17 July 2007

Some thoughts about universal healthcare

Under the heading of “Better late than never” this posting is a response to a comment left for me here. This response is pretty long; and I’m not in the habit of leaving long comments at other peoples’ blogs, so I’m posting it here.

Anonymous writes:

…i couldn't agree with you more. the police and fire departments are hardly comparable to our current healthcare system... they actually work while the healthcare system is broken.

Actually, you don’t agree with me. The point of comparison was not the efficient operation of the healthcare “system” with the police and fire departments. The comparison was of the “services” they provide. The services are not comparable. The services of the healthcare “system” are part of the GDP; the “services” of the police and fire departments are not. And as for your contention that the police and fire departments actually work while the healthcare system is broken let me just say, first, that there are those who would argue that their police and/or fire departments don’t work, and, second, that we don’t have a healthcare system any more than we have a police or fire system, or a supermarket system. I would also add that 14.66 percent of our population without healthcare insurance hardly constitutes a national crisis – or a broken “system”. Let me ask you a sort of control question: If 14.66 percent of all crimes were never solved would you assert that our law enforcement “system” was broken?

Anonymous writes:

however, in the united states in which i live, the fire and police departments operate exactly that way: they "take wealth in the form of currency (acquired through taxes)" and transfer "that wealth (in the form of goods and services) to others" (e.g. water, protection, law enforcement, emergency medical treatment, et cetera). so when you say, "this is not what police and fire departments do" are you making the claim that tax dollars don't flow to these departments, or are you making the claim that these departments don't provide services?

The police and fire departments don’t operate in the same way (i.e., ["take wealth in the form of currency (acquired through taxes)" and transfer "that wealth (in the form of goods and services) to others" (e.g. water, protection, law enforcement, emergency medical treatment, et cetera).] ). The key word is “transfer”; it’s a term of art. The way you’re using it amounts to an illegitimate totality transfer. I was using the term “transfer” in a specific way, specific to economics. The provision of healthcare services, I was saying, is comparable to a transfer payment. In economics a “transfer payment” is a payment of money from one or more individuals to one or more individuals via government, and for which no good or service is required in return. Transfer payments can be thought of as a negative tax, since in the case of a tax, people pay the government without getting any good or service in direct exchange. Examples of transfer payments include welfare, unemployment insurance, social security payments, publicly-funded pensions and public support for students, including scholarships and financial aid and death benefits for parents. What I was getting at was the fact that although (unlike welfare and those other examples) there is no transfer of money, there is yet a transfer of wealth, one might say, in kind. What distinguishes “transfers” from the services of the police and fire departments is the element, if you’ll look back at the brief explanation, of direct exchange. And before you protest too loudly let me remind you that one entity which also makes this distinction is government, the provider of those “services” you speak of and love so much. So, if the government makes a distinction between “transfers” and other “services” I think we can also. And that is what I do. I maintain my claim that the healthcare “system” you envision would constitute a transfer, in kind, of wealth from one to another.

Anonymous writes:

you invalidate your own point, because having a car isn't an attribute of a person's "general welfare". i'm sure that most americans agree that a person's "general welfare" is directly tied to their health. obviously the capitalist system has so clearly failed a growing majority of americans in the area of health care.

There is no such thing as a person’s “general welfare”. There is “general (i.e., public) welfare” and “personal welfare.” A person’s personal welfare may be tied directly to his health, but the general welfare really isn’t tied to anyone’s personal welfare. If you’re going to employ phrases from the Constitution you ought to employ them in the way the Constitution does. (That’s a task called “exegesis”.) And in the Constitution “general welfare” isn’t used the way you use it. But even granting your notion about “general welfare” I doubt too many people will satisfied with you and your ilk being the ones who decide what is or is not required for one’s personal welfare.

But even if all that isn’t true, as long as you’re going arbitrarily to redefine the phrase “general welfare” in the Constitution to include healthcare, nothing prevents anyone redefining “general welfare” to include, as I argued, anything that I may need, including an automobile. My argument, that my neighbor is obligated to provide my anything I need, still stands because “general welfare” is a very broad concept.

Neither has the “capitalist system” failed anyone. The capitalist system is a system of doctrines about how scarce resources are distributed; it’s a scientific (i.e., economic) theory, not an organic distribution system. The capitalist system of economics has no more failed anyone than the Newtonian system of mechanics fails the passengers of a plane that crashes.

Anonymous writes:

you're taking extra liberties to draw the conclusion that you have no right to live. roe v. wade provided mothers the right to choose to whether carry a fetus to term, putting the onus on your mother to decide whether you would be born or not. once born, the constitution does protect your inalienable rights (bill of rights, constitutional amendments) as originally eluded to by thomas jefferson in the declaration of independence, when he included "life, liberty, and the pursuit of happiness" among these rights. so, i suppose you can thank you mother for the decision she made and you can thank roe v. wade for protecting her right to make that choice. as far as i know, the u.s. does not have forced abortions or zero population growth laws.

To look into the logical implications of a proposition is not to take “extra” liberties in drawing conclusions. In fact, it is taking no liberties whatsoever. Let me see if I can make it more explicit for you. Two preliminary remarks: (1) We need not have forced abortions or zero population growth laws in order for it to be true that we have no right to life; the relation between the two is not truth-functional; (2) I don’t think you’ve even read the Roe opinion. Most people, especially lawyers, know there is only the slightest resemblance to a legal opinion in Roe, if even that much. Not only have I done, I’ve also read the early drafts of the opinion as well as the memos exchanged between Justices Brennan and Blackmun (who wrote the majority opinion). These drafts and memos make it very clear that both justices believed there was no such right to be found in the constitution, that they were creating such a right from whole cloth, and that it was only a matter of how to pull it off.

Now, although I mentioned the Supreme Court, my primary reliance was not upon the opinion. In my very first comment, I did not say any government said I had no right to life. What I said was: “I find it odd to live in a land in which many of the very people who tell me I have no right to be here in the first place (i.e., no right to life), also tell me that I have a right to those things which make life possible. And, furthermore, that I have these rights at others' expense.” I did not mention any government; and I wasn’t alluding to any government. I said “people”; and I meant “people”. You mentioned government. When I responded to your comment it was only as if to say, “Well, to the extent any government has said, then the Supreme Court can serve well enough as an answer.” For clarity’s sake, I will set aside the Supreme Court for present purposes.

So then. My conclusion that I have no right to life is not based on taking any liberties. It is, as I said in my second posted comment, what I believe to be a logical implication of the proposition that the fetus has no right to life. If you disagree then simply show me that this is not a logical implication. Simply saying it isn’t a logical implication -- or that I'm taking liberties -- just won’t do. And telling me that the Supreme Court didn’t say won’t do either; legal opinions are irrelevant: I’m talking about a philosophical matter, not a legal matter.

Assuming the fetus is human:

It is argued that a mother has the right to terminate the life of the fetus in her uterus at will. The fetus is human. Therefore, a mother has the right to terminate at will the life of a human (so long, of course, as that human is the one in her uterus). If the life of humans can be terminated at will, then humans do not have a right to life. You could of course continue to press this argument by asserting a relevant distinction between unborn humans and born humans: Born humans have a right to life, but unborn humans do not. (Judith Jarvis Thomson made very close to such an argument in her 1971 Philosophy and Public Affairs article, “A Defense of Abortion” [an article in which she grants, if only for argument’s sake that the fetus is human]). If you do press that argument then I think you should show how the distinction between unborn-human and born-human gives a right to life to the latter but not the former. To sum up then:

Assuming the fetus is human:

1. For all humans, if the life of a human may be taken at will, then a human has no right to life.
2. The life of a human (e.g., a fetus) may be taken at will (even if only by its mother).
3. Therefore, humans have no right to life.

You correctly state that the Constitution protects my “right” to life. But the truth is only that the Constitution prevents the government from taking my life, and even then only without due process of law. I need not truly have a right to my life for the Constitution to limit the government’s power to take my life. Neither must humans have a right to life in order for the law to prohibit murder. We as a society could agree that even though we don’t truly have a right to life we nevertheless want to live and agree together not to take each others’ lives (i.e., social contract, making “right to life” a legal fiction). I maintain that if one accepts the proposition that a mother has the right to take at will the life of her unborn child (a human) then it cannot truly be said that humans have the right to life. We live – at least in utero – by the good graces of our mothers. That hardly counts as a right to life.

Assuming that the fetus is not human:

We need not assume that the fetus is human in order for me to argue that humans truly have no right to life. If I don’t have a right to have been born into the world, then I do not have a right to be in the world. Being in the world means living. I think it quite clear that if I do not have a right to be born, then tautologically I do not have a right to be here, a right to live. That being the case I wonder that there are those who assert both (1) mothers’ right to deny birth to unborn children as well as (2) a right of humans to their lives and those things, like healthcare, which make their lives possible. I don’t think I’m asking too much for an explanation of the difference between an unborn child and a born child such that the born one acquires a right to its life while the unborn child is denied a right to its life. It’s a philosophical question, Anonymous; and such questions are not resolved (at least to my satisfaction) by the Supreme Court. To sum up:

Assuming that “a right to be here” (i.e., in the world) and “a right to live” (i.e., a right to life) are equivalent expressions; and

Whereas, every person living was once a fetus; and

Whereas no human could be here (i.e., be alive) without having been born:

1. If a mother has the right to terminate the life of a fetus then no human has a right to have been born – tautologically, no right to be here, no right to life.
2. A mother has the right to terminate the life of a fetus.
3. Therefore no human has a right to have been born; no human has a right to be here, no right to life.

So then: humans have no right to life. Therefore, they ought not be considered to have a right to the means of preserving their lives, at least not at the expense of others. All you have to do is show me how I have a right to life; then you can show me how I come to have this right to life such that my life is to be maintained at others’ expense, whether they wish to take this burden upon themselves or not.

Anonymous writes:

on the other hand, we do have many states that enforce the death sentence which does say that a jury of people can revoke a person's right to life.

Juries don’t “revoke” anyone’s right to life, depending upon one’s worldview. On a Judeo-Christian view the death penalty is rooted in the Noachide law. See Genesis 9.5-6. On that same view a human’s right to life is a right granted by God against all other humans. But a human doesn’t have that right against God. Human governments have had the requirement from God to take the life of murderers, and act as His agents in doing so. So in maintaining the right of an unborn child to its life, and the permissibility of the state to take the life of a murderer, we maintain that the distinction between the two is that the murderer has murdered and the unborn child hasn’t.

On a secular view it is difficult to see how anyone can have a right to life, or anything else. I suppose it’s just because we want to have it so. Even so, resolution of this seeming contradiction depends at least upon (1) what rights are; (2) which rights we have; (3) how we come to have them; and (4) under what conditions, if any, we can be said to surrender them (i.e., whether they are absolute and irrevocable). (A fifth issue may well be: who has the authority to render a verdict on these questions.) Leaving aside (1) and (3) let’s say that we have a right to life. Saying so need not imply that we have this right irrevocably and absolutely. We might have this right conditionally (e.g., on condition that we not murder other humans). Besides, what’s your point? That since the life of a murderer may be “revoked” so may the life of a fetus? If so then guilt or innocence of wrong-doing must be irrelevant to you.

DISCLAIMER REGARDING CHRISTIANITY AND CAPITALISM:

Nothing about any statements in defense of capitalism are to be taken as evidence that I believe capitalism to be required by or even identified with the Christian faith. I do believe that, unlike macro-evolution, capitalism does not conflict with any tenets of the Christian faith. As I mentioned above, capitalism is a scientific theory. I think I am as free, as a Christian, to believe in capitalism as I am to believe in string theory, or the Big Bang, or even theistic evolution.

Economics is a social science, not a branch of ethics. It studies the production, distribution, and consumption of goods and services. And capitalism is a theory within that science. As a theory in economics, capitalism is not a normative economic theory; it is a positivist theory. In other words, it isn’t a theory about what ought to be the case; it is a theory about what is the case. What is the case is that free markets, however paradoxical, more efficiently (though not perfectly) distribute scarce means which have alternative uses than do command economies (i.e., quasi-capitalist or socialistic economies).

That last point is important because most criticisms of capitalism appear rooted in the notion that it must be appraised ethically. Capitalism doesn’t help the poor; therefore people who “like” it don’t care about the poor. It follows then that capitalists are selfish, greedy people – immoral people. That is a silly notion. A similar approach to a different scientific theory is the approach which rejects evolution because of certain ethical considerations. For example, many years ago Tim LaHaye asserted evolution was responsible for, among other things, pornography. That may be true. But it is not an argument against evolution.

It is true that capitalism does nothing for the poor. I freely admit that. But my Christian faith doesn’t demand that I give my assent to scientific theories based on what such theories supposedly “do” for the poor. No scientific theory does anything for the poor. For that matter no scientific theory does anything for the rich.

My faith requires that I do something for the poor. And I do. And the quasi-free market economy that we have helps me to do something for the poor. A truly free market might help me do more. My faith doesn’t require that I construct from whole cloth a scientific theory that benefits – or at least doesn’t “fail” – the poor.

I may, it is true, reject some type of evolutionary theory which conflicts with my Christian faith. But it is logic which forces me to do so. A form of evolutionary theory may be a proposition which in turn implies the proposition, There is no creator. As a Christian, I believe the proposition, There is a creator. I cannot believe both that There is a creator and that There is no creator. Either I reject this form of evolutionary theory, or I renounce my Christian faith. Because I believe Christianity is true, I logically reject that form of evolutionary theory which implies there is no creator.

I am not in this position when it comes to capitalist economic theory. I may as a Christian believe the proposition that I have a duty to the poor and the proposition that Free markets more efficiently distribute goods and services. As a Christian, I believe that as my economic circumstances improve my financial duty to the poor increases as well. So if the operation of the free market improves my economic conditions (and…uh…they do) then I have more means at my disposal with which to assist the poor.

When, however, it comes to a redistributionist government I am in the position of having a conflict with one of the requirements of my faith. I cannot find where the Scriptures teach me to support a government which simply takes one person’s money and gives it to another (even “in kind”) just because the first person has it and the second doesn’t have as much. Stealing doesn’t cease to be stealing just because the government does it. And it doesn’t cease to be stealing just because the stolen money is given to another (well, some anyway: the government gets its “take”; it doesn’t perform that service for free, you know). (Also, this operation corrupts politics more than it is naturally subject to. Politicians of both Right and Left make appeals based on either how much of our money they are going to help us keep, or how much of someone else’s money they are going to transfer to us. In other words, they buy votes. And worse: they do so with other peoples’ money.)

My faith teaches me to be both innocent and wise. I think I’m wise enough to know stealing when I see it, and not fall for it when the thief says, “But it’s for the poor.”

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James Frank Solís
Former soldier (USA). Graduate-level educated. Married 26 years. Texas ex-patriate. Ruling elder in the Presbyterian Church in America.
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