One way to argue that the state is obligated to provide health care (in some manner) to its citizens is to draw an analogy to the obligation of the state to defend its citizens from “enemies foreign and domestic.” While thinkers disagree about the obligations of the state, almost everyone except the anarchists hold that the state is required to provide military defense against foreign threats and police against domestic threats. This seems to be at least reasonable, though it can be debated. So, just as the United States is obligated to defend its citizens from the Taliban, it is also obligated to defend them against tuberculous.
Another approach is to forgo the analogy and argue that the basis of the obligation to provide military defense and police services also extends to providing health care. The general principle at hand is that the state is obligated to protect its citizens. Since anthrax and heart failure can kill a person just as dead as a bullet or a bomb, then the state would seem to be obligated to provide medical protection in addition to police and military protection. Otherwise, the citizens are left unguarded from a massive threat and the state would fail in its duty as a protector. While these lines of reasoning are appealing, they can certainly be countered. This could be done by arguing that there are relevant differences between providing health care and providing armed defenses.
One way to do this is to argue that the state is only obligated to protect its citizens from threats presented by humans and not from other threats to life and health, such as disease, accidents or congenital defects. So, the state is under no obligation to protect citizens from the ravages of Alzheimer’s. But, if ISIS or criminals developed a weapon that inflicted Alzheimer’s on citizens, then the state would be obligated to protect the citizens.
On the face of it, this seems odd. After all, from the standpoint of the victim it does not seem to matter whether their Alzheimer’s is “natural” or inflicted—the effect on them is the same. What seems to matter is the harm being inflicted on the citizen. To use an obvious analogy, it would be like the police being willing to stop a human from trying to kill another human, but shrugging and walking away if they see a wild animal tearing apart a human. As such, it does not matter whether the cause is a human or, for example, a virus—the state’s obligation to protect citizens would still apply.
Another approach is to argue that while the state is obligated to protect its citizens, it is only obligated to provide a certain type of defense. The psychology behind this approach can be made clear by the rhetoric those who favor strong state funding for the military and police while being against state funding for medical care. The military is spoken of in terms of its importance in “degrading and destroying” the enemy and the police are spoken of in terms of their role in imposing “law and order.” These are very aggressive roles and very manly. One can swagger while speaking about funding submarines, torpedoes, bullets and missiles.
In contrast, the rhetoric against state funding of health care speaks of “the nanny state” and how providing such support will make people “weak” and “dependent.” This is caring rather than clubbing, curing rather than killing. One cannot swagger about while speaking about funding preventative care and wellness initiatives.
What lies behind this psychology and rhetoric is the principle that the state’s role in protecting its citizens is one of force and violence, not one of caring and curing. This does provide a potential relevant difference; but the challenge is showing that this difference warrants providing armed defense while precluding providing medical care.
One way to argue against it is to use an analogy to a family. Family members are generally obligated to protect one another, but if it were claimed that this obligation was limited only to using force and not with caring for family members, then this would be rightfully regarded as absurd.
Another approach is to embrace the military and police metaphors. Just as the state should thrust its force against enemies within and without, it should use its medical might to crush foes that are literally within—within the citizens. So, the state could wage war on viruses, disease and such and thus make it more manly and less nanny. This should have some rhetorical appeal to those who love military and police spending but loath funding healthcare. Also to those who are motivated by phallic metaphors.
As far as the argument that health care should not be provided by the state because it will make people dependent and weak, the obvious reply is that providing military and police protection would have the same impact. As such, if the dependency argument works against health care, it would also work against having state military and police. If people should go it on their own in regards to health care, then they should do the same when it comes to their armed defense. If private health coverage would suffice, then citizens should just arm themselves and provide their own defense and policing. This, obviously enough, would be a return to the anarchy of the state of nature and that seems rather problematic. If accepting military and police protection from the state does not make citizens weak and dependent, then the same should also hold true for accepting health care from the state.
As a final point, an easy way to counter the obligation argument for state health care is to argue that the state is not obligated to provide military and police protection to the citizens. Rather, the military and the military, it could be argued, exists to protect and advance the interests of the elites. Since the elites have excellent health care thanks to their wealth and power, there is no need for the state to provide it to them. Other than the elites in government, like Paul Ryan and Trump, who get their health care from the state, of course. On this view, support for using public money for the military and police and not health care makes perfect sense.
Here’s an idea. How about everyone serve their country in the military, police, or similar type of government public service and then, after their term of service is up, they receive government health care? That’s what I did. No government public service, no government health care. “Ask not what your country can do for you, ask what you can do for your country.”
Michael LaBossiere says
Robert Heinlein would approve!
Glen Wallace says
From the perspective of what I like to call ‘applied social political philosophy’, I prefer to bypass the whole debate about whether health care is a privilege or a right that the state is obligated to provide. Instead, I ask the question, is a society that provides universal health care coverage achieving an ideal compared to a society that doesn’t? Can that ideal be practically achieved using a reasonable level of human and material resources? If the answer to those two questions is ‘yes’, then proceed with taking steps towards the state providing universal coverage. If there isn’t yet sufficient support from the constituents for such coverage, then proceed with arguments and facts to sway them otherwise.
Regarding any counter arguments about government coverage leading to complacency, I think the facts and reasons point in the opposite direction. If memory serves me correctly, I believe I read a statistic that European nations are greatly outpacing the U.S. in business startups. And given that universal single payer coverage is much more common in Europe, it would stand to reason that that difference is a fundamental reason for Europe besting the U.S. in such bootstrapping. That’s because here in America, the worker is much too dependent on their employer for health care coverage and thus discouraged from even dipping their feet into the business startup waters. Compare the American worker with dreams of starting their own business but are wary of leaving their employer with its comfortable health insurance coverage. Our system of private insurance, generally provided through employment, acts as a disincentive to bold entrepreneurship. Conversely, a single payer universal coverage system, by limiting risk, would act as an incentive to the sorts of bold bootstrapping that built the United States business empire — an empire that is now showing signs of flagging compared with the rest of the developed word that wisely provides universal healthcare coverage.
Michael LaBossiere says
Very reasonable points.
Mike, would you agree that what you are proposing fundamentally changes the relationship between the citizen and the state?
If so, should not all the ramifications of this proposal be considered?
In Oz we have a universal single payer health system with optional private health insurance. Seems to work reasonably well though there is rationing via waiting lists for public patients for elective surgery…but if anyone has an accident or heart attack say, they are looked after immediately.
One thing that the Oz gov does do and that is something that the pharmaceutical cos hate, and that is act as a single buyer for medications but at a big discount.
Last time I looked, Oz spent 7 or 8% of GDP on healthcare and the US spent double, with no real better general health. Where is that money going?