Rethinking Universal Healthcare, Part I

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.