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Rethinking Universal Healthcare, Part I

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Consider the following exchange. To my mind, it encapsulates the two positions with respect to any legislation which aims at revamping our healthcare system (HR676, US National Health Care Act, for example), pro and con:

PRO: Health care should not be a choice. One should not have to pick between health care or rent or . . . food on the table. Not in a civilized world.

CON: It does seem like such a moral truism in our current context, but the context obfuscates the central issues. In simpler terms, if the world consisted of you and me and I decided I didn't want to want to work in the garden or help with the food or exchange you anything of value for it, should you be forced to work twice as hard for the rest of your life to do it for me? The answer might very well be yes, but there is a distinct tradeoff. Food and healthcare don't just magically appear; someone is working their ass off to make it happen. Because our society is large and our services big and complex does not make that simple fact any less true.

In an effort to distill this argument, I’ll dispose first of the attempt at reductionism, then say a word or two about an alternative way to think about rights. I think we’re way past the point where questions about healthcare – whether it’s a safety net, for example, an entitlement, or a right – are decisive, let alone helpful anymore; in fact,I shall argue they’re not. Also, I’m not going to go much into the details of this proposal or that; that’s for experts and healthcare professionals to decide. Think of this exercise as a “conceptual approach” to this nagging problem.

The matter of reductionism first. It’s all fine and dandy to insist on the absolute right to the fruits of one’s labor, and what goes with it, the spirit of no cooperation, while in a "state of nature" defined by general hostility, or enmity, between all and all alike, a state when life is “solitary, poor, nasty, brutish and short.” Which is why humans enter into a “social contract,” to experience the peace that comes with a civil society; and part of the price they pay is that their “rights” – at long last, guaranteed – are no longer deemed absolute but relative.

Consequently, the proper context is a “civilized world” as the "pro" argument has stated.  Perhaps a “civil society” would be a more fitting term, since we haven’t reached such a happy state yet, and what comes with it, a certain prosperity: a society must be prosperous enough to be able to afford the basics to each and every member, so that choosing between healthcare, food or shelter isn’t necessary.

What are some of the benefits which accrue to each and every member, now a part of a political community, and how are they paid for? And what is the tradeoff involved in compromising one’s would-be absolute rights to life and property, and freedom to do as one pleases with the fruits of their labor, for rights that are somewhat imperfect (because curbed and made relative)?

Consider the business of “offering protection,” surely the first if not the foremost concern which would make a person give up some of their “perfect” freedoms and enter a social contract. Prior to these arrangements, it would be up to the individual to protect their life and property. And whilst ‘tis true that any number of individuals so moved would be apt to join forces for the express purpose of protecting their interests – a “mutual protection agency” is the term in use – it’s also true that any such agency and the interests it’d purport to represent could also be challenged. Hence the solution: a “dominant protection agency,” to encompass every member of the society in order to guarantee a nonviolent resolution of all conflicts and offer equal protection to each and everyone alike – in short, a “minimal state” in the jargon of political philosophy (see Nozick’s Anarchy, State, and Utopia).

The proposed solution, the formation of a (minimal) state, is not a result of moral deliberation but is born out of (social) compromise. It’s utterly functional in basis, having nothing to do with what’s right or wrong, only with what’s to everyone’s advantage.

We shall return to this important distinction and the corresponding instruments of social change, the moral and the pragmatic. Of particular interest is the resulting interaction between the two – an interaction without which no social change would be possible; and it bears directly on the present debate concerning our healthcare crisis. The fundamental right of each and every citizen to equal protection – perhaps the only viable model upon which all subsequent rights are to be construed – has its origin not in moral but pragmatic thinking.

But why compromise at all?  Aren’t the rich, i.e., those with property to protect, already powerful enough to fend off any and all counterclaims and challenges? Especially if they were to band together and present a united front, wouldn’t it stand to reason that the armies they could raise in their own defense would more than offset anything that could be thrown by the opponents?

That may be so, but the outcome of such struggles is always uncertain. The rich may be powerful but they’re only a few, the few against the many. Hence the compromise as a happy solution. It’s like taking an insurance policy where the cost of the premiums (taxation) far outweighs the risk of losing it all. Indeed, even the poor are in for a bargain because of a lower premium; and there are always some who are poorer than you. It is thus that a zero-sum game is magically transformed into a win-win situation: there are no losers.

In closing, I’ll extend the notion of compromise, and the implicit notion of “taking an insurance policy” serving as a kind of analogy, to include other “rights.” What we are currently looking at as a healthcare crisis is ripe for solution – which is to say that the moral argument on behalf of healthcare as a right (or a safety net, if you like) has already been won. All that remains is a compromise.

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About Roger Nowosielski

  • Dan, nobody is more frustrated than we Comments Editors with the current way the site is functioning.

    The issues Pablo raised have been responded to, both directly to him in the comments space and through the groups that serve as the communications medium between all Blogcritics writers and the editors group.

    He was just taking another opportunity to disport his fixed ideas.

    Ruvy, another whose thinking is set in stone, simply leapt on the chance to have a go at me, as he frequently does for a variety of churlish reasons that are mostly based on his many misunderstandings compounded by the fact that he knows I have no respect for his superstitious beliefs or his frequently expressed final solution to the complex issues facing the Middle East, which is basically nuke everybody he doesn’t like, which on one occasion at least, included a call to nuke all those non “proper” Jews in Tel Aviv.

    You may be inclined to be endlessly patient with those who won’t absorb simple facts when they are presented to them, but I am not…

  • Ruvy, correcting all your misconceptions could be a full time job, so I usually ignore your confusion, but let me make an exception for this one.

    Pablo has made this “observation” many times and has been told the situation many times right here in the comments space.

    He is also a Blogcritics writer so will have seen the many emails reporting and discussing problems, just as you have.

    I wasn’t whining, I was exasperated that his ego and his presumptions were YET AGAIN blocking his perception, qualities you both share, so it comes as no surprise that you are compounding his mistake.

    It has nothing to do with anybody adjusting to anybody, it is simply a matter of paying attention when you are told something.

    Similarly, marketing has nothing to do with this at all, so your remarks about customer versus contributor are as meaningless as your remarks about the British, just more of the pointless bile you specialise in.

  • Christopher, you say Do try to keep up rather than displaying both total ignorance and a little hissy fit, neither are attractive qualities…

    I would like to be able to thank you for your kind understanding of the difficulties experienced by others in braving the BC comments interface, which after just over a month and a half is very little if at all better than when it first appeared and still has a long way to go before it approaches its former usability. Since you evidently speak for BlogCritics, or at least appear to think that you do in this regard, that would be good. It would be an “attractive” quality.

    Unfortunately, I can’t. I agree with Ruvy’ Comment # 18 except to the extent that he seems to contend that those who write articles should suffer in silence.


  • Chris,

    Pablo submitted one article here, which was rejected. From his point of view, he can’t get a fair hearing here. So he is a commenter only. To put it differently, he is a customer, as opposed to a contributor to the site. He has no obligation to “keep up”. I do, as I write here. But Pablo doesn’t. For you to whine that he throws hissy fits when he is plainly dissatisfied with the architecture of the site, is a display of that arrogance that Brits are so famed for.

    He doesn’t have to adjust to you – you have to adjust to him. It’s a basic law of marketing that I’m sure you do not ignore when it is your own bread and cheese that may not be on the table.

  • Hi Pablo,

    As a Blogcritics writer, if you had been following either the internal or the external discussions about the new site architecture, you would already be aware that the work to improve the commenting system is both planned and underway. You may not have noticed but at least you will when you read this comment. Do try to keep up rather than displaying both total ignorance and a little hissy fit, neither are attractive qualities…

  • I agree, Pablo. That’s why the notion of right discussed here is in quotation marks, lumped with such things as service or safety net. In fact, even the so-called innate or inalienable rights, as they’re about to emerge in the course of this and the ensuing discussion, end up on the side of ideology.

    You’re making a very astute observation, BTW, concerning the status of civil right; the distinction between what we regard as inalienable rights and those which are won as a result of legislation is well taken. Which, in turn, poses an interesting question concerning universal suffrage. And given your schema, their status, too, is rather uncertain. And this suggests (to me) that perhaps the whole concept of rights could well be moral/or political fiction.

  • pablo

    I rarely offer my comments on this site anymore due to the interface that I find annoying, and impersonal. That being said I would like to comment on Roger’s article.

    First about the “social contract”. Last time I checked a contract whether legal or rhetorical includes voluntarily entering into an agreement. This is not the case in our governmental structure anymore. You are born into it whether or not you agree with the fundamental principles or not, and if you stray, the Man will surely come and take you away. Hence there is not social contract in Amerika anymore, nor it there any real consent of the governed.

    As to health care being a “right”, it is absurd on its face. Rights are by nature innate, and as some would argue, Thomas Jefferson comes to mind, we are born with them, and not given to us. There are civil rights which frequently are intermingled freely among those left leaning denizens, however civil rights are not rights in the true sense of the word, but legislated by a majority of legislators.

    I am not saying that universal health care is not a good idea, I am saying that it is not a right as such, anymore than it is a right that the fire department come and put out a fire in my house.

    Not that most of you care, but I would write more on this site, should the management return to a friendlier interface, particularly by showing all comments on one page instead of having only 20 comments at a time show up. It is not only annoying to me, but fractures the discussion in such a way that I don’t really want to participate. Also by not showing numerous fresh comments on the home political page discourages activity and discussion as well.

    I will still peek in now and then, and offer up my two sense worth. But as far as I am concerned the new interface did not take into account at all user friendliness, but was made for the back end, which is a shame.

    I am a fan of infowars.com

    Alex Jones remains one of my true heroes in the land of politics. I will henceforth plug him on any comment I make on this site.

  • Cindy, although your anarchist comrade is, indeed, a cutie, he is so small that I must wonder whether his selfless efforts to help his various equine comrades by giving them most of his grain haven’t stunted his growth.

    Please do insist that he eat more grain; there are some excellent Manifesto flavored supplements which might help.


  • Dan(Miller),

    Not a problem. I am very patient (hums while standing on the curb) Your travel VP is quite a cutie. Yet is hardly a match for my own anarchist comrade who appears here whilst engaging in direct action to avoid wage slavery.

  • Correct, Dreadful. The next step is tricky. I’ve got to do it right.

  • Good piece, Roger, succinctly argued. However, I suspect you’re not quite done yet. I’ll wait until Part 2 to comment further.

  • Cindy — I am very sorry, but my executive vice president in charge of travel deals with that sort of thing. Just as soon as he has a free moment, he will doubtless get back to you.


  • However, just in case you are sending me to Italy though, I will go pack now. Be back after I am all ready to get in the taxi.

  • Dan(Miller),

    Are you trying to send me to a health spa in Italy? Well, thank you. I would love to go to Italy and I hope they serve wine at the health spa there. Some of my fondest memories are of Italy.

    If, however, you were not trying to link to http://www.ponzi.com, which is at the end of your URL when one points to it and which is a health spa in Italy, then you may wish to tell me exactly where my social contract is not located.

    again 🙂

  • Cindy, you say: This would be good stuff to wash a hog with, if I had a hog to wash.

    Sigh, you have stumbled on the greatest problems facing society today — the hog shortage and the the resulting hogwash surfeit. Unfortunately, we just swallow the excess.

    As to the social contract, I am surprised that you didn’t receive your copy. Have you checked Mr. Madoff’s website? This probably isn’t it.


  • Un-EOM (ha! knew that wouldn’t work)

    It is all ‘fine and dandy’ to make up rationalizations after the fact. I recommend studying societies that don’t work by this presumption. It might take actually looking at some stuff rather than just guessing as if there is no information to be had.


  • The matter of reductionism first. It’s all fine and dandy to insist on the absolute right to the fruits of one’s labor, and what goes with it, the spirit of no cooperation, while in a “state of nature” defined by general hostility, or enmity, between all and all alike, a state when life is “solitary, poor, nasty, brutish and short.” Which is why humans enter into a “social contract,” to experience the peace that comes with a civil society; and part of the price they pay is that their “rights” – at long last, guaranteed – are no longer deemed absolute but relative.

    This would be good stuff to wash a hog with, if I had a hog to wash.

    Since I was born, I’ve been waiting for someone to show me the ‘social contract’ and where I ever signed it.

    What has happened is that some had power over others and made rules which society demands that we live by whether we like it or agree, lest we be punished.


  • I think you should put on your reading glasses, bliffle. If there’s one thing that is conspicuously absent in this presentation is “moral argument.”

  • Bliffle

    Another long-winded moral argument regarding UHC vs. private health insurance.

    We simply pay too much for the current system, just for the exquisite pleasure of denying healthcare to 40 million people and watching 20,000 people per year die from lack of healthcare.

    I know, to many of us it’s well-worth the cost to be secure in the knowledge that so many despicable under-achievers are being properly punished, but, dammit, I’m getting tired of the high cost!

  • Thanks, Joanne. I happen to think, however, that UHC is not only doable under the circumstances but inevitable as well. That’s the point of the argument (to be continued in the sequel). The Dems are in power and one way or another, it’s going to pass. As I said, the moral argument has already been “won” since even the opponents are bequeathing it; all that remains is to work out the details.

    And I’m not competent to comment on that aspect of it – we haven’t seen enough – only on the concept of UHC (as no different from, say, the Food Stamps program).

  • Roger, this seems like a sensible argument, however, when one deals with the government, there is rarely sense involved.

    Take my father, for instance. He’s retired from the Army. When he retired in the mid-70s, they promised him a lot of things (including health care) that they reneged on later. We had what one considers universal health care via the government when we were dependents. Believe me, it was not unlike having no health care at all. There is something noxious about those health providers who are government workers. My sister almost died in a government hospital because of a misdiagnosis, and thank God they transferred her to a (US) city hospital where she recovered.

    This is not to say I don’t think that universal health care isn’t doable. It would require a tremendous amount of forethought and accountability. When you put the government in the mix, there’s often a lack of those two qualities.