Healthcare Arguments = Missing Parameters

All the hip kids these days are debating the whole healthcare crisis thing. And I agree it is a crisis. Yes, we’re living longer than ever before — so one might argue that we have no crisis, because we should just be happy with the way things are — but I would argue that the crisis is not really physical; it’s moral.

As usual in the American political world, the two sides are throwing accusations at each other, packed with unspoken and inflammatory assumptions. Like-a so:

GUY 1: Opposing the President’s healthcare reform clearly indicates that you think it’s okay for people to die just because they’re poor and because the pharmaceutical companies are greedy.
GUY 2: Supporting the President’s healthcare reform clearly indicates that you think the Federal government should take away taxpayers’ freedom to keep their own property and make their own decisions.
GUY 1: You obviously believe that only spoiled rich people have the right to a healthy, pain-free life!
GUY 2: Well, you obviously believe that victims and lazy people should be able to demand honest, hard-working people’s money at the point of the IRS’s gun!
GUY 1: You, my friend, are apparently a Fascist.
GUY 2: And you, sir, are a Communist.

The problem as I see it, as in many political issues, lies ultimately in our oversimplification of the issues. Well, some of us. Others don’t do this. But pretty much anyone on TV is leading the oversimplification army over the cliffs of doom every freaking day.

Here’s some ideas:

1. Wealth is not, primarily, a function of personal characteristics or personal effort.
2. Healthiness is also not totally determined by personal characteristics or behavior.
3. Therefore, an injustice exists when personal financial status is a primary determinant of individual health, length of life, or ability to care for loved ones.
4. Despite the above, it is also true (I think) that personal freedom is a critically important value. People should not, in general, be coerced into doing things they don’t want to do.
5. An injustice of a different sort exists when one group of people uses threats, extreme incentives, or other coercion to induce another group into doing something, even if the goals are beneficent.
6. The free(ish) market has shown itself to be an effective economic engine, in general. Everyone, even our poor, is richer than their great-grandparents. And everyone, even most of the very sick, will live longer, healthier lives than matched individuals in our great-grands’ day. I’m not going to suggest that diminishing capitalism amounts to injustice; I’m not sure I believe that; but if we do it too much, it might amount to shooting our GDP in the foot, and that would hurt a lot of people.
7. In matters of happiness, relative inequality between people, independent of absolute deprivation, reflects on the people who allow or encourage it to continue.

Those principles are all correct. They should all be values. This debate should be about the relative ranking and interaction of those values with each other, in a particular domain. Is it better to force someone to pay for a poorer, sicker person’s treatment, or to respect personal autonomy? Maybe those choices are dimensional rather than categorical; if so, how much should each weigh in our decisions?

The nature of democracy is that the minority must inevitably bow to the will of the majority (or of wise and just elected legislators; but I have a hard time remembering one of ours making an important decision based on anything but polls), or else face the consequences. This is a terrible power, so we have elections and referendums and such to decide whether that should happen on any given issue, and if so, how.

Much of this debate (on both sides) avoids an important, uncomfortable issue: a deficit of charity. Almost every American would probably agree that we should be charitably compassionate toward the needy. And Americans, by some measures, are more financially charitable than most other nations. But our poor still sometimes die of treatable illnesses, our prisoners go without sympathy, and our mentally ill sometimes die homeless and alone. One side of this debate, by arguing for healthcare reform, seems to be endorsing a solution whereby everyone is coerced (even if they don’t need coercing) to give more of our substance to the suffering poor. Sounds brutal, but democracy is always like that. The other side of the debate is vocal in arguing that this violates their freedom of choice (among other points). It is probably naive to suggest the following, but here it is: nobody, including me, should have to be forced to help the needy. We should do it simply because the need exists.

Maybe we’ve been living for too long in a nation whose political and economic systems exemplify a compromise with the worst parts of human nature: use some people’s selfishness to counterbalance that of other people. Maybe we’ve come to believe that this is somehow the best way to live. It’s not. Democracy and capitalism are fallback positions in the face of humans’ apparently incorrigible inhumanity. They represent government from the top down, from the outside in. Even our founding fathers recognized this. They urged us to become better people. They told us that even these systems would break down if we stopped caring for each other and for basic morality and justice, as individuals.

I suggest (hardly originally), if human compassion were to reach a very high saturation point in the daily lives of enough people in any society, that specific forms of political and economic management would be almost indistinguishable from one another. It would be nearly impossible to tell capitalism from communism, democracy from socialism, anarchy from monarchy.

But that level of compassion does not exist in high enough concentrations. The biggest problem seems always to have been that of managing the ugly side of homo sapiens. Therefore, there are often real and glaring differences between governments and nations, in terms of the happiness and prosperity of citizens. I think we argue about the specific forms of government because we have no real hope that societies will change from the inside out, from the bottom up, enough to obviate our arguments.

The healthcare debate will go on, partly because we don’t want to think about what we all know we should be doing. We should be finding people who are in need and helping them, in the best way we can. Instead, one side argues that the other side is trying to take away its agency, and the other side argues that the first side has no compassion. Both sides know that, without the coercion of law, they will not inconvenience themselves to the extent necessary to help the needy.