Rethinking Universal Healthcare, Part I

Rethinking Universal Healthcare, Part I

(A version of this article was published in Blogcritics on June, 2009)


Consider the following exchange. To my mind, it encapsulates the two positions concerning any legislation which aims at revamping our healthcare system (HR676, for example), pro and con:

PRO: Healthcare should not be a choice. One should not have to pick between healthcare 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 variegated and our services big and complex does not make that simple fact any less accurate.


To distill this argument, first, I’ll dispose 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, an entitlement, or a right – are decisive anymore, let alone helpful; in fact, I shall argue they’re not.

Also, I’m not going to go 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 ‘n dandy to insist on the absolute right to the fruits of one’s labor, and whatever goes with it, while in a “state of nature,” life is “solitary, poor, nasty, brutish and short.” Which is why humans enter into a “social contract” in the first place, to experience the peace that comes with 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 would have it.

Perhaps “civil society” is a more fitting term since we haven’t reached such a happy state yet, and what comes with it, a level of prosperity. Society must be prosperous enough to afford the basics to every member so that choosing between healthcare, food, or shelter isn’t necessary.

What are the benefits that accrue to every member of a political community? How are they to 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 one’s labor — for imperfect rights (because they’re curbed and made relative)?


Consider the business of “offering protection,” surely the first if not the foremost concern, making a person give up some of their “perfect” freedoms and enter a social contract.

Before these arrangements, it would be up to the individual to protect their life and property. And while ’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, are subject to challenge.

Hence the solution: a “dominant protection agency,” to encompass every member of the society 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, e.g., Nozick’s Anarchy, State, and Utopia).


Notice that 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 all-important distinction and the corresponding instruments of social change, the moral and the pragmatic. Of particular interest here and now is the resulting interaction between the two – an interaction without which no social change would be possible — and this bears directly on the present debate concerning our healthcare crisis.

Indeed, the fundamental right of every citizen to equal protection – perhaps the only viable model upon which all subsequent rights can be construed – has its origin not in moral but in pragmatic thinking.


But why compromise at all?

Aren’t the rich already powerful enough to fend off any & all counterclaims and challenges? 

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 defense would more than offset anything that the opposition could throw?

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, a compromise is 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.  

Even the poor are better off —   because of a lower premium. And there are always some who are poorer than you.

It’s a zero-sum game, magically transformed into a win-win. There are no losers!


In closing, I’ll extend the notion of compromise and the implicit notion of “taking an insurance policy” to include other “rights.” And the general idea is, what we’re currently experiencing as a healthcare crisis is ripe for a solution – which is to say that the moral argument on behalf of universal 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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