Friday, March 26, 2010

Thinking out loud about health care reform

According to the canons of liberalism (as I understand them), it is wrong for citizen X to pass a law that limits a fundamental liberty of citizen Y if the latter is not required by reason to accept the law passed by X. This is usually applied to issues like abortion (see, e.g., my American Journal of Jurisprudence critique of J. J. Thomson's argument in this regard): Yes, the prolife position is not irrational, but it is not so reasonable that a rational person may not disagree with it for good reason; so, since abortion prohibition would touch on a fundamental liberty–the right of privacy and personal conscience–and reason provides no definitive direction as to what faction in the abortion controversy is correct, then abortion prohibition is illiberal and thus not justified.
Given liberal sensibilities, if it is wrong to prohibit abortion because reason does not require that one accept the prolife position, why is it okay to force citizens to buy health insurance–thus touching on the same fundamental liberty upheld in Roe v. Wade, the right of privacy and personal conscience–when it is not unreasonable to reject such a policy? Given liberalism as applied to abortion, it seems to follow that the health care reform law is illiberal and thus not justified. Discuss.


Keith DeRose said...

I think you're probably wrong about that being a canon of liberalism. I know that I don't support the criminalization of abortion and that in my case this position doesn't derive from anything like that "canon." (But maybe I'm not a real liberal? I'm happy either way on that question.)

On the matter of "forcing citizens to buy health insurance"...
I have no problem with that -- in principle, or in the way the new Health Care Reform law does it (at least as I so far understand that law), though of course, such a policy *could* go wrong if it imposed too great a burden on some not well enough positioned to bear it. The way a lot of us see that matter involves some thinking like this. We do have to decide whether we're going to be the kind of society that will, say, bring people to the hospital for emergency treatment regardless of their ability to pay, or whether we're going to be libertarian enough to let them die on the street in such situations. That may not be an obvious choice for some more strongly inclined toward libertarian positions than me, but I'm all for our society being "pro-life" in the way currently under consideration. But then we are "forcing" others to pay for the relevant health treatment of those in emergency situations who can't pay for their own treatment. In some way or other, we're forcing some citizens to pay for at least the emergency health insurance of others. (If the government pays for these services, then the forcing happens through taxation. If the government instead mandates that hospitals absorb these costs, then, in addition to forcing this upon hospitals, the hospitals will no doubt pass these costs on to paying patients, who are then forced to pay.) Once you're into forcing some to pay for health care treatment/insurance for *others*, isn't it less problematic to force people to pay for insurance for themselves? Of course, that's only part of the story. So far as that thinking goes, it might only be insurance for *emergency* care that can be mandate-able. But it is a part of the story, and there is more. I'll just say for now that in the end, I think laws such as the new hcr law are perfectly fine, and even good and wise, ways to "promote the general welfare." (& some of the ideas in it are apparently owed to the Heritage Foundation!)

Francis Beckwith said...

Keith, you are not a real liberal. :-) I have no dispute with your reasoning as a legitimate political proposal that may or may not find its way in our laws. But what I am suggesting in my original post (which was not clear about this point) is that given the principles of justificatory liberalism (the sort found in the Thomson piece I critique) it seems that any controversial conception of the "good" that requires other citizens to support that with which they can reasonably disagree cannot be placed in our laws without violating justice. I, of course, disagree with that. So, even though you and I may offer different policy prescriptions, we at least agree that justificatory liberalism (or at least that version of it) is mistaken.

Concerning health care, there is a difference between what the city of New Have does v. the Federal government in terms of jurisdiction and the Constitutional constraints on Congressional power. One could, for example, agree with a policy such as the one you are suggesting, but disagree that the Federal government has the constitutional power to institute it. So, there are two levels of assessment for me. (1) Does the government have the power to do it? Answer: New Haven, yes. Congress, no. (2) Is it a good policy that advances the common good? Answer: Don't know enough about it to make that judgment.

Ironically, it was Griswold v. Connecticut that put in place the understanding that issues of personal reproductive health are not the business of the government or your neighbors. It seems to me, then, that on such matters of controversy, whether or not the unborn are persons and whether contraception is immoral, civil respect would require that the state not impose its understanding on those who do not share this understanding. Just as the state should not tax Baptists to fund Methodist churches, the state should not tax prolifers to pay for abortions. After all, there are many of us who do not believe that pregnancy is like cancer, or that properly functioning reproductive organs are inconsistent with human flourishing.

I guess I'm becoming more MacIntyrian every day. I'm more convinced than ever that these culture war questions cannot be solved by arguments detached from deeply embedded moral traditions. So, this is why on issues like the APA anti-discrimination policy, each side simply cannot imagine how the other can think otherwise. It's not that one side is full of bigots (anti-religious or anti-gay) and the other full of tolerant folks (religious or gay). It's just the each locates its position in a philosophical anthropology that it is convinced it has no good reason to abandon. What comes out at the end is going to be a policy that harms some folks and benefits others. But the side that wins believes its just, since those harmed are baddies and those benefited are friends. But the reason why one "knows" these truths is because they are connected to something deeper and more enduring than an isolated argument about one issue.

So, what happens is that our spats start to resemble conflicts between ethnic groups each of which swears the other group doesn't understand them.

It's sort of a philosophical version of the "ugly American."