DAS Blog

I've been thinking on and off about the comments of Alan Greenspan and others regarding the economic impacts of health-care, and it has occured to me that part of the problem in our public discourse on the subject (and on many economic subjects) is that people always ask (and correctly) "can we afford it?", perhaps specifying what "it" is (e.g. universal access to health care) without really specifying who this "we" is as well as without specifying what is meant (which varies depending on who "we" is) by "afford".

It seems to me, there are about four levels of "we", which need to be distinguished. And a little bit of the question raised by Deutero-Isaiah of "why spend money on that which does not satisfy" needs to be raised.

(1) Can individuals afford it? E.g. do individuals have to make a choice "do I have health insurance or do I eat?" In the case of health care, the problem is, in fact, that many individuals (and not just those our "Great Society" takes care of because they are impoverished) have to make this choice -- many individuals simply cannot afford health care/health insurance!

(2) Can the government afford it? E.g. is it within local/state and/or federal budgets to pay for it? At present, in the case of health care, because we're spending so much money (justified or not) on other things and because of our tax structure (and can we really afford to pay more in taxes?), this particular "we" cannot, as Greenspan pointed out on Fresh Air recently.

(3) Can society afford it? E.g. if somehow enough money was reserved so that everyone who needs health care could buy it, or if someone or some entity paid for enough medical professional man hours (and enough of society's labor capacity were devoted to health care), would that mean fields would be untended, infrastructure neglected, etc., so we as a society have to choose between providing health care or providing food? Unless our vaunted productivity is much lower than they tell us, our economy as a whole certainly can manage to both feed our population and provide it with health care. Conservatives keep telling us there is no lump of labor -- we are far from a zero-sum economy ... ergo, we can afford to divert economic resources to providing more health care ... without some of us starving.

(4) Can future generations afford it? And I don't mean in terms of debt. Certainly if X borrows money from Y, the cost of X buying something in the present on borrowed money may be that X may not be able to afford things in the future. But for a society as a whole, it doesn't work this way -- I cannot borrow food from the future ... I can only borrow from the present. For any debtor, there is a creditor ... if we are in debt, someone is in credit.

No, what I mean here is whether our economy is (e.g. environmentally) sustainable? Of course, in general, the answer here is no. But since when are reactionaries so concerned about this? True conservatives would be concerned, but such people have either (like my late great-grandparents) passed on or have bolted from the GOP.

Anyway, what disturbs me about the economic discourse is the conflation between the "we" of #2 and the "we" of #3. Certainly, there is the question of how, if we as a society can afford to provide universal health care, that translates into actual provision of health care: a liberal or progressive might say that if "we" as a society can afford it, then with suitable juggling of government budgets and tax codes, our government can and perhaps should just pay for it, while a conservative might say that if we as a society can pay for it yet some individuals cannot, those with extra resources should provide charity to those who lack (and government should encourage general morality so that people who can be charitable will be charitable). But in either case, there is a distinction between government (or private charity) paying for something like health care and society's ability to pay for it.

Meanwhile, you hear people like Greenspan acting as if "government can't pay for it" is the last word. Since when is government = society? I guess Greenspan, Randroid as he is, doesn't believe in a society that has the capacity to pay for things. Still, to me, this conflation of governmental and societal resources smacks of fascism.

The liberal position does not conflate these two sets of resources but merely asks that the extra-resources possessed by society as a whole be redistributed by government to those who need them. Some would call this redistribution "stealing" (although it is part and parcel of the Levitical code the right claims is the basis for morality even as they ignore all parts of this code not dealing with teh hawt sex ... c.f. the Yom Kippur afternoon readings -- so count this as my weekly Parshas blogging! ;) ), but even if it be stealing, there is still no conflation between the identities of the thiever and thievee. Yet, those who, while complaining about liberal boondogging, act as if government isn't merely redistributing the resources of society but rather is society, are de facto fascists even as they protest government "coersion".

Of course, as a friend of mine, who is a former defense attorney points out, these people have an odd idea of what is coercive governence: what could be more coercive of government than to deny you your freedom and lock you up in jail? Such actions are often quite justified (and perhaps less controversially so than wealth-redistribution), but how can you deny that removing someone's liberty, no matter how justified and how appropriate was the due process by which it was removed, is more coercive than taking someone's, no matter how much "they earned it", surpluss wealth?