Rethinking Universal Healthcare, Part IV

Rethinking Universal Healthcare, Part IV

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


In Part I, I spoke of widespread conflict & enmity that’s bound to exist in, if not define, the condition commonly referred to as a “state of nature.” As Hobbes would have it, life under those conditions is “solitary, poor, nasty, brutish and short,” because individuals living in such a state have to fend for themselves – there being no such thing as the formal apparatus of the state to protect them from one another and offer agreed-upon procedures for conflict-resolution should the need ever arise.

In Part II, I argued that despite a quasi-natural, hypothetical transition from state-of-nature – admittedly, a philosophical construct whose sole purpose is to enable us to think about the essential characteristics of a (minimal) state – to that of a “civil society” and a full-fledged political community, the state of conflict doesn’t actually disappear.


True, this conflict is ameliorated somewhat by the hypothetical transition.  It’s made less pronounced and biting since now there’s a state to serve as a buffer to intervene as occasions arise to prevent a full-scale eruption of an all-out hostility as individuals would be liable otherwise to take matters into their own hands.  But however subdued or stripped of its potential to create total havoc, there’s no denying that even in “civil societies,” conflict is the natural order of things – if only to preserve the status quo and safeguard the interests of the powers-that-be!

Moreover, I argued that the transition in question, from state-of-nature to that of civil society, represented perhaps the last act of genuine compromise.  A zero-sum game was miraculously transformed into a win-win. Everyone was a winner, no one a loser.  

Everything after that, if granted, was granted begrudgingly. None of the gains secured by the “lower classes” since the inception of civil society have been bequeathed in that spirit; they’ve been won, instead, by bitter struggle, tooth and nail.  And they’ve all come at the expense of the dilution of power, the power of the privileged classes.


That was one of the imports of Part III.  There, I also spoke of

  • rights which are deemed fundamental – rights which inaugurated the hypothesized passage from state-of-nature to civil society; and
  • rights which come with membership in that society and which, minimally at least, define that very society and provide it with its raison d’être.

It is with respect to the latter kind of rights that the matter at hand is unmistakably clear.  For whether we be talking about extending the original franchise or civil rights, all such have been born out of bitter struggle and against stiff resistance from the forces of status quo — all intent on preserving their position of power and privilege.

For indeed, as I argued above, there was no longer anything to gain from making the concession – i.e., of granting these rights to those who didn’t have them — only everything to lose, for it would, ultimately, represent a definite realignment of political and economic power. The very fact that, however begrudgingly, those rights have been granted and are now part of the society’s legal corpus is a testimonial to human progress – the proliferation of rights, again, serving as a reliable benchmark. And I spoke of that, too.


Another point of note was that the recent focus on rights, the cornerstone of modern political theory, has its grounding in moral theory – the point being to imbue the practice of politics with ethical principles and thought (to make it more responsive to moral demands). Which is why progress in the area of human rights represents real progress, since “rights” serve here as an extension of the moral worth and moral equivalence of persons, properly transliterated to mean citizens’ rights in the context of a full-fledged political community – the most natural of human habitats!

It is in this regard that universal healthcare, the topic of this series, presented an anomaly of sorts.  Unlike other rights – such as universal franchise, for instance – a would-be right to (universal) healthcare is contingent in a very real sense on the material conditions of a given society: in a nutshell, the society must be prosperous enough to be able to afford it. And since human rights, especially those appertaining to, or spelling out as it were, the moral equivalence and worthiness of persons, are unconditional, it followed that we couldn’t speak of universal healthcare as a bona fide right.

Hence the necessary corrective, a re-conceptualization of universal healthcare in terms of benefits and social or societal obligation to provide some such to every member – again with an all-important proviso that the society be prosperous enough to be able to afford it!


What remains is to show is that

  • the obligation in question is, in effect, a moral obligation; and that
  • the cause of universal healthcare wouldn’t suffer from having been “demoted” thus from its ill-conceived status as a right.

Once done, we can still hold on to the idea of universal healthcare as a moral imperative, though contextualized this time to a particular society – namely, a society that can presumably afford it.


Once again, let me refer the reader to the exchange which served to kick off the entire series:

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 large and our services big and complex does not make that simple fact any less true.


Notice that the opponent well-nigh concedes the moral point of the debate, for he does speak of “moral truism” of sorts – namely, that in a civilized world, “healthcare should not be a [matter of] choice” in that one shouldn’t have to choose between healthcare or rent or food on the table. Her objection, instead, is a practical one, having to do with who is going to pay for it, or more succinctly perhaps, who is going to have to work twice as hard to make it happen.

Whether a “civilized world” entails a prosperous one as well is another matter; I assume that it does. I shall also assume that when push comes to shove, our society can afford it. But practical considerations aside – and that’s a subject for another place and time – the moral point remains.

The question is why.


Again, I’m going to fall back here on the notion of rights as representing an extension of the moral equivalence and worthiness of persons (as members of a political community). And by the same token, just as our fundamental human rights (to life, property, and so on), or the extended citizens’ rights (such as civil rights or universal suffrage), are but some of the manifestations of that worthiness, it’s no different with healthcare: they all espouse a system of values whereby humans and human well-being are central!

Consequently, it doesn’t really matter whether healthcare is a right or a social obligation, reflecting a mere possibility in the actual world (and therefore contingent for the fact) because the relationship is the same. And it’s a relationship between human worthiness (and all that it entails), which is the highest value, and its different expressions.  And since no material contingency can conceivably upset a relationship that’s essentially logical or concept-bound, it follows that every human society ought to aspire to promote the well-being of all its members, regardless of whether it can afford it or not. 

And this includes healthcare.


Indeed, in this scheme of things, individuals and their well-being come before a political community or the state: it is for their benefit that the state is instituted, not vice versa. Which explains, I suppose, why the only credible objection to universal healthcare is a practical one, having to do with affordability and redistribution of wealth, or the passion which infects all the proponents – a passion, I might add, that’s clearly born out of moral conviction, there being no other source. (I think we can safely discount the few die-hards who still argue the case on moral grounds; they’re dinosaurs!)


We’ve come thus a full circle, or so it seems, having endowed universal healthcare with the status of moral imperative. Its present status as a moral obligation, dischargeable only in some cases and not in others, ought to be viewed only as a temporary condition.

Which suggests a no-nonsense agenda for all right-thinking women and men: forging a more prosperous world, a world in which poverty and hunger are no longer, a world where all the usual amenities and dignities which are due to humans are available to all.

If a world government or the new world order is the answer, so be it. The important thing is – no one must be left behind!


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