I believe in a right to health care. I think this is one of a number of birthrights that attach to all children. And everyone I have ever met is somebody’s child.
This makes a huge difference in the policy arena. If healthcare is a commodity, a service that is purchased, a privilege to be earned or afforded, then it is completely possible to decide that some people get none, that some people get a lot, and that everyone else will fall in between, mainly a function of their financial situation, but probably also due to matters of race, class and gender. Limits are easy to find when it is something you purchase.
What if it is a right?
If it is a right, then it is a “call” upon the larger society: “You must care for me when I am sick.” But no society can ever provide 100% of the care desired by 100% of the population. There simply isn’t enough time, energy and money. Therefore, each society has to make tough choices about how much care they are willing to give and to whom and under what circumstances.
I think most wealthy enough societies will meet almost all of the healthcare demands of their children, and then start to make tough choices at the other end of life. Along the way, there will be some limits, like with cosmetic surgery (not after trauma or disease, but strictly for appearances). And some communities will decide that certain treatments are so unlikely to help that they won’t pay for them, while other societies might make a different evaluation.
But what is clear is that if healthcare is a right, then it is up to the government to provide it, since the call is upon the community, and the government is the agent of the community. That is what TR Reid, the author of The Healing of America, found in the countries he visited, that they started with the notion that healthcare is a right, and that led them to universal coverage.
Lots of politicians have said the words – healthcare is a right – but they have not worked towards policies that are consistent with those words. Obama has said that he thinks healthcare is a right, but the ACA is not based upon such a principal at all. Sanders is the main person making the connection between the idea and the policy that follows from the idea.
Where do rights come from?
That is an easy question for me to answer, but I have found it so tough for others to answer it that they don’t even want to be asked the question.
As a public health ethicist, I have found that almost all of my colleagues in the field think that health care is a right. In fact, a famous public health leader (Jonathan Mann) won quite a bit of acclaim for his argument that the basis of public health ethics was “human rights.” But I have found almost no one amongst my colleagues who wants to discuss where such rights come from. Either they hem and haw, or they mention something about the Universal Declaration of Human Rights, from 1948. But were there no rights before that?
In the Declaration of Independence, we say that:
"We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain inalienable rights – that among these are life, liberty and the pursuit of happiness. That to secure these rights, governments are instituted among men, deriving their just powers from the consent of the governed."
The existence of these rights are “self-evident.” You don’t need to conduct research on this. These rights exist and we know that their existence is obvious. Such rights are often referred to as “natural rights,” those rights that arise from the nature of what it means to be human. They are inalienable (inseparable) from any human being, by virtue of his or her humanity.
And we get these rights from our Creator. Some of you, who believe in a personal God, accept this as a direct statement.
For people like me, who have a strong concept of Transcendent Meaning, but do not believe in a purposive entity named “God,” then this is really a metaphor. For me, this means that there is a transcendent reality from which we draw meaning, and that the experience of this transcendent reality and the understanding of that meaning is what I label as “the holy.”
A religious gesture
But whatever we call that which exists within Transcendence, we are making a religious gesture. It is a spiritual commitment to the existence of Transcendent Meaning. Our lives have meaning, and one of the things we know about that meaning is that every society owes its members certain rights, and that the government is assigned the duty of providing for those rights. (That part of the Declaration is usually not included when this section is quoted. More neoliberalism, I think.)
And among these rights are the right to life, liberty and stuff. (The Founders really were referring to property rights, but thought that wasn’t gentile enough, so they used the euphemism of “pursuit of happiness.” It is intended to mean a right to own stuff.) Among these rights, but not only those rights mentioned.
So, if there are such rights beyond these three, we as a community have an obligation to figure out what they are; we need to make exactly those choices. And the basis for those choices ends up having to be our belief in Transcendent Meaning.
My assumption is that my colleagues don’t want to talk about where rights come from because they don’t want to have a conversation about religion, most (but not all) of them being atheists or agnostics, as are so many intellectuals today.
What if rights aren’t transcendent
If rights aren’t transcendent, if they are only material, then they are only the result of our agreements to uphold certain of them. And agreements made can be unmade. Non-transcendent rights are, therefore, dangerously ephemeral.
Plus, if you want to condemn the practices of horrible people around the world, you need something I have referred to as “Transitive Morality.” (From an earlier blog post.) We have to be able to say that the third of the world that denies the dignity of women is morally wrong in doing so, and that they must change. And that “must” must be based upon something other than a handshake. It has to be based upon the moral ground that comes from the community agreeing to recognize the transcendent source of such moral values.
Otherwise, who are we to judge these misogynists? After all, it is only their culture.
But, of course, the oppression of half the race is not a matter of mere culture. It is a call to the rest of us to act on behalf of the oppressed. It is a call to us, because those women have rights that are being denied. And we may act because those rights have a basis in Transcendent Meaning.
I do think healthcare is a right, and I am comfortable with the religious origins of my views. And I feel the call to act. Anyone else feel the same?
Thursday, March 31, 2016
Giving up would be a historical mistake
My friend and colleague, Marc Rosen, commented on one of my earlier posts that finding optimism is difficult, amid today’s depressing displays of political appeals to public stupidity. This is true.
Marc suggests the negative case for not giving up. One way to bolster optimism is to ask people to consider the alternative – doing nothing? Moving to Canada? Giving up, in this view, is impractical, in spite of how much allure it has for me on my worst days.
I would, however, like to state the positive case for optimism. Giving up would be a historical mistake. Here is what I mean.
What abolitionism started
If you go back to the middle of the 19th Century in America, you find a relatively small group of people fighting against extraordinary odds to battle against slavery, America’s “original sin.” To the abolitionists, it must have seemed a daunting task. All of the big money was on keeping slavery, the only pressing question being where it would be allowed to be practiced. Yet, as the archetype social movement, abolitionism fought for decades and, ultimately, succeeded, albeit at the cost of a civil war.
This began an unprecedented century of American political progressivism, where one social movement after another battled the rich and the powerful and numeric majorities, in order to establish policies that promoted justice. Here is a partial list of those movements:
The antitrust laws in the latter part of the 19th Century were a direct affront to the power of the richest class to control the economy as they saw fit.
In the early part of the 20th Century, Progressives past the pure food and drugs laws that have been the basis of the last 100 years of food and pharmaceutical safety. As with many of these social movements, that work is not over, but we shouldn’t forget the fight that began that effort.
It is well to remember that it was the leaders of the Republican party that championed conservationism at the turn of the last century. Our system of national parks and forests, and our wildlife refuges on land and in the sea, are the magnificent evidence of the wisdom of that movement.
We passed child labor laws when the richest and most powerful fought to preserve the profits from the work of tiny fingers.
We recognized the rights of women to vote at a time when all of the country’s wealth and power was concentrated in the hands of men.
After decades of fighting, politically and literally, with the deaths of many protesters, the labor movement in the early part of the 20th Century led to passage of national labor law reform. While there is much still to be done, and while recent anti-union efforts have been scornfully successful, the basic legal statement that workers have rights to bargain collectively is the outstanding result of that progressive fight eighty years ago.
The New Deal brought us Social Security and the minimum wage. That both of these successes are under attack doesn’t take away the accomplishment of the movements that achieved them, but calls to us to continue that fight anew.
In the middle of the 20th Century, a small minority of citizens started to make the case that the laws of the country did not provide equal treatment to all Americans. Where did the Freedom Riders in 1961 get their optimism as they faced down Bull Connors’ dogs? I imagine that, sitting in that jail in Birmingham in 1963, finding optimism might have been difficult for Dr. King. Yet, the civil rights movement resulted in Brown v. Board of Education, the Civil Rights Act of 1964, the Voting Rights Act of 1965 and the Fair Housing Law of 1968.
In spite of Ronald Reagan’s 1961 phonograph oratory against socialized medicine and the potential end of freedom as we know it, healthcare for the elderly and the poor was guaranteed in the passage of Medicare and Medicaid. The social movement that continues to strive for true universal healthcare, based upon an acknowledgment of the right of all people to treatment when they are sick, is not done, the Affordable Care Act notwithstanding.
In the 1960's and into the 1970's, social movements for women’s rights and environmentalism and occupational safety and health saw significant victories.
An end or a hiatus?
But this all came to a stop in 1980, as the right wing backlash, started in the 50's and 60's, finally out-organized us, and, I am afraid, out-thought us, and came to power.
From 1865 to 1980, this century of progressive public policy was the result of social movements that were numerical and political minorities fighting daunting odds and, yet, succeeding. This era came, not to an end, but to a temporary hiatus in 1980 (see my earlier blogs on Decades, parts 1 and 2).
That is the real key – did this period “end” or are we waiting through a backlash? Do we see the end of the ability of concerned and organized people to make a difference, or do we need to find the way to make such concerted efforts successful again? That is the crux of the question posed to us by our current dismay over the ridiculousness of our current public policy making. Are we seeing the final end of that progressive era? Or might this, too, pass?
Frankly, I see no contemporary or historic argument that says that that century of Good works, from 1865 to 1980, was an anomaly. If social movements can do something as unlikely as electing a black man to the Presidency, the approach must still hold some validity.
Social movements need seven things. They need intensity, focus, cohesion, structure, a bit of luck, a supportive reaction from the media and leadership. Want to see what that looks like? Check out any presentation by Bernie Sanders.
But he can’t really win, right? Back to the basic question – are you a pessimist or an optimist? I think pessimism, while absolutely delicious in its appeal, is a historic mistake. As it always has been, it is still time to get to work!
Marc suggests the negative case for not giving up. One way to bolster optimism is to ask people to consider the alternative – doing nothing? Moving to Canada? Giving up, in this view, is impractical, in spite of how much allure it has for me on my worst days.
I would, however, like to state the positive case for optimism. Giving up would be a historical mistake. Here is what I mean.
What abolitionism started
If you go back to the middle of the 19th Century in America, you find a relatively small group of people fighting against extraordinary odds to battle against slavery, America’s “original sin.” To the abolitionists, it must have seemed a daunting task. All of the big money was on keeping slavery, the only pressing question being where it would be allowed to be practiced. Yet, as the archetype social movement, abolitionism fought for decades and, ultimately, succeeded, albeit at the cost of a civil war.
This began an unprecedented century of American political progressivism, where one social movement after another battled the rich and the powerful and numeric majorities, in order to establish policies that promoted justice. Here is a partial list of those movements:
The antitrust laws in the latter part of the 19th Century were a direct affront to the power of the richest class to control the economy as they saw fit.
In the early part of the 20th Century, Progressives past the pure food and drugs laws that have been the basis of the last 100 years of food and pharmaceutical safety. As with many of these social movements, that work is not over, but we shouldn’t forget the fight that began that effort.
It is well to remember that it was the leaders of the Republican party that championed conservationism at the turn of the last century. Our system of national parks and forests, and our wildlife refuges on land and in the sea, are the magnificent evidence of the wisdom of that movement.
We passed child labor laws when the richest and most powerful fought to preserve the profits from the work of tiny fingers.
We recognized the rights of women to vote at a time when all of the country’s wealth and power was concentrated in the hands of men.
After decades of fighting, politically and literally, with the deaths of many protesters, the labor movement in the early part of the 20th Century led to passage of national labor law reform. While there is much still to be done, and while recent anti-union efforts have been scornfully successful, the basic legal statement that workers have rights to bargain collectively is the outstanding result of that progressive fight eighty years ago.
The New Deal brought us Social Security and the minimum wage. That both of these successes are under attack doesn’t take away the accomplishment of the movements that achieved them, but calls to us to continue that fight anew.
In the middle of the 20th Century, a small minority of citizens started to make the case that the laws of the country did not provide equal treatment to all Americans. Where did the Freedom Riders in 1961 get their optimism as they faced down Bull Connors’ dogs? I imagine that, sitting in that jail in Birmingham in 1963, finding optimism might have been difficult for Dr. King. Yet, the civil rights movement resulted in Brown v. Board of Education, the Civil Rights Act of 1964, the Voting Rights Act of 1965 and the Fair Housing Law of 1968.
In spite of Ronald Reagan’s 1961 phonograph oratory against socialized medicine and the potential end of freedom as we know it, healthcare for the elderly and the poor was guaranteed in the passage of Medicare and Medicaid. The social movement that continues to strive for true universal healthcare, based upon an acknowledgment of the right of all people to treatment when they are sick, is not done, the Affordable Care Act notwithstanding.
In the 1960's and into the 1970's, social movements for women’s rights and environmentalism and occupational safety and health saw significant victories.
An end or a hiatus?
But this all came to a stop in 1980, as the right wing backlash, started in the 50's and 60's, finally out-organized us, and, I am afraid, out-thought us, and came to power.
From 1865 to 1980, this century of progressive public policy was the result of social movements that were numerical and political minorities fighting daunting odds and, yet, succeeding. This era came, not to an end, but to a temporary hiatus in 1980 (see my earlier blogs on Decades, parts 1 and 2).
That is the real key – did this period “end” or are we waiting through a backlash? Do we see the end of the ability of concerned and organized people to make a difference, or do we need to find the way to make such concerted efforts successful again? That is the crux of the question posed to us by our current dismay over the ridiculousness of our current public policy making. Are we seeing the final end of that progressive era? Or might this, too, pass?
Frankly, I see no contemporary or historic argument that says that that century of Good works, from 1865 to 1980, was an anomaly. If social movements can do something as unlikely as electing a black man to the Presidency, the approach must still hold some validity.
Social movements need seven things. They need intensity, focus, cohesion, structure, a bit of luck, a supportive reaction from the media and leadership. Want to see what that looks like? Check out any presentation by Bernie Sanders.
But he can’t really win, right? Back to the basic question – are you a pessimist or an optimist? I think pessimism, while absolutely delicious in its appeal, is a historic mistake. As it always has been, it is still time to get to work!
Subscribe to:
Posts (Atom)