Tuesday, August 04, 2009

Socrates in Chicago Debating Health Care

(The following is an dialogue written in the style of Xenophon, between a wonkish Washingtonian, whom I'll call Socrates, and a citizen from the U.S. heartland, whom I will call Critobulus, after the dialogue figure in the famous work Oeconomicus, regarded as one of the earliest works on economics. The proper title for this dialogue should be Oeconomicus Sanitatis, but I thought the Latin would scare people away.)

INTERLOCUTORS: Socrates and Critobulus

PLACE: Grant Park, Chicago

CRITOBULUS: Ah, so it goes, my friend: politics as usual. I don’t know why a person would continue to fight a losing battle. Money is what makes things happen not altruism.

SOCRATES: That's right. Abdicate. We can use fewer nay-sayers in the fight.

CRITOBULUS: Well, food, shelter, and clothing are more important than health care. One can get along for substantial periods of time without health care services, but one cannot survive for long without food, shelter, and clothing. Given this plain fact, why don’t the proponents of "free" universal health care demand "free" food, shelter and clothing?

In other words, if a citizen, just in virtue of being a citizen, has a right to health care, why doesn’t the same citizen have the right to what is more fundamental, namely, food, shelter and clothing?”

SOCRATES: You think human beings don't have an inherent right to these? Is it all right if I take them away from you, then?

CRITOBULUS: You have no more right to take them away from me than you have a requirement to give them to me. But "inherent right"? As in, because I’m a human being others are required to see that I have these things?

SOCRATES: Inherent right. If you don't have an inherent right to food, shelter and clothing, then no one has a right to exist. Everyone may be killed, tortured, stolen from, raped, anything you want.

What did you think was meant by "We hold these Truths to be self-evident, that all Men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness"?

CRITOBULUS: Right. “Life, Liberty and the pursuit of Happiness,” but not free food, free shelter, free health care and whatever else the government comes up with. Food, shelter and health care is not the responsibility of the federal government.

SOCRATES: What do you think sustains "life"? People can live without food and shelter and other essentials? Can you?

CRITOBULUS: What am I supposed to answer? That, no, I don’t need food to live? I wish that it were so. But does that mean than someone has the responsibility to feed me?

SOCRATES: Well, if you need these things to live and you have a right to life, then there is an inherent right to food, shelter and other essentials of life, isn't there? Are we agreed on this?

CRITOBULUS: We are in agreement that it is essential to have food and shelter in order to live.

SOCRATES: The proposition is "There is an inherent right to food, shelter and other essentials of life." Agree or disagree?

CRITOBULUS: Oh, all right. Agree.

SOCRATES: So, then, do children procure their own food, shelter and essentials, say, when they are one year old?

CRITOBULUS: No.

SOCRATES: So, if they have an inherent right to the essentials of life, someone must procure that for them. Right?

CRITOBULUS: Yes.

SOCRATES: Who should that someone be?

CRITOBULUS: His or her parents.

SOCRATES: What if the parents are unemployed, disabled, sick or dead?

CRITOBULUS: Then grandparents, aunts and uncles, brothers and sisters, cousins.

SOCRATES: What if things are so bad that none of them has any time or resources to spare?

CRITOBULUS: Well, the community.

SOCRATES: What if the community is poor or unable or even unwilling?

CRITOBULUS: Then the State.

SOCRATES: OK, so assuming that by "the State" you do not mean Montana or Maryland, but government in general, you will also agree that a similar chain of responsibility exists with respect to the elderly and the infirm, right?

CRITOBULUS: By “State” I did mean Montana. Montana takes care of their residents; Maryland takes care of theirs.

SOCRATES: Conceptually there is no difference. They are simply different levels of government. Distinctions between states and the federal government are almost entirely artificial.

Functionally, it is very difficult to separate the states and the federal government or distinguish between them. All states have tripartite government, agencies modeled after the federal, constitutions similar to the federal, etc., etc. If you had a Kingdom of Montana and a Grand Duchy of Wyoming and a Soviet Republic of Idaho, well, that might be somewhat different. But they all function on basically the same Lockean theory of government.

CRITOBULUS: OK. The state, in general. And I see the same chain of responsibility for the elderly and infirm.

SOCRATES: So what about people who are laid off? Or towns in which a plant that is the main industry, after the plant closes? Should government help them make sure they have the necessities of life?

CRITOBULUS: I think the idea of unemployment insurance is good if it’s used as it was intended. In other words: a means of seeing someone thru an in-between-jobs length of time. I don’t think a differentiation should be made between layoffs of large employers and small employers.

At the same time, people have to get back in touch with the idea that you don’t spend everything you make as soon as you make it. I don’t know how that can be accomplished if they always have someone to bail them out. I know this isn’t an option for people making minimum wage but it is an option for more people than seem to be using it.

SOCRATES: OK, but in principle, you've agreed that a rather large proportion of the population should get government for the necessities of life. Is there any reason this should not be extended to all citizens who need such help?

CRITOBULUS: It would be ideal if everyone who needed help received it and received it in the amount that they truly needed and in a manner that didn’t undermine their self worth.

SOCRATES: OK, then, we have agreed that, provided it is financially feasible and done well, there ought to be a system of social insurance and health to make sure that everyone has the necessities of life.

CRITOBULUS: I don’t think I would go that far. Health care doesn’t have to be insurance, does it? In other words, I don’t think the heath care business would be in the shape it’s in, if insurance hadn’t been involved. Insurance was supposed to be a "gamble." They gamble that you won’t need it, you gamble that you will. It wasn’t supposed to be they win if you don’t use it and they win if you do, because they get to jack up the premium.

SOCRATES: In this context, "social insurance" not insurance in its everyday sense.

I'm speaking of a system, or set of programs. In this framework, the risks that one might not be able to obtain the essentials of life are transferred from the individual or household to society. The resources needed to face the risk is pooled by society, though the government. After all, in a republic, the government is the holder of public goods and resources.

The result is that, when any person faces circumstances that prevent him or her from obtaining the essentials of life, society would rush in to the rescue. A single-payer health plan, for example, might be one component. Unemployment compensation would be another, and so on.

CRITOBULUS: That sounds good. Until the end-of-life decisions need to be made. Who says when? Who says this much treatment and no more? Would I rather have the government make that decision or make it myself within whatever means I can finagle? And I guess it boils down to how much trust do I want to place in the government.

SOCRATES: The question in political philosophy is what the proper role of government is. We've agreed, with the framers of the U.S. Constitution, that government is properly involved in the general welfare of the people, particularly when people can't do so themselves. No one should have to face the choice between good health and food or rent.
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