Thursday, February 25, 2010

Healthcare Reform: Conservative vs. Liberal

My B-2/3 made an astute comment about the healthcare debate as it has manifested itself between conservatives and liberals in this country. I think there is something to her observation.

She noted that for conservatives it seems as if the main issue surrounding the healthcare debate and the government's potential role in it has to do with $$$$$. The question seems to have less to do with the moral question of whether healthcare is a fundamental human right and something government should provide for its citizens as part of its obligations to promote the general welfare.

Liberals, on the other hand, see the whole question as defined by the moral side of it. Consequently, the cost of having the government involved in making healthcare available for all citizens is less of a concern than ensuring that people have access to adequate healthcare as their birthright.

This is not to say that the moral dimension does not factor into conservative calculus or that cost does not factor into liberal calculus, but rather that one seems to take precedence over the other depending on one's ideological leanings.

It stands to reason that if someone considers something a fundamental human right and a right of citizenship, then of course that person would be willing to absorb the cost of meeting this moral obligation in some fashion, and would see opposition to meeting this obligation as a evidence of a moral failure. It also stands to reason that if someone does not consider something a fundamental human right and a right of citizenship, then forcing someone to pay for meeting this benefit is perhaps an immoral coercion.

One can see the dilemma here and also understand the strong feelings that folks have on both sides of the issue.


eric said...

Great observation. With very few exceptions, conservatives and libertarians tend to be opposed to calling something a right if it requires a third party to deliver it. For instance, we could still have a right to bear arms even if every gun manufacturer magically decided to shutter their doors, but a right to healthcare *requires* that healthcare facilities be made equally available to everyone. The right to bear arms, or the right to free speech, or the right of religious freedom.... those do not confer upon the government the responsibility of providing the means to those rights. We don't tax everybody in order to supply every home with a gun, or a newspaper, or access to a pastor.
But a right to healthcare, especially as defined by liberals, is a right of a very different quality in that it harnesses the government with the responsibility of providing that service. Taken to its logical conclusion, you can see scenarios where, if such a right is granted, the government may be obligated to force people into the medical profession (not unlike how they sometimes must draft people into the military) in order to meet its obligation to provide a "right to healthcare".

And conservatives will likely always be very weary, if not downright offended, by attempts to assert such rights. About as close as you might be able to get some (few) conservatives to agree to is to accept as necessary mandated health insurance, and then probably only at the state level.

eric said...

I will say this though: many (if not most) conservatives and libertarians are either too weak-kneed or not logically consistant enough to advocate for one of the most logical "conservative" solutions to the healthcare cost problem: Repealing laws that force all hospitals to accept any patient who shows up in their emergency room. Such laws represent a sort of legislative end-around that bestow a "right to healthcare" by proxy, and they contribute greatly to the "free rider" problem that nobody seems to be able to come up with a workable plan to address. I don't want hospitals to turn people away, but if we are going to measure injustices, I think it is more unjust to force everyone to buy insurance under threat of fine and imprisonment than to turn people away from privately owned institutions if they can't afford to pay those institutions for services rendered.

Huck said...

Eric - I have a few comments on your postings, which are sensible and just represent a difference of opinion on measuring justice and injustice.

First, there is a reason why many libertarians and conservatives don't wish to take what may be perceived as a draconian measure to repeal laws that force hospitals to take patients regardless of ability to pay. That reason, as I see it, has to do with how healthcare is seen as it relates to human rights. I believe the majority of Americans (and probably a vast majority) think of healthcare as a fundamental human right, a right that must be ensured by government if not provided for by the market. As for a constitutional basis for this position, one might point to the government's constitutional obligation to promote the general welfare to justify comprehensive healthcare reform. This is something that even conservative intellectuals like Friedrich Hayek have supported.

Healthcare, in my mind, is one of those "very few exceptions" (as you might consider it) where a right provided by a third party and guaranteed by the government is part of its proper functioning.

More to say, but I have to run.

eric said...

Huck, from an academic and philosophical standpoint, I think part of the problem is that the argument in favor of healthcare being a "fundamental human right" is confusing because it seems to be stuffing healthcare into the role of a classicaly defined natural right, which it absolutely cannot be (a Hobbesian natural right is by definition the absence of an individual obligation). What you are arguing for (I think) is basically a recognition of a new legal/civil (i.e., obligatory) right, and furthermore you are arguing that the proper vehicle for delivering such a right is via governmetn's obligation to provide for the general welfare of the country.

Here is my argument (actually it is more of a plea), not just to you but to anyone who wants to see healthcare recognized as a Constitutional right: At least acknowledge the fact that you are promoting an obligatory legal right that is a significant departure from what has been covered under "general welfare" for most of our country's history. By claiming the "general welfare" clause, you are basically asking for "gimme" on what amounts to an extraordinary amendment to the social contract we live under in America. A serious and fair examination of the issue can only lead one to believe that the proper and ethical way to advocate for a Right To Healthcare is via Constitutional Amendment, which is a much harder legislative slog than simply writing bills (which is why nobody attempts to do it).

Just some food for thought... I gotta get back to work too.

Huck said...

Eric - I don't disagree with you about the distinction between a natural right and a legal/civil right. But I think the distinction is, properly, an academic one. I'll explain more in a bit; but I do want to say now that I think the classification of something as a basic "human" right implies, for me, both an inalienable right that you might call a "natural" right, and a legal/civil right that is linked to the obligation of the duly constituted authority charged with both defending and promoting the conditions that realize one's "natural" rights. So, for instance, the inalienable rights to life, liberty, and the pursuit of happiness require, if they have any meaning to individuals at all, a social contract guaranteed by the authority to create the conditions for realizing these inalienable rights. Hence we have a state that assumes the financial obligations attendent to some of the things that are necessary for guaranteeing these inalienable rights: a military, a police force, a judicial system, roads and sewage systems, education, vaccinations, etc. All of which can be provided by private third party entities.

Second, even the "natural" rights you might probably identify are only such because they are accepted as such by people. How is the "right to bear arms," which is practially as much a right to coercion as it is a right to defend oneself, a "natural" right for individuals when we prohibit any individual from "bearing" a nuclear or biological "armament"? When we qualify such "natural" rights, which any practical application of them requires, how can they really be called natural and/or inalienable? Natural rights are also civil/legal rights by virtue of the requirements of the authority of the state through the social contract to promote and defend them. I think of the state's provision of healthcare no differently in the social contract obligation to defend and promote the right to life, liberty, and the pursuit of happiness as is the state's provision of defense.

eric said...

"So, for instance, the inalienable rights to life, liberty, and the pursuit of happiness require, if they have any meaning to individuals at all, a social contract guaranteed by the authority to create the conditions for realizing these inalienable rights."

Correct, but to a certain degree that social contract is spelled out in our constitution. Otherwise "the pursuit of hapiness" could be widely interpreted to mean providing everybody a 2500 square foot home, swimming pool, and a pantry full of the finest organic food and a personal chef to cook it.

What I'm saying here is that, while there is room to disagree on whether healthcare is a properly defined "human right" (though I still say it categorically cannot be defined as a natural right, but admit that is an academic distinciton, which isn't to say it lacks importance) I do think a reasonable survey of the ethical landscape would lead one to believe that defining healthcare as such, at the federal level, is a broad new interpretation of what should be covered by our social contract, and as such the distinction should be pursued by a formal amendment to that contract (i.e., the Constitutional Amendment). Otherwise we will continue to have this debate over and over in the years to come, with "healthcare laws" being created and reformed and done away with and created again based on the swing of the political pendulum.

"When we qualify such "natural" rights, which any practical application of them requires, how can they really be called natural and/or inalienable?"

We can certainly argue about whether our qualifications of such rights are ethical or not, but at the end of the day, a "natural" right remains a right that men enjoy in an anarchic "state of nature" that they cannot reasonably be expected to give up for the sake of creating civilization.

"Natural rights are also civil/legal rights by virtue of the requirements of the authority of the state through the social contract to promote and defend them."

I disagree. Civil/legal rights are often created in order ot secure natural rights, but they are preceded in importance and in logic by natural rights. i.e, if you could come up with another way to promise me justice and fairness when I am accused of wrongdoing by my fellow man, you could reasonably do away with my right to trial by jury. But, generally speaking, you could never reasonably do away with my right to speak my mind on an issue. In much the same way, even the best argument for government guaranteed healthcare can only be made on the basis of it being an antecedent of the right to life (which is arguable). There is no natural right to healthcare.

Norma said...

Maybe you could start by sourcing where it says in our government documents, either founding, amending, or case law, that health care is a "fundamental human right." Then, please explain how much health care and for whom. Is it a right for the unborn? Is it a right for an 85 year old who needs a pacemaker to survive to 90? Is it a right for that microcephalic child? Is it a right for a woman who wants larger breasts or just one who has had a mastectomy? Is tooth bonding included, or nose jobs, or cataract surgery, or non-malignant mole removal so you can stay competitive in your job? Is it shingles vaccines (not currently covered in gov't programs), or just polio vaccines (which are). Is it retroviral HIV/AIDs treatment for gay prostitutes who want to continue in that line of work, or antibiotics for blood infections from tattoo removal you got when you were drunk, or eye glasses or hearing aids, or colored contacts, or diet pills to use because you ate too many brownies, or is it anti-smoking patches because you can't do it on your own, or is it farmers markets in every community because Michelle Obama thinks it's good for you? Can you be more specific about what and how much healthcare is a fundamental right?