I’m co-authoring a paper write now that takes a critical look at the implications of David Estlund’s Democratic Authority (and related papers) on what he calls Fair Epistemic Proceduralism.  There are a number of places when it comes to governance, where FEP is possibly not the most appropriate avenue of decision-making (and I think Estlund would agree) but there are many political decisions where something like a strong commitment to FEP would be absolutely helpful.

One place that it seems helpful to me is with regard to health care rationing.   First, democratic decision-making is most likely to be convinced that we do, in fact, need to demand better rationing from the institutions that work together to provide us our medical treatments.  

Second, as President Obama notes in this interview (and Ezra Klein echoes in his blog post that alerted me to both David Leonhardt pieces in The New York Times), the actual rationing decisions we make are of not only a distributional, but also moral consequence.  Health Care rationing means attempting to assert control over the distribution of happy endings in medical treatment as best as possible.  

Estlund’s democratic model of decision-making where experts attempt to persuade, not decide for everyone, and citizens attempt to listen to sound advice and make the best possible decision is appealing for decisions of this sort as well.  

The democratic process is the most reliable at getting the correct answer, most likely to eliminate all crazy answers (see Rawls on reflective equilibrium for why), and the most likely to change its answer to be more correct with repeated iterations of decision-making.  

By correct, I’m referring to a pragmatic version of truth, which insists that to hold something is true is to believe it for the best possible reasons as tested against an active search for a legitimately better reason to hold something else as true.  President Obama talked about his grandmother getting hip replacement surgery while terminally ill.  Is that worth medical coverage in a system with national support?  The answer is: it depends.  If there are no other more serious problems that are not already paid for, then yes.  If not, then no.  

These sorts of judgments are the types of difficult practical decisions we ought to confront and make democratically. Democratic decisions can at the time speak with authority and be subject to revision and criticism precisely because they are decisions of by everyone and no one.  For some, this may raise the specter of a majority tyranny telling grandma she cannot live comfortably in her last days, let us not forget that when we endorse money for grandma, we refuse to endorse money somewhere else.  Grandma’s situation is not good, but neither are the situations of any of the other people in need of important medical attention who are receiving sub-optimal care.  Doing our best to be prudent is not the same thing as playing God.