Liberty, Equality, and Market Impartiality

Classic liberalism gives rise to a number of different moral-political philosophies, in particular, conservativism and modern liberalism. The core of liberalism, whether classic or modern, concerns liberty and impartiality. The concept of liberty, guarantees the individual a sphere that is his or her own. Liberty provides an area in which one can operate unencumbered by the strictures of the society within which one lives. The state remains impartial to the individual's choices in this sphere: it guarantees liberty.

Given this core, how does modern liberalism address inequality? Liberal notions of equality celebrate the belief that all people are the same in their humanness, that no matter what physical and mental differences exist between us, society accepts each and every member as beings of incomparable worth. Thus, the concepts of both liberty and equality can represent the optimistic belief in perfectibility that characterizes liberalism of all flavors. Yet, as noted above, classic liberals and especially their conservative offspring might see some conflict between the values of liberty and equality. To understand this potential conflict, let us define liberalism more closely.

In the liberal state, an individual's liberty is primary, and the individual enjoys and utilizes his "freedom from" interference to develop his notion of a good life. This liberty is guaranteed by rights. Each citizen, in a model liberal polity, has an equal set of rights that includes an equal right to opportunities. The individual's liberty should not be, or should only minimally be, hampered by the policies of the state. The classic liberal conception assumes that a free market will provide the means for maximizing an individual's free choice. The government tends to stand aside and let the market order societal relations, allowing its citizens to take advantage of their liberty.

The classic liberal state is therefore fundamentally impartial. It allows the citizen to formulate her own notions of goodness, and to pursue them with little interference. As John Rawls notes, the liberal citizen need possess only two moral powers, a sense of justice and a notion of the good.15 There are no special notions of virtue that underpin liberalism. Rather, liberalism encourages pluralism. Each citizen is allowed to develop and pursue her own sense of morality in the ideal

liberal state. The government stands by impartially, making sure that the free market economy remains in place.

Of course, as modern liberals recognize, this state is only an ideal. The impartiality of liberalism does not empty the society of its sense of community. The liberal state is a polity, and its citizens realize they must live together, and so there are constraints on liberty. Instead of a formal impartiality and rampant pluralism of moral ideals, the modern liberal state features what Rawls calls an "overlapping consensus."16 So long as there is some degree of consensus, the liberal state is a place where many views are tolerated. Certain views of moral behavior, such as those that call for racial purification, are excluded. Every Nazi or white supremacist cannot be allowed to take action based on his own sense of morally. While the liberal state does not preclude any view of society, it does exclude putting some into effect. Absolute liberty, is thus diminished for the sake of the community. The modern liberal state is accomplished only through a series of compromises with the traditional liberal ideal, compromises between equality and liberty.

The classic liberal ideal overlooks the fact that natural differences between persons are unavoidable. To bring about equality, it is thus sometimes necessary to have the state interfere in the pursuit of individual projects. Notions of equality thus tend to restrict liberties; in particular they restrict free choice in the market.

The liberal state, then, must carefully weigh the competing values of liberty, and equality. Rights often act as the operators within this negotiation. The nature of the rights to which a citizen is entitled tends to outline the compromise between equality and liberty that has been reached within a society. On the one hand, a society that creates a right to health care that requires a great deal of government subsidy to realize it, will probably sanction a more than modest interference with liberty. On the other hand, a society that sanctions a fundamental right to personal property, and that prohibits takings by the government will probably largely prohibit interference with liberty.

Indeed, different liberal states, each of which is based on the notion of what I have termed modern liberalism, will make different sets of compromises and sanction varying rights. Thus, while an ideal state can be imagined that more or less perfectly reflects classic liberalism, conservativism, or modern liberalism, real liberal states are not so pure. The United States, Great Britain, and Canada are all liberal states, yet they reflect different renditions of liberalism. (I will argue that the

United States is a modem, or should be a modem, liberal state, though certain aspects of it reflect conservative views.)

The classic definition of liberalism tended toward a state in which liberty was emphasized. The impartiality of classic liberalism extended beyond a mere tolerance for different moral points of view, to a true impartiality of the state with regard to individual activities, especially economic activities. In this sense of liberalism, a fight to health care does not seem comprehensible as a fight. Classic liberalism's fights were simply rights claims staking out negative freedom. Historically, John Locke's contractual ethics seem to condone this attitude toward rights, portraying them simply as properties of individuals that protect their liberty, a notion that is quite powerfully emphasized in conservatism.17 Rights were not really thought of as the operating concepts of a compromise between the principles of liberty and equality, but rather as a means for asserting one's liberty. The rise of personal liberty was central to the forms of liberalism-pluralism that developed during the eighteenth and nineteenth centuries and that were so well characterized by John Smart Mill.

The modem liberal state cannot, however, allow rights to guarantee liberty without regard for equality, nor market impartiality to remain entirely unfettered. Moreover, pluralism cannot run rampant, Both the free market and the choice of moral enterprises must be limited for the liberal state to be a political community. For the former, some regulations of economic activity and taxation will be necessary, to promote equality. For the latter, constraints regarding the important differences between beliefs and truths in political dialogue are necessary to main-rain the transcendent objectivity central to liberalism. In other words, to paraphrase Nagel, one who asserts that his moral beliefs are grounded in truth must be able to present that truth such that others accept it as true. This invalidates the claims, for instance, of the racial supremacist.

Perhaps the most fruitful way to conceive of the modern liberal state is to say that it takes as its constitutive ideal that citizens should be treated as equals.18 Of course, treating citizens as equals can be two very different things. In one sense the government treats citizens as equals by treating them with equal respect and concern. Alternatively, the government treats all as equals in a very different sense by ensuring that goods are distributed in an equal manner. The former is a regulative principle, while the latter is a substantive principle.

The end state of distribution is critical to the substantive principle

of equality. It requires that the government define the nature of distributive equality. This is no easy task. Consider, for instance, the distribution of health care. Some of my patients are quite well disposed to medical care. They want tests and have questions and welcome treatment. That is their choice. Others tend to avoid visits, do not want to undergo tests, and do not wish to take medications for minor or even major ailments. How would the state go about distributing health care equally? If it is distributed on the basis of need, we must recognize that choice will play a role in some people's needs. Clearly, equal distributions are not easily accomplished, and they often have very little to do with choice.

The liberal can accept only the regulative principle of equality as constitutive of the liberal state. Individual choice is critical to liberalism, and end-state theories of equality must be based on governmental determinations of equal distributions. The liberal cannot tolerate this lack of impartiality. This does not mean that the liberal must become a utilitarian fanatic who relies on the unfettered market economy for formal equality, maximizing only the average welfare of all individuals. It is of no solace, and provides little meaning for modem liberals, that some members of our society have millions while others go without proper medical care because they have no insurance.

So in what sense can equality, defined as equal concern and respect for each person, act as a constitutive principle for liberalism? First and foremost, as we have seen, liberal equality must be neutral or impartial. Only official, governmental neutrality can allow the choice and liberty central to liberalism. Specifically, liberal equality cannot be based on any particular notion of the good life. One citizen must be free to choose to avoid medical care. Another must have the liberty to seek the medical care she can afford.

Given equal concern and respect for every citizen, and official neutrality regarding the good life, what kind of state does the modern liberal countenance? How does he distribute the goods and services available in society? It is doubtful that he will rely wholly on a market to distribute goods. Nor does it seem likely he will allow the government to make all distributional decisions. With his commitment to individual choice and also to equality, he will want resources distributed roughly equally, modified by the caveat that individuals must be able to exercise their preferences and transfer goods for those they value more.

Rough equality and maintenance of individual preference (negative freedom) are difficult values to satisfy mutually. Suppose, for the sake of argument, that all people have roughly equal talents and that each starts life with the same resources as everyone else. Given these rather unrealistic conditions, the modem liberal acknowledges that the market is the best way to conserve free choice and also maintain rough equality.

Consider again two patients. One values medical care and wants to purchase as much as possible. She invests in special diets, takes part in fitness programs, and requests medications that may be of only partial or marginal benefit. She wants above all to stay alive and directs her physician that should she become incompetent, she wants every possible measure to be taken to keep her alive. She develops leukemia at an advanced age. She has saved her money, giving up the enjoyment of sports cars and exotic travel, and she wants to spend her savings on a bone marrow transplant. In the ideal world in which we all start out with the same resources and same talents, her free choice or negative freedom is respected, and she purchases what she wishes. Yet our second patient has decided that eating well, smoking good cigarettes, and in general living a fast life is the best use of resources distributed to him. He does not seek therapy for his high blood pressure or his high cholesterol, and he develops heart disease, He has not saved for a heart transplant, and so he cannot purchase it. He dies of his heart disease, but he started out life with the same resources and same talents as the first patient. He exercised his negative freedom in an appropriate fashion, and he bought what he wished.

These examples reveal the ideal manner in which the market acts as a means for guaranteeing a roughly equal distribution of goods and services to individuals. In our example, the woman chose to trade aspects of a "good life" for more medical care. The man's choices were just the opposite. They had freedom to choose, and their use of resources was roughly equivalent. The difference was in their values, not in the distribution of goods. We do not have to feel sorry for the man who cannot have a heart transplant, nor do we feel uncomfortable about the elderly woman's bone marrow transplant. The choice of the market revealed equal concern and respect for both individuals, and the choices they made.

But we live in a real world, and political theories for ideal worlds are only of limited help. In any real liberal state, there are inequalities

of talent and resources at birth. For example, on any given morning, I have several patients scheduled. One I see is a twenty-year-old man. When I asked him about his occupation several years ago, he told me he "hustled." It turns out that hustling includes a variety of illegal activities, the most profitable of which are male prostitution and the cocaine trade. While hustling, he contracted the human immunodeficiency virus (HIV). He is one of seven children from a home without a father. His mother was and is very. insistent that I be firm with the patient, as she had already lost two sons in drug-related deaths. He has not always taken good care of himself, but now he appears to recognize that some medical follow-up is important. He is applying for general relief but is hampered by the fact that his reading skills are minimal.

Another of my patients is twenty-two. He is a junior at a local college and has sought medical treatment because there is a familial pattern of high cholesterol. He has had several sessions with the dietician in our office and now returns periodically for follow-up cholesterol tests. He studies mathematics, and in fact he derived a negative binomial statistical test for me so that I could win a bet with an epidemiologist friend. He, like my other patient, is both charming and decidedly entrepreneurial.

Without engaging in too great a "Prince and Pauper" fantasy, I do not find great differences in these two gentlemen. Although I would probably not ask the former to babysit for my kids at this point, I can imagine that he might perform in much the same manner as the other fellow if he had the same opportunities. While some might dismiss this as Pollyannaish, as a modern liberal, or even a classic liberal, I have to have some faith in the perfectibility of man and the value of each individual. Given that disease strikes people from all walks of life, I, like other physicians, have become well aware of the inequality, in starting points for many people. And these inequalities of birth tend to disrupt the sense of equal concern and respect that the market can provide.

Thus the modern liberal state must address the inequalities in skills and birthright of individual citizens. A modern liberal citizen would like to develop an economic system that allows some inequalities, in particular the inequalities that reflect market choices, but not allow others, such as those that result from biological or social differences. In our liberal state, the market allows both types of inequality; indeed it is difficult to imagine any system in which the former inequities exist

without the latter. Since the liberal, even the modern liberal committed to equality, cannot give up the principle of individual choice, he will probably stick with the market, or at least with simulations of the market, in his construction of a social order.

But if the market is to be retained, it must be modified through reforms that help develop a more equal distribution of goods while leaving in place the value of economic choice. In medicine, this could be done through taxation and development of a series of welfare programs so that people like my HIV seropositive patient have a fighting chance to live the best lives possible. However, if one spends a lot of time with the urban poor, and others generally disenfranchised by the market, even the most liberal person may begin to argue that the market itself should be done away with in large segments of society and replaced by a socialist system. Negative freedom in this scenario would be protected by simulations of the market in the pricing structure developed by the government. In any event, recognition of the inequalities that occur in a market regime, and realization that the market perhaps overvalues negative freedom, forces the modern liberal to reflect on the values of a modified market, and even on the value of socialist alternatives to the market.

Of course, the liberal need not fear that the particular mix of market and nonmarket aspects of the economy is to be decided autocratically. He will rely on representative democracy to decide the best way of dealing with the inequality, that arises from the market, or the lack of equal respect and concern that develops when the socialist approach curbs free choice in the market. Every individual, and groups of like-minded individuals, will be able to lobby for changes in the mix of market and socialism that they believe are appropriate. In this manner, the liberal state reinforces its commitment to equality, by giving each individual an equal vote.

I am not so naive as to think that my vote counts as much as the small campaign contribution I might make to my favorite elected official. Nor do I think that my contribution matters as much as the much larger contribution that the AMA's political action committee makes to a candidate. The liberal legislature can, however, create a more equitable political sphere by passing legislation that prohibits campaign contributions above a certain level. The legislature would thus address inequality, by trading free choice (of the members of the PAC) for greater equality. (between voices of citizens).

There is no doubt that democracy can still result in the majority's

abuse of minorities. Not infrequently, the majority, decides that it cares little about the equality, of a certain insular minority. For instance, say the legislature in Massachusetts decides that the best way to deal with the budget crunch is to cut off disability and general relief for drug users. This would mean that my patient will not be able to qualify for Medicaid. His uninsured status means he will not be able to get drugs that will slow the affect of HIV in his system. His death will be hastened, and he will be treated with less respect than an insured patient. One unfortunate justification for this unequal treatment is that the average drug user is not a campaign contributor; indeed it is unlikely that he votes.

To avoid the inequities of majoritarianism, the modern liberal must advocate a set of civil liberties that will help maintain equal concern and respect—the principles at the heart of liberalism. He must also advocate a set of welfare rights to guarantee that poor people will have a right to aid, medical care, and legal representation. Insofar as our state fails to provide these rights, it fails to guarantee the equality central to modern liberalism. It is thus not illiberal for us to advocate wider civil liberties to guarantee the equality, that gave rise to the market and representative democracy as the major institutions of our society. As Ronald Dworkin notes:

The familiar idea, for example, that rights of redistribution are justified by an ideal of equality that overrides the efficiency ideals of the market in certain cases, has no place in liberal theory. For the liberal, rights are justified, not by some principle in competition with an independent justification of the political and economic institutions they qualify, but in order to make more perfect the only justification on which these other institutions may themselves rely.19

That justification is an equal concern and respect for individuals.