Building a Healthy and Just Society
Barton Hinkle of Barticles (and the Richmond Times-Dispatch) has taken a stab at the question previously posed by Political Prof. How is opposition to a national health care system the right way to build a healthy and just society?
To avoid talking at cross-purposes, I would note that when referring to a “national system” for healthcare, I’m not referring to any specific implementation scheme. So long as we have functionally universal access to health services, we’ve agreed on the goal. The who pays, how, for what questions are, of course, important. But those are a lot easier to answer if we agree that we want everybody in the country to have access to medical care and that we’re willing to do what it takes to make it happen.
Mr. Hinkle offers three points. First, he argues that looking at other basic necessities suggests that a national system for healthcare might not build a healthy and just society. He mentions education, housing, and food, asserting that we lack national systems for housing and food and that we’re not happy with public education system. I think he is wrong on all three.
Housing and food are both largely private industries—but in both cases we have federal policies in place to cover the gaps in the private system. We have both project-based and Section 8 housing subsidies. Between VA, USDA, FHA, and now FNMA and FHLMC loans, the lending industry is dominated by public players as well. (For those who don’t want to Wikipedia all those acronyms: the bulk of U.S. mortgages have some level of implicit or explicit government guarantee.) Food has less government involvement—though we subsidize it on both the production end with farm subsidies and the consumption end with SNAP and [WIC](http://www.fns.usda.gov/wic/aboutwic/ “Women Infants and Children).
Education is an even more interesting example. We’re not happy with our public education system. But … (virtually) nobody wants to eliminate it. There are a wide variety of proposals for reform—some of which include greater privatization through vouchers. But that’s still a government payment system. (It’s a bit like medicare, but for schools.) When we’re unhappy with our education system, we’re unhappy because we don’t think it’s good enough. We want to fix or improve it—not eliminate it. I don’t think anybody is seriously proposing we just shut down every school in a struggling district and see what happens.
Mr. Hinkle’s second point is that there is no guarantee that a national system will produce a healthier society. As he points out, we can cherrypick statistics all day long to support our preconceptions. Or we could delegate the question to a slew of healthcare professionals who can present us with a set of proposals that are likely to lead to a healthier society.
That’s a deal I’m willing to make. (And I’ll happily sell it to anybody left of center.) If we can agree on the goal of a healthy society, agree that we’re willing to invest some resources to make it happen, agree that we care about everybody’s health, and agree that we want to take a fact-based approach, I’m happy to set aside ideological preferences. And if the People Who Understand Public Health better than you or I come back and say a completely hands-off, free market approach is the best thing for the nation’s health, I’ll feel a bit embarassed, but I’ll vote for it. With that said, I don’t think Mr. Hinkle would be willing to shake on that deal. Because we pretty well know that things like increasing access to preventative care is an all-around-win for public health.
Mr. Hinkle’s third point is that justice is a fuzzy concept. we haven’t been able to definitively nail down exactly what a just society looks like in thousands of years of philosophical debate.1 He mentions the Aging Violinist hypothetical as an example of a sticky question of medical ethics.
Speaking of fuzzy things, my parents have a very, very fluffy cat. He’s pictured below, in a box. Carolyn and I have long suspected the cat is obese. My parent insist that he just looks that way because of the insane quantity of very long hair. There is something to that. He is so fluffy it’s hard to tell how big the actual cat is. He’s the embodiment of a playful yet blurry line.
The cat is in Illinois. I’m in Massachusetts drinking my coffee. And while any spot within a foot of the gravitational center of the cat may be a liminal zone between Cat and Not Cat, I am very confident that my coffee cup is firmly in the Not Cat category. In this case, it’s not a difficult question.
Similarly, while the line between justice and injustice can be difficult—particularly in carefully constructed hypotheticals—it’s not always hard. Should I feed somebody who is starving (AAINH2)? Yes. Should we care for somebody who is sick? Yes. If a kid got hit by a car and we can set the bone in ten minutes so his arm isn’t screwed up for the rest of his life, should we do it? Yes. These generally aren’t close questions. Nor is the question of whether a just society will ensure that the basic needs of its members are met.
If you don’t believe that a just society is a worthwhile goal, I disagree but understand that you’ve reached that conclusion. Similarly, I can understand if you believe that a just society is a worthwhile goal but don’t think it is incumbent on you to advance it. Finally, I can understand if you think the consequences of things like caring for the sick would lead to a less just society. (I think it’s a bit silly when people argue that, say, a 10% tax on artificial tans is a greater injustice than medical insecurity. But I respect bold stands.) But emphasizing that justice is a difficult concept and arguing that the philosophy is still out seems like a way of avoiding an inconvenient question.
Mr. Hinkle’s fourth point is here. I’ll leave it largely untouched—because I think he implicitly concedes an important point. An argument for federal preemption of state health consumer protection laws to advance accessibility and afforability both concedes the importance of accessibility and affordability and acknowledges a comfort with subrogating traditional state prerogatives to do so. So long as we’re doing that, we shouldn’t have any concerns about talking about the data on how that’s likely to work. We’re back in the same deal discussed above. If the goal is the best and most widely accessible healthcare system possible, we can put everything on the table. That includes Medicare, Medicaid, and every variety of deregulation. But once your onboard, you can’t just grab your party’s favorite goodie and bail.
Edit: Mr. Hinkle responded to this post here.