Posts Tagged ‘rights’

Spurious Invocations and Socialized Medicine

Sunday, 19 March 2017

Advocates for funding or for in-kind provision of medical services through the state — some degree of socialization of medicine — frequently assert that there is a basic human right to health or to medical services. But there is invariably a bait-and-switch, because health cannot be provided as a right, basic or otherwise, universal to human beings or even held by all members of a large, naturally formed community such as a nation; and a right to medical services gauged in terms other than consequences for health would be grossly implausible and otherwise unappealing.

It should be immediately obvious that there cannot be a basic right to medical services, because a basic right exists in any context in which there is a person, even when that person is in isolation. One cannot make a claim to the services of others if there are no others, nor can one make a claim to the use of technologies that simply don't exist. That's why genuine liberalism understands that basic rights aren't claims to the services of others, but instead are claims to be free from various sorts of interference by others. Robinson Crusoe cannot see a doctor when he is alone on the island, yet can speak his mind whether he is alone or has neighbors.

Derived rights are another matter. Derived rights are founded upon basic rights, but may emerge in a social context and be informed by the available resources, including technology. And there might even be a derived right that, though only emerging in some context, were universal to some population and involved positive claims to goods or to services. To provide an argument that health or medical care were just such a right, advocates of socialized medicine would have to identify and explain a process of derivation. While some persons making the assertion that there were instead a basic right to health or to medical care are simply swept-up by emotion, doing so also short-circuits a recognition of responsibility for that identification and for its explanation.

There are advocates who speak and write of the social contract and propose to find support thereïn for socialized medicine at present levels, and perhaps at still greater levels. But what is here called the social contract is not the contract that Hobbesians or liberals once imagined to be adopted at the beginnings of civil society; rather, a set of expectations held by some members of a society is being called a contract, as if such expectations alone could somehow contractually bind everyone within that society. The need to identify and explain the derivation of an ostensible right to medical care remains unmet by the use of the misleading metaphor of a contract. (Perhaps Mr Crusoe expects Friday to begin studying medicine upon arrival, but what of it?) It might also be noted that reference of this sort to a social contract is profoundly conservative — in the original sense of conservative — because the principal informant of expectations about social outcomes is tradition. And, if such expectations did have the sort of moral force that is imputed to them by the invocation of the social contract, then practices such as the subordination of women in various societies could be defended by reference to the social contracts of those societies. Even if such defense is somehow progressive, it is utterly illiberal.

In any case, health itself cannot be delivered as a right universal to human beings nor within some smaller but still large and naturally formed community. Some people have dire medical conditions for which there is no effective treatment, so there is no right to health itself. One might acknowledge that indeed there is no right to health yet assert that there were still a right to medical care; but others have conditions that could be corrected only by diverting resources that would otherwise be used to provide medical treatment to different people; and it is incoherent to speak of rights as things that may be in conflict — indeed, the point of insisting that health or medical care were a right (as opposed to a lesser desideratum) is to make an over-riding claim. One might finally punt to an assertion that everyone simply had a right to medical care regardless of need; but, thus unlinked, there is no more reason to suppose an entitlement to some allotment of adhesive bandages and of aspirin tablets than to suppose an entitlement to an allotment of bubble gum.

The actual provision of medical goods and services under socialized medicine cannot be about rights, and so it isn't about rights; it is instead a matter of politicized collectivist calculations. Essentially, popular opinion is motivated by a naïve and incoherent utilitarianism — trying somehow to maximize an implicitly quantified sum of human well-being (with perhaps odd lexicographical properties), but making exceptions here and there driven by pity or by respect for some people and enabled by blindness to the costs to others; and officials of various sorts try to keep some share of the public happy but more generally pursue their own interests. Those who are not served under the programme or who find their access to medical care reduced or even effectively ended by socialism are waved-away as unfortunate victims of practical limitations, previous talk of rights not-withstanding.

I'm not at all a fan of collectivist calculations; typically they assume quantifications that don't hold, and otherwise they seem arbitrary in what they seek to maximize. But, if those calculations truly made sense, then one would want to consider the long run, to include the well-being of people in the future in one's aggregation; and thereïn lies the rub. Unless one assumes that humankind is fairly soon to come to an end, there are more people yet to be born than are alive to-day. If there truly were a collective aggregate to maximize, then anything done to-day that impaired economic development in the future would be counter-indicated. If people in the future were generally wealthier, then they would enjoy better medical care and almost surely better health. If we allow for considerations beyond the medical, the case for economic development is greater still. And, because it cannot allocate resources with economic efficiency, socialized medicine is ultimately a drag on economic development and thus on medical progress.

Socialized medicine doesn't deliver a basic right; it doesn't deliver a derived right; in the long run, it means that more people suffer (though suffering itself has no aggregate across persons) and that at any given age a greater share of people die. Refusing to face these points doesn't make one a nicer person; accepting the truth doesn't make one uncaring. Forcing the innocent to swallow bad medicine is not kindness.

It Is the Soldier

Wednesday, 20 February 2008

I've been pondering ideological taxonomy again.

As a classical liberal, I believe that there is a right-or-wrong prior to any actual human choice or action. A standard term for this preëxisting morality is natural law. Classical liberals typically test their notions of natural law by pondering how they would work in a state of nature — that is to say in a hypothetical environment when social institutions have been zeroed-out.

But what I've been pondering lately isn't classical liberalism per se, but conservatism — how it proceeds from a different foundational model, and how that that model affects (or effects) the politics of to-day.

Some conservatives have explained the essential difference between conservatism and liberalism (by which they may mean classical liberalism, or the social democratism that absconded with the name liberal in the 20th Century, or both) in that liberals did not believe in Original Sin. What one perhaps first sees here is a rejection of human perfectability; but there's something darker here.

There's a famous poem by Charles M. Province, It Is the Soldier, which declares that our freedoms and rights are not given to us by ministers, by reporters, by poets, by campus organizers, by lawyers, or by politicians, but by soldiers. The declaration is not merely that the front-line of defense of these rights is provided by the soldier, but that these rights are literally given to us by the soldier. In what sort of framework does the soldier give these rights to us?

Thomas Hobbes wrote of a state of nature in which rights as most of us now conceptuälize them did not exists. Hobbes indeed uses the word right, but it doesn't refer to anything that morally constrains others; rather, it is some sort of obligation binding its possessor, and in this case binding him to follow a lex naturalis which is of Every man for himself:

The right of nature, which writers commonly call jus naturale, is the liberty each man hath to use his own power as he will himself for the preservation of his own nature; that is to say, of his own life; and consequently, of doing anything which, in his own judgement and reason, he shall conceive to be the aptest means thereunto.By liberty is understood, according to the proper signification of the word, the absence of external impediments; which impediments may oft take away part of a man's power to do what he would, but cannot hinder him from using the power left him according as his judgement and reason shall dictate to him.A law of nature, lex naturalis, is a precept, or general rule, found out by reason, by which a man is forbidden to do that which is destructive of his life, or taketh away the means of preserving the same, and to omit that by which he thinketh it may be best preserved. For though they that speak of this subject use to confound jus and lex, right and law, yet they ought to be distinguished, because right consisteth in liberty to do, or to forbear; whereas law determineth and bindeth to one of them: so that law and right differ as much as obligation and liberty, which in one and the same matter are inconsistent.

And because the condition of man (as hath been declared in the precedent chapter) is a condition of war of every one against every one, in which case every one is governed by his own reason, and there is nothing he can make use of that may not be a help unto him in preserving his life against his enemies; it followeth that in such a condition every man has a right to every thing, even to one another's body. And therefore, as long as this natural right of every man to every thing endureth, there can be no security to any man, how strong or wise soever he be, of living out the time which nature ordinarily alloweth men to live. And consequently it is a precept, or general rule of reason: that every man ought to endeavour peace, as far as he has hope of obtaining it; and when he cannot obtain it, that he may seek and use all helps and advantages of war. The first branch of which rule containeth the first and fundamental law of nature, which is: to seek peace and follow it. The second, the sum of the right of nature, which is: by all means we can to defend ourselves.
Now, Hobbes would still be interesting if we discarded the famous stuff about life in a state of nature being nasty, brutish, and short — he'd got hold of the notion of sub-optimal Cournot-Nash equilibria being overcome by introduction of a commitment mechanism — but that business of life being thus wasn't simply grim speculation of how things would be, but an interpretation of how things had been; and, hence, on a deeper level, of how things were and always will be.

Consider the pre-feudal period in Western Europe, and feudalism in theory. Outside of the major cities, the central Roman state provided ever-weakening protection against raiders. (Indeed, to the extent that the state acted upon the country side, it was as itself a sort of looter.) Those with sufficient resources and leadership abilities put together their own gangs (perhaps cobbled-together from the remains of the state). These gangs might themselves function as no more than local protection rackets, seizing tribute in exchange for protecting weaker people from nothing other than worse seizures by the gang itself, while protecting only themselves from other raiders. But in theory what the local gang did was to hold back those raiders, in exchange for goods or services from those who were subordinates of the leader of the gang.

As it evolved, the ideology of feudalism didn't present the gang simply as providing service-for-hire. Rather, the gang-leader was presented as himself the owner of the land and of what it produced. He granted use of this property, in exchange for stewardship.

Look at this model of the world. The community is under constant menace from external raiders. The warrior holds back those raiders; by virtue of this, he makes the community possible. All rights within the community are thus creäted by him, and any rights possessed by others have thus been granted by him — It is the Soldier.

Aside from ostensibly protecting the locals, the other engagement of the lord was in, well, raiding some other community. In fact, even when feudalism was operating according to theory, the immediate reason that each community needed a lord was that other communities had lords of their own. But, within this framework of rights being creäted by the soldier, there is nothing wrong with this — after all, the rights of the other community ostensibly were brought into existence by warriors to whom the raiders owe nothing! (And savages, who do not have a proper leader, are especially regarded as fair game, for they have no rights from anyone.)

Conservatisms emerge from and are informed by various things, including a respect for subtleties of social evolution. But I think that this model of civilization as carved-out of barbarism and always threatened by barbarism plays much the same rôle for most of them as do the thought-experiments of the classical liberals for them. The classical liberal begins with a perhaps romanticized model of the state of nature, to think about natural law, and adds barbarians (if at all) as a complication of the model; the conservative begins by imagining barbarism, and subsequently perhaps romanticizes the warriors who carve territories from it.

Even if I am wrong in this belief about conservatism, I think that a useful taxonomy could classify ideologies by what thought, if any, they gave to states of nature.

I have a conservative friend whose take on Dirty Harry was significantly different from my own. He saw men such as Callahan as dirty because such men must be, in order that there be civilization for the rest of us. In hindsight, I reälize that it was natural for my friend, qua conservative, to read things thus — it's a variation on the theme of barbarians (the Scorpio Killer) and of warriors (Callahan) who are required and thus empowered to do terrible things to stop them, though these warriors may be sickened by what they are doing.

(Though I have left him here unnamed, in justice I should draw attention to the point that my conservative friend indeed saw Callahan as dirty; my friend would by no means join and worship in a cult of the military. He speaks of soldiers wanting to be honored with parades every day, in what I take to be a metaphor for their propensity to mistake an essential contribution for a uniquely essential contribution.)

Almost every war-time Presidential Administration has tapped into the presumption that war suspends the ordinary rules. (That is, after all, why war is declared by these and by other administrations on things such as poverty.) But now-a-days, we've seen a resurgence, partly fostered by the present Administration, of a world-view in which barbarians are naturally and persistently at-the-gates, held back by warriors of various sorts (some apparently fighting in offices, armored in Loro Piana wool), who are the creätors and maintainers of civilization and thus (like Hobbes' Leviathan) not truly bound by the rules of civilization (though it is admitted that it is generally good policy for them to conform to those rules most of the time). And, within this ideology, it is not just in dealing directly with the barbarian (the enemy combatant) that the warrior is licensed — It is the Soldier, not the lawyer / Who has given us the right to a fair trial. The Soldier giveth, and the Soldier taketh away.

And, of course, as in the Middle Ages, those who have claimed the prerogatives that this ideology would grant to the warrior needn't actually have held back barbarians, or even tried to do so. They may, in fact, be more concerned to exploit the local population.

This mythology is also very much playing into the on-going Presidential election. The Republican nomination has been won by a man whose political career was founded upon military service, and who continues to be widely considered first-and-foremost as a soldier. Some conservatives have made it plain that they cannot abide by this man, but virtually all for reasons distinct from his performance as a soldier.