Somewhat astonishingly (though why I continue to find this astonishing, at my age, remains a mystery), recent discussions of health care as a type of social provision have precipitated impassioned declarations of (what certainly sounds like) libertarian ethical norms: the (allegedly - this is the locus of a begged question) mere fact that someone is suffering from a malady, the treatment for which he cannot afford out of his personal resources, does not imply, create, or impose, let alone entail, an obligation on the part of any other individual to remedy that want. So strong is this libertarian principle that it is not merely 'socialized medicine' that traduces it, but the very vaunted private health care system itself, which, through the mechanisms of mandated insurance coverages, risk-pooling, and the proscription of genetic screening, ensures the extension of coverage to many who would be excluded were risks to be individualized. The sick do not have a right to our money, in order to procure treatment, not even the comparative pittance factored into an insurance premium so that such higher risks might be adequately underwritten. Presumably, a starving man would not have a right to our bread, either.
Moreover, in accordance with such principles, those risks should be socialized on a purely voluntary basis, in and through families, churches, and other voluntary institutions established for charitable purposes; there obtain no enforceable claims upon such benefactions, which should alight upon the sick and infirm only insofar as those possessed of health and wealth will it, and only to that degree made possible by the gratuitous movements of their sovereign wills.
Much could be said of this, especially that a species of economistic dogmatism now impels some ranged along the right spectrum of our political culture to war against an inevitably flawed, but fundamentally decent, system, and this in the name of an ideological figment which cannot be translated into reality, and that this intransigence will eventually beget something far worse. The endeavour to fully marketize the domain of health provision, leaving the individual naked, with all of his weaknesses and frailties, before the utterly impersonal and unforgiving mechanisms of the market, petitioning those who clutch their wealth to their breasts like the misers of many a parable for relief, as a pious man might petition the Almighty, will shipwreck on the very structural foundations of modern society. Indeed, the argument has already been sketched:
...since the origin of any thing is, at a minimum, a clue to its nature or essence, we ought to attend to the fact that widespread health provision was originally a ministry of the Church, and founded as a charitable endeavour. Nevertheless, the Church or, more broadly, charitable institutions, can only assume such a tremendous burden - particularly in a more complex modern society - if they can command vastly more social authority than they do presently, exercise more overt social power on the basis of that authority, and command a greater percentage of adherents' resources than those adherents presently provide under our purely voluntaristic models of giving. One cannot recreate a social form without first recreating its conditions of existence.
The problem is amenable of simple restatement, yet the solution is difficult: yes, there was a time when the provision of health services was largely under the direction of the Church, when this was mainly a charitable work, and occurred under the auspices of few, if any, civil laws; and in those times, the Church wielded such authority and power and wealth as modernity has stripped from Her, and, not to mention, standards of care, and the technologies by which those standards were realized, were orders of magnitude more primitive. Libertarians, I can only assume, presuppose that the existence of any social institution is as arbitrary as the movements of will in the breast of the superman; that we have the health care and insurance systems we do is thus arbitrary, not in the loose sense of being artifactual, but in the strict sense of reflecting, and conforming to, no facts in the real world. We only have them because certain interest groups have foisted them upon us, and not because they answer to any aspect of reality - and those people are very bad for doing the foisting.
In reality, total expenditures on health care exceed the wealth commanded by all churches combined; moreover, a perusal of the budgetary statements of the average church - say, a parish like my own - will confirm that there exists no fiscal fat that could be trimmed to pay for 'routine' cancer treatment, let alone every medical necessity that would portend the bankruptcy of a family. The counsel that 'we cannot know unless it has been tried' is not merely an exercise in ideological anachronism, but a declaration that folly is not folly until it has been performed.
Moving onward, of course it cannot be the case that medical need generates an individual claim right, enforceable against any individual who might be supposed to possess the requisite resources. This, not because there obtains a 'right' not to support one's ailing fellows, or to the disposal of every last farthing of one's wealth, but because it would be absurd, contradictory, to have society enforce claims against individual members, when such claims would be both unpredictable and catastrophic. Such a claim-right would enlist society in the destruction of its constituent members, pitting some segment of society against another; and what society can endure if a faction within it claims the right of undermining another? The skein of ordinary and healthy social relations would be rent, and irreparably. But why tarry on this rhetorical trope any longer? No one seriously supposes that such an arrangement would ever be instituted, and it is merely reflective of the histrionics of the sovereign individual when his plenipotentiary powers are challenged.
Perhaps, then, there obtain no claims upon society for health provision, just as the libertarian - the dogmatic sort, I should say - asseverates. In that case, it would be perfectly consistent with principle to permit people to perish, willy-nilly: let all men be smitten with disease and infirmity, only touch not the Holy Ark of the individual's sovereign will, and his property rights. This, too, however, would be absurd, and for reasons consonant with those already articulated. If it would be a grievous impairment of the stability and goods of society for any individual to be liable, at any time, for the full expense of some other's infirmities, so also would it be a grievous impairment of society and its goods if the lives and fortunes of its constituent members, individuals and (more importantly) families alike, were to be exposed to the personally and financially ruinous risks of catastrophic, chronic, and unpredictable illness and/or debilitation. In the former scenario, what security in his dealings, plans, and prospects could an individual possess, if at any time, some infirm person could wield the cudgel of the state to secure the means of his care? In the present scenario, then, what surety could any individual, any family, any undertaking, possess, liable as they would be, naked before a pitiless Market, for the entire cost of an infirmity? There could be none, and individuals, families, and their undertakings - businesses and other callings beneficial to society - would stand beneath a proverbial sword of Damocles, and fall to bankruptcy and ruination with regularity. This would foster nothing but instability, inconstancy, a pervasive fear of impassive fate, and the notion that it could be justified by some individual 'right' is merely another claim that society is obligated to enforce the means of its destabilization or dissolution. Let us speak plainly: there exist no rights to the destruction of the social conditions of rights, no rights to destabilize the very foundations of the enforcement of rights-claims.
We must speak, therefore, of a sort of social good, which can be secured only by a collective undertaking, in this instance, private entities which aggregate and pool, thus mitigating, risk. The assertion of a 'right' to a purely individualized system of health provision, such that no wealth need ever be spent involuntarily on the mitigation of the risks and the care of the infirmities of the less fortunate, is another form of the incoherent claim that we ought to collectively enforce a claim-right against collective institutions and agency: society should enforce the claim that there exists no such thing as society. This is a truly peculiar form of intellectual autism.
For those, however, who might find all of these ratiocinations inapposite, there remains a purely pragmatic consideration: the marketization of health provision will exacerbate inequality quite radically, which will be perhaps more destabilizing than our burgeoning economic inequalities, considered in themselves; and confronted by such dismal prospects, people will agitate, not for the old, flawed system of private insurance, but for socialized medicine. And they will receive it. And the sophisters and calculators of the right, ever blinded by some spectral, Cartesian vision of economic rationality, will have enabled it, by making the unreal the enemy of the imperfect, real, and good. It won't be the first time, not by a long shot, and it probably won't be the last time, either.