Rethinking Universal Healthcare, Part III

It’s been fashionable of late to reduce all manner of social struggles and conflicts to the question of human rights. This shouldn’t be surprising because the concept of human rights has indeed become one of the central concepts in modern political theory, and for good reasons.

The first thing that comes to mind is the idea of infusing the practice of politics with moral thinking, or to put it more succinctly, of bringing the state (or the government, if you like) more in line with ethical principles and thought so as to make it more responsive to demands for redressing whatever inequalities still exist, or are perceived to exist, in a civil society. To that express purpose, the concept of rights is ideally suited because it tends to endow all humans (and in a more restrictive sense, the citizens of a political community) with equal moral worth. Which is to say that these rights, to the extent they’re recognized, represent an extension of the moral equivalence of persons — each such right, again to the extent that it’s recognized, being an aspect, or a dimension, if you will, in regard to which each and every member of a civil society is presumed to be equal.

This privileged status of “rights” hasn’t been lost on political activists and the presumptive leaders of the many social movements which have sprung in our recent past and spread throughout the globe like wildfire. From John Stuart Mill to Martin Luther King, Jr., from Betty Friedan to Harvey Milk, from NAACP or Planned Parenthood or NRA to ACLU – each of these organizations or individuals have used “rights” as a banner, a call to arms under which not only to mobilize sufficient public support behind the heralded cause but also to carry the fight to a successful conclusion.

Just think. Everywhere you look, in every significant social gain that has been won in the past century or so – from universal suffrage to civil rights, from gay rights to the rights of the handicapped, from Brown v. Board of Education (which overturned the “separate but equal” clause) to abortion rights – there is this magic word “rights” affixed to it, attesting to its indefeasibility. And no wonder, because there’s no better or more effective way of espousing a cause other than by couching it in terms “the moral equivalence of persons,” Only then are you liable to muster significant support from all those who believe themselves to be discriminated against in the pertinent respect but more importantly perhaps, to demoralize the opposition.

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Article Author: Roger Nowosielski

I'm Polish-born but as American as apple-pie. I've seen a great many changes since I first set foot in this land in 1961 - many of them, I'm afraid, not for the better. Thanks to the Internet era and the "blogging" phenomenon, we can address the issues …

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  • 1 - roger nowosielski

    Jul 03, 2009 at 5:42 am

    Forgive the open-italics tag on page 5. It's about to be removed (I hope).

  • 2 - Scott Greene

    Jul 03, 2009 at 8:13 am

    The product of health insurance is to provide you with medical coverage when you need it.
    Unlike other businesses that need to provide you with their product in order to make any money, health insurance companies actually make more money for themselves when they restrict and do not pay claims.
    In other words, they make more money when they do NOT provide the product that you have paid them for.

    Read the 50 to 70 pages of your health insurance contract.
    Pay particular attention to the section entitled “limitations and exclusions”.
    People’s health is not a product that needs to be left to the whims of money motivated CEO’s and stockholders.
    If that is your thinking, you might as well have your police and fire department protection based on insurance premiums you pay.
    Then you can go to the police and fire protection insurance page for ‘limitations and exclusions’ on whether or not the police or fire department would come out to your house in the event of an emergency.

    The point is, you would never think of discriminating against another citizen if he was the victim of a fire or crime.
    So why would you be ok with health insurance companies discriminating against fellow citizens who have pre-existing medical conditions?

  • 3 - Dave Nalle

    Jul 03, 2009 at 8:20 am

    Although, as usual, you express it in an overly complex way, I think you've got a good basic point here on the difference between fundamental rights and those things which we believe people should have in a modern, affluent society.

    Dave

  • 4 - Dr Dreadful

    Jul 03, 2009 at 8:51 am

    Agree with Dave that this is a good argument which could probably have been expressed better in half the number of pages.

    This may be coming in the promised Part IV, but I don't think the matter of what makes certain rights innate has really been addressed yet. The rights to life, liberty and property/the pursuit of happiness were put into the founding documents because the founders liked the ideas of certain philosophers. For most of the history of the human species, though, these rights were very far from being accepted as innate - unless you happened to be the king or a powerful lord.

    For that reason I think the commenter whose remarks this piece is based around is on shakier ground than Roger acknowledges.

  • 5 - roger nowosielski

    Jul 03, 2009 at 10:15 am

    Dreadful/Dave:

    The exact content as to which rights can be thought of as "innate" is less important here than the distinctions I'm drawing - between first-order and second-order (member's rights). And I grant that liberty, life, etc are context and culture specific, reflecting an affinity to certain philosophies. I'd rather leave the matter of the content open-ended, simply saying that what's an innate right represents an extension of the moral worth of persons and presumed moral equivalence. So this, in effect is my definition of "innate rights." And I like to leave it general so as to be unaffected by cultural/social/political influences.

    Furthermore, since a full description as to what is a person's moral worth can never be complete, so it goes with the content. So I don't really address the matter of which are or which are not "innate rights," only assume that we can talk as if there were such things. And from that kind of talk, certain things follow.

    Another point of note - that membership rights are in effect an extension of persons' rights translated into a political arena.

    Perhaps I should have been able to condense the argument from the form in which it has been presented - especially now that it's been written down. But the exact argument, which is to say, in the form it has been written down, represents a progression of thought in the exact manner in which it has occurred to me - somewhat on the order of a series of move, like in a chess game. So the order of the presentation is not to be faulted, I think: it's a valid order. If anything, the argument should have been edited better and made more concise. But Dave had poor internet access for us to be able to go back and forth.


  • 6 - Joanne Huspek

    Jul 03, 2009 at 11:55 am

    Interesting argument, Roger. As to the back and forth, if you and Dave get in a room together IRL, could someone film it and post it on YouTube? Honestly, the exchange would be worth it.

  • 7 - roger nowosielski

    Jul 03, 2009 at 12:01 pm

    You're making more out it of, Joanne, than was intended. What I had in mind is editorial advice. But thank you for getting through it in spite of its unredacted form.

  • 8 - Lumpy

    Jul 04, 2009 at 11:46 am

    This article is more succinct than ohers in the series. But I do think hat what the enlightenment philosophes did was to identify rights rather than to create them. Hobbes was an observer and critic more than a creator and he started the whole trend of analyzing government.

  • 9 - roger nowosielski

    Jul 04, 2009 at 3:50 pm

    Correct, Lumpy. Hobbes was the first of the moderns who got political science/political theory off the ground. The ancients were doing it, too, but because of the Dark Ages they were forgotten.

  • 10 - Cindy

    Jul 07, 2009 at 12:46 pm

    Hobbes was the first of the moderns who got political science/political theory off the ground.

    And yet, we should remember Hobbes' limitations. Hobbes thought the earth was 6000 years old.

    Quoting myself: "Hobbes was dead before Darwin was born."

  • 11 - Bliffle

    Jul 07, 2009 at 6:42 pm

    Unlike everyone else on BC, I'm not an expert on ethics and morals, so I won't attempt to deal with the ethics and morals of healthcare and whether HC is a 'right' or not.

    IMO the case for UHC can be made on the basis of cold, hard cash, and the survival of our very capitalistic business system.

    UHC is nothing more nor less than the best strategy for the USA to adopt so that our business interests prevail in the future.

    Elsewhere on BC I've demonstrated with math that any high school graduate (who was not ALWAYS asleep in class!) should be able to understand, that US society should be able to save about a half trillion dollars every year while extending healthcare to ALL our citizens, including the famous 47 million who are presently uninsured.

    Even our business community, staunch conservatives all, recognizes this. Businessmen across the country have lamented that they have a distinct disadvantage competing with foreign competitors because the foreigners have their employees healthcare taken care of by their national UHCs. Consequently, there is an extra burden of costs associated with our expensive private healthcare system. The automobile makers have been particularly vociferous about this, and look how strapped they are to compete.

    Right now the USA pays about 18% of GDP to private healthcare, about twice the other industrialized countries. That's an expensive surcharge to pay for the exquisite pleasure of seeing slackers and under-achievers suffer consequences for their poor planning, lack of foresight, and general laziness.

    But that 18% threatens to increase to 30% within a few years! And why not? What is there to restrain it? There is no competition in the private healthcare insurance system, which is an open oligopoly. Because of Special Privileges cast into the law. They cannot be prosecuted for Federal Anti-trust violations. And there is NO transparency into their operations so we know little about either their over-generous compensation to predatory executives, or the amount of fraud that they sustain. So nothing of importance to the business community will be lost by obviating them.

    It's either that or open the insurance companies to federal regulation.

    Anyway you look at it the USA business community must change the healthcare system to stop them from consuming even more in the future. What happens when private monopoly insurance consumes 60% of the economy?

    Private health insurance cost is projected to increase by 6% a year (even the most optimistic estimates of actual medical costs only reduces that to 5%, and the private companies are backing off from that reduction).

    Save American business! Bring in Universal Health Care.

  • 12 - Cindy

    Jul 07, 2009 at 7:25 pm

    ...the difference between fundamental rights and those things which we believe people should have in a modern, affluent society.

    For all our civilization and affluence what a bunch of losers we turned out to be--how much science and culture we have. We can describe in such sophisticated voices, how much better and more advanced we are than ...'noble savages'. Only the people who were we regarded as such, fed and cared for all the people in their societies.

    We have devolved.

  • 13 - roger nowosielski

    Jul 08, 2009 at 8:25 am

    Although #12, I'm aware, is directed at Dave Nalle rather than myself, it warrants a response.

    The point of the article was to make certain conceptual distinctions, not to offer a portrait of the evolution, or the devolution (as the case may be), of human societies.

    Aside from the fact that no reference to "noble savages" was made, the idea of "noble savage" itself is a myth. If some of the more "primitive," early societies were marked by a greater degree of cooperation than what is known today (and inspire thus a certain kind of longing), that cooperation was a by-product of necessity, not any natural or innate feelings or "nobler nature." And if "the people who were we regarded as such, fed and cared for all the people in their societies," it's because they had to. (Which does offer an interesting perspective on "human nature" as something not necessarily given but rather a by-product of material conditions/circumstances in which a society finds itself: so in that sense, "human nature" is malleable.)

    Still, "the difference between fundamental rights and those things which we believe people should have in a modern, affluent society" holds - and that's apart from what one thinks as to the kind of people we've become - because "affordability" and "affluence" are real factors which determine what is and what is not possible.

    Having said that, we still have the paradox: because something it's affordable, it doesn't follow it will be granted willingly. But then again, a prosperous society is one that has transcended the dictates of necessity (and the "spirit" of cooperation that comes with it). Cooperation is not deemed as functional as it is in "traditional" societies - because of affluence. So the better off we are materially, the less it seems we feel we must cooperate (and indirectly, be "caring for others"). A conundrum, to say the least.

  • 14 - Cindy

    Jul 08, 2009 at 2:04 pm

    There are no fundamental rights that are absolute. Without agreement there are no intrinsic rights. Rights are either self-determined, collectively determined or determined by those with authority.

    All other discussion of rights is an invention.

    To talk about whether health care is a right or a this or a that, it's all just what anyone cares to make up. In my opinion the human community has the right to share in the benefits of human achievements.

    Here is my proposal for a new social contract. It seems as reasonable and valid as the one devised by others.

    All human beings reap the benefit of living in the human community, therefore all human beings should share the invention and advancement they develop. Being a member is what enables their developments. Use by the community is in repayment to the community for having been endowed with its historical and collective knowledge--and therefore not having had to begin such development from the ground up.

  • 15 - roger nowosielski

    Jul 08, 2009 at 3:02 pm

    No comment. Any further discussion along those lines are at cross-purposes. Part III, was an exercise in concept analysis, not a futuristic vision of a possible society. There is a point at which these two might intersect, but that point in my exposition hasn't been reached yet. As to "rights," it's political theory, at present the point of focus of modern political theory. There is no ontological argument advanced here on behalf of "rights" and their ontological existence/status. The best that could be said - "rights" represent an extension of the moral worth and moral equivalence of persons. That's one fairly comprehensive and fairly satisfying definition. So if there is any argument on behalf of rights quarights as representing some kind of reality, it's only indirect one, and only to the extent that morality itself, and morality of persons, are accepted as having valid ontological status. And if and when one does accept some such thesis, then the reality of rights follows by derivation.

  • 16 - Cindy

    Jul 08, 2009 at 4:46 pm

    And if and when one does accept some such thesis, then the reality of rights follows by derivation.

    Sure.

    My comment is mostly marking my own thinking so far. Keep in mind I have an ongoing argument in my head with Dave regarding rights.

    I just wanted to get that down before I forgot. Because Dave expresses rights like they are objectively ordained by the universe or as he would put it the state of nature.

    (which, I have to admit I used to argue along that line as well. things change.)

  • 17 - roger nowosielski

    Jul 08, 2009 at 5:46 pm

    That is a good point you're making, if you're attacking the idea of "essences." I hope I have not given the impression of arguing on behalf of "essences" as though existing independently of humans, human societies, etc.

    It's mostly a matter of how we talk - which is important because how we talk determines how we see the world.

    To speak of rights as being "absolute" may commit one to believing in "essences," which is one negative. Besides, "rights" are not absolute in a sense that they're all contingent on a human society; it wouldn't make sense to speak of rights on a desert island when you're the only inhabitant.

    However, within the context of a human society, some distinctions are doable and they are worth making - such as the one I made with respect to "innate rights" and "membership rights" - again, not in any absolute kind of sense but only with that context in mind: in particular, that distinction came useful when it came to identifying "obligations" as being different than "rights."

    Of course in so far as futuristic societies go, the goal ought to be that the whole world would share in general prosperity so that such things as hunger, poverty, healthcare, etc. would be available to all.

  • 18 - roger nowosielski

    Jul 08, 2009 at 6:40 pm

    A faux pas: "hunger, poverty ... et al" would be available to all."

    Keep on plugging, Einstein.

  • 19 - Bliffle

    Jul 08, 2009 at 7:06 pm

    I suppose it's useful for people to exercise their ethics/morals chops, but I don't have much confidence in that route because ethics/morals are more often used to exclude people than to include them. Witness the strident declaration that rendering med care to everyone necessarily means taxing some to pay for others, and the premise that private property ownership is the highest right, therefore UHC is immoral.

    I just think it's cheaper and easier to include everyone in to the health system. And I've demonstrated that is so. We have to pay a premium to exclude some people, and that premium threatens to absorb our entire economy.


  • 20 - roger nowosielski

    Jul 08, 2009 at 7:50 pm

    I don't think I've been advancing those kinds of argument, Bliffle - if anything, tried to clear the ground so that discussion of healthcare could proceed on correct rather than incorrect set of assumptions: and the clearest way to look at it (from the vantage point of our, American society), that it is not a right but ought to be regarded as a kind of moral obligation on the part of society to extend healthcare benefits to all citizens - especially since we can afford to do so.

    As to the exact kind plan and how are we going to do that - I'll leave it up to the experts, and people more knowledgeable than me, to decide.

  • 21 - Cindy

    Jul 08, 2009 at 9:43 pm

    "such things as hunger, poverty...etc. would be available to all."

    When hunger and poverty are available to all that's when something will be done about them. That is a sort of serendipitous slip. :-)

    (I missed Bliffle's argument to the effect of 19. I'd better find that, it sounds good and useful. There've been an awful lot of violent uprisings lately to attend to.)

  • 22 - roger nowosielski

    Jul 09, 2009 at 7:50 am

    I'm glad then that so far we're on the same page. As to the details of what's the best healthcare plan to implement, I'm less interested in that than the conceptual framework upon which some such plan must rest.

    I'm content, therefore, to leave such matters to other minds - such as Bliffle, e.g. - which are more keen than I am on number crunching and things of that sort. As you know, my interests lie elsewhere.

  • 23 - Bliffle

    Jul 09, 2009 at 9:46 am

    Cindy,

    Just for you, I'll copy it here

    137 - Bliffle Jun 27, 2009 at 9:10 am

    "How Does Universal Health Care Save Money? Easy..."

    Here's how:

    Given that about 18% of the GDP, about $2.2trillion, and that insures about 200million people, and there are about 50 million uninsured, and private insurance overhead is about 40%, and medicare overhead is about 3%, then:

    converting everyone to medicare reduces total cost for 200 million to:

    $2.2T * (1 - 0.40 + 0.03) = $1.5T and adding the 50million uninsured adds 25%: Total cost = 1.5T * (1.25) = $1.9T a clear savings of $300billion per year.

    Any high school graduate who was actually awake in math class should be able to figure this out.

  • 24 - Cindy

    Jul 09, 2009 at 11:43 am

    Thanks Prof. Bliffle. It saves me a lot of time trying to find it; I wouldn't want to have missed that point. I have been very busy lately. I am much obliged.

  • 25 - Cindy

    Jul 13, 2009 at 10:19 am

    With Friends Like These: Wal-Mart, Health 'Reform’ and Obama’s 'Public Option’

    Well worth reading imo.

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