legally bound to provide.
"I hate to break this to you, but, no, you can't." - Rob
Citations:
Gonzales v. City of Castle Rock, 307 F.3d 1258 (10th Cir. 2002). The Tenth Circuit Court of Appeals held that a mother whose children were murdered by her estranged husband may sue the city police department for failure to enforce a temporary restraining order against him.
Bronx Blaze Survivor To Sue City? (NY Press, June 13, 2007) Mamadou Soumare, one of the men who lost his family in last March’s Bronx inferno, moved to file a $100 million negligence lawsuit against the city yesterday, filing a notice of claim reserving his right to pursue the matter in the future. The claim charges that the Fire Department failed to respond in a timely manner, listing potential defendants as the FDNY, Department of Buildings, the Department of Housing and Moussa Magassa—the homeowner who also lost five children. Mayor Bloomberg noted that the FDNY’s response time of 3 minutes and 23 seconds once a neighbor called 911 was well within the range for which the department strives, adding, “I don’t think there’s any basis for a suit and I don’t know that there’s going to be a suit.”
With the IRS, I'm not sure whether you can sue them, but there are legal procedures for contesting your tax filings which are binding on the IRS based on the fact that they have rules as to what they demand from citizens and what they provide. Again, relationships between beneficiaries and charities impose no such legal obligations on the charities, meaning they have little incentive to meet performance benchmarks.
JohnGalt47: The British have an integrated health plan, much like the medial services provided by our armed forces. They don't have a single payer system. And where did you get your information about limiting kidney transplants to people under 55?
Rob: If the Democrats win a big enough victory in 2008 and if they stick together, the US will have a Massachusetts style health insurance plan within a few years. Among other things, this means that low income women will be able to afford pelvic exams, pap smears, and mammographies. This in turn means that more cancer will be detected in time for surgery. I realize this will be a terrible blow to you, and I extend my sympathy in advance.
"Most of my patients (I take care of poor uninsured Hispanics) have cell phones, without which they could not get to day labor jobs. Maybe cell phones are not part of a minimum standard of living?"
How about cigarettes? Most of the poor people I know spend more on those than phone service costs. True, it's only $5 at a time - but it's $5 several times a week.
And they'll have their heat and lights shut off for non-payment, even when it's -20 outside, before they'll give up smoking. That's the problem with Megan's ideal that assistance should be in cash without the government or private charities poking their noses into the lives of the poor. Maybe Dickensian poor would have (for the most part) spent it wisely, but that was because the most irresponsible ones were already dead.
brooksfoe - Look at the comment right before your reply to me. Juan's already given my response. In case you don't want to look for it - "The added social benefit of charity -- aside from helping people -- is that it has the power to influence the behavior of recipients in productive directions. Because those who receive charity aren't entitled to it, they don't have an entitlement mentality, and are more often willing to do other things the charity requires of them (e.g., participating in a substance abuse program, etc.).
Thus religious charities are often more successful in rehabilitating ex-cons and the like than government agencies that throw money at someone regardless of their behavior."
To answer your question - "What is the point of a charity supposed to be? To serve the beneficiaries, or to make the donors happy?" The point is to improve the situation of the recipient. That isn't the same as serving the recipient, at least not in the sense of being under the control of the recipient or being used for anything the recipient wants.
Thorley - Re: "The 18,000 factoid is bulls***. The advocacy group who put out this “study” is basically taking people who were in situations like car accidents and didn’t go to the ER even though the ER won’t turn anyone away for lack of ability to pay or who were eligible for taxpayer-funded care like Medicaid but didn’t enroll."
Your claim is very believable, but do you have something more solid than your own claim to debunk the study?
"Government agencies, on the other hand, serve their citizens."
Brooksfoe, thanks for the comedy.
brooksfoe - Re: being able to sue those who give you money. - I wouldn't exactly call that an advantage in terms of the overall system. It might be an advantage for the recipients narrow short term self interest (or longer term if he actually wins a large award or settlement), but a lot of lawsuits, and more generally a sense of entitlement to other people's money, isn't something good for the country as a whole.
Tim Fowler, this discussion veers away on one small point of what Megan was writing about, but let me just assure you that there is a systemic problem with charities and NGOs regarding the divergence between their big claims and their small follow-through. I'm not so familiar with charities inside the US as I am with NGOs abroad, but what I read about, for example, the utter mess of the Red Cross's involvement in Katrina sounds all too familiar. The basic problem is a lack of accountability, because they expect people to simply be grateful for whatever help they do provide, rather than committing themselves to provide a guaranteed level of service and then following through on that. I'm not saying it would be a good thing for beneficiaries of charities to start suing people right and left. What I am saying is that it would be good if beneficiaries could hold charities accountable for their promises, because that would lead charities to strive harder to serve the interests of their beneficiaries, rather than trying to please their donors. I'm just trying to draw the contrast between the professionalism of an agency like the fire department and the loosey-gooseyness of a charity like the Red Cross, and pointing out that this has to do with the fact that the fire department is held accountable by the people it serves, rather than by the people who give it money.
brooksfoe - Red Cross' involvement in Katrina a mess? OK, maybe, but what about FEMA's? And FEMA didn't just do a poor job itself (probably a better job than most people think it did, but it could be a lot better than that and still be a poor job) it also hampered private charitable efforts.
If a recipient can hold a charity or government organization responsible for giving a certain amount of assistance, than the recipient will have a sense of entitlement to that assistance. And with such an entitlement will have less need to make efforts on his own to improve his lot in life. That's the exact opposite of what we need. The government, at least the government at its best, is really good at shoveling large amounts of money around. But the point isn't to shovel money around or measure how efficiently the money can be shoved around. The point is to help people out in an emergency, and possible to help them escape poverty and dependency, not to just funnel them money on a regular basis. Ideally the aid should be short term except perhaps for people utterly unable to improve their situation. It shouldn't be something that most recipients can rely on for the long run.
As for a fire department. To the extent they are professional, (and not all of them are very professional) a lot of it has to do with the nature of the challenges they face. They face specific challenges that can be overcome. Their performance produces results that usually aren't that hard to evaluate or understand. Also if they don't act in a professional and competent manner they put their own lives, and the lives of others at fairly immediate risk.
As for the Red Cross I think you overstate its "loosey-gooseyness" esp. and understate the mistakes and problems of the most similar government organizations.
This case was reversed by the Supreme Court in Town of Castle Rock v. Gonzales, 545 U.S. 748 (2005) which held that there is no Fourteenth Amendment property right in the enforcement of a restraining order (which was the issue in the case you cited).
"Red Cross' involvement in Katrina a mess? OK, maybe, but what about FEMA's?"
When politicians run on the premise that government does not work, then go about proving it by appointing incompetents to run important agencies, that is not proof that govenment doesn't work. It merely proves that government can be sabotaged.
You might as well point to charities that were run as scams to show that charity does not work. There's a hell of a lot of those. They tend to have even quicker response that real charities, popping into existance hours after 9/11, Katrina and the Indian Ocean Tsumami.
Red Cross' involvement in Katrina a mess? OK, maybe, but what about FEMA's?
Agreed: gutting formerly competent government agencies and replacing professionals with unqualified political cronies, and then failing, at the presidential level, to respond to urgent requests for authorization from said agency, are going to downgrade a government agency's performance. On the somewhat bright side, FEMA has faced a level of public scrutiny and outrage which a private charity would be unlikely to face, no matter how poorly it performed; and in all likelihood, once a competent administration gets back into power, FEMA will be revamped. NGOs (let's drop the word "charities" here, it's somewhat antiquated) can usually go stumbling on indefinitely from failure to failure, so long as they keep their donors happy.
In general, using the failure of the government in NOLA as a demonstration of why governments, in general, are poorly equipped to handle disasters is cynical and circular. The government has handled NOLA poorly, and has turned the job over to NGOs, because it is currently run by people who don't believe in government and want to hand its functions over to NGOs. So THAT is the philosophy which is being tested in post-Katrina New Orleans. And look how well it's working.
Thorley Winston: looks like you're right and I was wrong, you can't sue the police department for failing to protect you, only for beating you up or searching you for no good reason. But isn't there any legal recourse if the police literally decline to respond -- if you call to report a burglary in progress and they never show up?
The results of the response to Katrian where pretty bad to a large degree because of the scale of the disaster combined with a poor response by local and state governments. FEMA did bad as well, but its not like it uniformly did a good job in the past.
But lets assume for the sake of argument that FEMA did the worst job imaginable and that its all because of Bush and his appointees, and that if the Democrats were in charge everything would have been just great. Well even assuming that points out the risk of relying on government organizations. Even if its a case where "if we have the right guys in office everything will be ok" (a highly dubious assumption), the "right guys" aren't going to be in office all the time.
Also whatever FEMA's performance and whatever the reason, the state and local governments (not run by Bush BTW) obviously did a poor job, arguably a horrible job.
As for public scrutiny causing everything to be fixed? Well scrutiny of previous government mess ups hasn't kept the government from going back and messing up again. An organization like the Red Cross has more motivation to respond to such scrutiny. If it doesn't it will get less money. If it repeatedly fails in a big way the difference will be massive, possibly up to the end of the organization. Meanwhile the government can just collect taxes, and maybe fire the political appointee if the pressure gets too high, without ever really reforming the system in any fundamental way.
But isn't there any legal recourse if the police literally decline to respond -- if you call to report a burglary in progress and they never show up?
Just about none. You can try to get people responsible fired by making a political campaign against them or their bosses, but you can't sue them, or if you do you can't win.
Thorley Winston: looks like you're right and I was wrong, you can't sue the police department for failing to protect you, only for beating you up or searching you for no good reason. But isn't there any legal recourse if the police literally decline to respond -- if you call to report a burglary in progress and they never show up?
No. They have no legal obligation to protect you; that's long established. The question in Castle Rock was whether they could be sued even in the exceptional case in which the victim already had a restraining order. The answer was no. There's no right to police services.
scrutiny of previous government mess ups hasn't kept the government from going back and messing up again. An organization like the Red Cross has more motivation to respond to such scrutiny. If it doesn't it will get less money.
The main scrutiny which the Red Cross has been forced to respond to has nothing to do with how well it's serving beneficiaries. It has to do with whether it's using donations for exactly the purposes the donors intended. This is typical: donors want their money used for exactly the things they had in mind when they gave it, and they tend to give much more right after a disaster. That creates excruciating continuity problems for an organization like the Red Cross. Pretty obviously, if the Red Cross wants to respond to a disaster like Katrina it needs a constant, stable revenue in times when there isn't a disaster, in order to prepare; there's limited utility to a sudden influx of money after the disaster has already hit. And so such organizations generally use a lot of the money that's donated in crises like Katrina to fund other constant operating expenses or to build capacity for future crises. After Katrina, doing exactly this led to accusations of fraud from donors who expected their money to go directly to Katrina victims.
Funding disaster preparedness and response through voluntary donations that mostly come in after the disaster hits -- i.e., charities -- is a good way to guarantee lots of suffering. Pretending that poor governance can be compensated for through slapdash patchworks of charities is exactly the kind of chaotic third-world attitude which the US displayed to the world in the aftermath of Katrina. European countries which face similar flood issues -- the Netherlands, Austria's Danube valley, etc. -- have not displayed this kind of embarrassing incompetence in disaster response within modern memory.
And I have to say, the fact that in the US the police have no legal obligation to protect anyone is truly shocking to me. Doing a little internet research on this, it just seems indefensible. How exactly do American police departments justify their existence? What are they there for? To protect people whenever they feel like it? Whenever donuts aren't on sale? What was the Court thinking? Isn't there at least an anti-discrimination ground on which to justify this, that if police do grant protection to some people (public officials, for instance), they have to fulfill at least some standards of diligence for protecting everyone? It just seems crazy. Like I said -- you can sue the fire department for not responding within a reasonable amount of time, but you can't sue the police? Seems nuts.
brooksfoe:
You do realize the government that is able to provide police protection to everyone at all times is better known as "a police state"? That's the reason behind the current policy.
As I read your various postings, it seems that you view government as a provider of first resort, not of last. Is that a fair reading?
brooksfoe - The Red Cross has to please its donors. And if it does a horrible job of providing aid to people in an emergency it doesn't please its donors.
Also you seem to be thinking that I am saying that we shouldn't have any sort of government assistence in response to major disasters. I'm not. I'm just pointing out how government is not necessarily response or efficient, either in general terms, or compared to private organizations. Esp. if you consider efficiency to be more than the percentage of cash that goes to overhead.
re: "And I have to say, the fact that in the US the police have no legal obligation to protect anyone is truly shocking to me. Doing a little internet research on this, it just seems indefensible. How exactly do American police departments justify their existence? What are they there for? To protect people whenever they feel like it?"
They are there to apprehend criminals, and when possible to deter or otherwise prevent or stop crime. I don't understand where you get the idea that no organization can have a purpose if they can't be sued for failing to fulfill that purpose.
No, Tim, it's just that you'd think there would be some minimal standards of service which the police would be legally obligated to live up to. In the Colorado case of the woman with the restraining order, for instance, the Colorado law actually obligated the police to take "reasonable" measures to enforce the law. But the Supreme Court ruled that this Colorado law could not be seen as obliging the cops to take any particular action in any situation where taking action was up to their discretion. Which is a kind of tautological exception which absolves police departments of ever having to face legal demands from citizens, except in cases where the police have actually caused property damage to citizens. This system seems not to be the case in other countries; in Canada, as far as I can tell, there seems to be a "right to access emergency services". I'm curious whether anybody knows what the legal obligations of police are in other countries and how that affects their performance.
But I just can't help but wonder whether hostility between citizens and police in the US might be related to the fact that citizens don't have the right to demand anything of police except that the police leave them alone under certain circumstances. We frequently see lawsuits by people in black communities against police officers who have shot someone in the community; we never see lawsuits against the police because they're not doing a good enough job of protecting black people. I just never realized before that the reason for this is that you can't sue the police for not protecting you. I'm obviously not advocating a right not to be murdered, which would allow you to sue the police any time you were the victim of a crime. But there have to be at least some minimal standards of behavior that could be considered binding on police -- responding to emergency calls, or whatever? I dialled 911 a long time ago, can't you see how slow they're reacting, that kinda thing?
And if it does a horrible job of providing aid to people in an emergency it doesn't please its donors.
You would be surprised at the level of non-performance that can go on at a charity before word begins to filter back to donors. If you don't have any beneficiaries, there's no one to complain. And you can always find something to put in your brochure -- you can donate a suitcase full of pencils to the local school district, then say "We helped bring primary school education to over 50,000 children!" And put pictures of a classroom in. The American Red Cross does stuff that's similar to this, and I wasn't entirely surprised to hear how poorly they performed in New Orleans.
Again, I would not denigrate NGOs broadly, not at all. The thing that drives me up the wall is that it's the ones who do good publicity that get the rewards, not the ones who do good work. And I think the attitude that beneficiaries ought to be grateful and have no rights because that helps motivate them is actually very harmful.
brooksfoe -
Re: "the Colorado law actually obligated the police to take "reasonable" measures to enforce the law. But the Supreme Court ruled that this Colorado law could not be seen as obliging the cops to take any particular action in any situation where taking action was up to their discretion."
I don't think most states have laws like that. You only have political pressure to improve if the force does do its job. As for the court decision, it may be correct. Technically correct in that "Reasonable measures" is pretty vague, and it might be good policy as well. I don't think the courts should generally monitor and control how police perform their job (obviously any specific crime by the police could go in front of the courts, but I'm talking about normal operations, not crimes).
Re: "And I think the attitude that beneficiaries ought to be grateful and have no rights because that helps motivate them is actually very harmful."
I didn't say the beneficiaries should be greatfull that they don't have the right to sue if charities don't serve them well (which doesn't equal having "no rights" BTW). You're either misreading what I wrote, or distorting it in your response.
My actual viewpoint is that things work out better for society as a whole if such lawsuits are normally disallowed or easily defeated, because 1 - If charity is an entitlement, it removes incentives from the poor, and 2 - If the lawsuits are allowed it provides a great disincentive to charity.
I'd also add that if there is some legally enforcible privilege to receive the charity than it isn't charity any more. Charity is voluntary.