The State & Health Care

One way to argue that the state is obligated to provide health care (in some manner) to its citizens is to draw an analogy to the obligation of the state to defend its citizens from “enemies foreign and domestic.” While thinkers disagree about the obligations of the state, almost everyone except the anarchists hold that the state is required to provide military defense against foreign threats and police against domestic threats. This seems to be at least reasonable, though it can be debated. So, just as the United States is obligated to defend its citizens from the Taliban, it is also obligated to defend them against tuberculous.

Another approach is to forgo the analogy and argue that the basis of the obligation to provide military defense and police services also extends to providing health care. The general principle at hand is that the state is obligated to protect its citizens. Since anthrax and heart failure can kill a person just as dead as a bullet or a bomb, then the state would seem to be obligated to provide medical protection in addition to police and military protection. Otherwise, the citizens are left unguarded from a massive threat and the state would fail in its duty as a protector. While these lines of reasoning are appealing, they can certainly be countered. This could be done by arguing that there are relevant differences between providing health care and providing armed defenses.

One way to do this is to argue that the state is only obligated to protect its citizens from threats presented by humans and not from other threats to life and health, such as disease, accidents or congenital defects. So, the state is under no obligation to protect citizens from the ravages of Alzheimer’s. But, if ISIS or criminals developed a weapon that inflicted Alzheimer’s on citizens, then the state would be obligated to protect the citizens.

On the face of it, this seems odd. After all, from the standpoint of the victim it does not seem to matter whether their Alzheimer’s is “natural” or inflicted—the effect on them is the same. What seems to matter is the harm being inflicted on the citizen. To use an obvious analogy, it would be like the police being willing to stop a human from trying to kill another human, but shrugging and walking away if they see a wild animal tearing apart a human. As such, it does not matter whether the cause is a human or, for example, a virus—the state’s obligation to protect citizens would still apply.

Another approach is to argue that while the state is obligated to protect its citizens, it is only obligated to provide a certain type of defense. The psychology behind this approach can be made clear by the rhetoric those who favor strong state funding for the military and police while being against state funding for medical care. The military is spoken of in terms of its importance in “degrading and destroying” the enemy and the police are spoken of in terms of their role in imposing “law and order.” These are very aggressive roles and very manly. One can swagger while speaking about funding submarines, torpedoes, bullets and missiles.

In contrast, the rhetoric against state funding of health care speaks of “the nanny state” and how providing such support will make people “weak” and “dependent.” This is caring rather than clubbing, curing rather than killing. One cannot swagger about while speaking about funding preventative care and wellness initiatives.

What lies behind this psychology and rhetoric is the principle that the state’s role in protecting its citizens is one of force and violence, not one of caring and curing. This does provide a potential relevant difference; but the challenge is showing that this difference warrants providing armed defense while precluding providing medical care.

One way to argue against it is to use an analogy to a family. Family members are generally obligated to protect one another, but if it were claimed that this obligation was limited only to using force and not with caring for family members, then this would be rightfully regarded as absurd.

Another approach is to embrace the military and police metaphors. Just as the state should thrust its force against enemies within and without, it should use its medical might to crush foes that are literally within—within the citizens. So, the state could wage war on viruses, disease and such and thus make it more manly and less nanny. This should have some rhetorical appeal to those who love military and police spending but loath funding healthcare. Also to those who are motivated by phallic metaphors.

As far as the argument that health care should not be provided by the state because it will make people dependent and weak, the obvious reply is that providing military and police protection would have the same impact. As such, if the dependency argument works against health care, it would also work against having state military and police. If people should go it on their own in regards to health care, then they should do the same when it comes to their armed defense. If private health coverage would suffice, then citizens should just arm themselves and provide their own defense and policing. This, obviously enough, would be a return to the anarchy of the state of nature and that seems rather problematic. If accepting military and police protection from the state does not make citizens weak and dependent, then the same should also hold true for accepting health care from the state.

As a final point, an easy way to counter the obligation argument for state health care is to argue that the state is not obligated to provide military and police protection to the citizens. Rather, the military and the military, it could be argued, exists to protect and advance the interests of the elites. Since the elites have excellent health care thanks to their wealth and power, there is no need for the state to provide it to them. Other than the elites in government, like Paul Ryan and Trump, who get their health care from the state, of course. On this view, support for using public money for the military and police and not health care makes perfect sense.

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  1. Dennis Sceviour

    Mike LaBossiere wrote,
    “One way to argue that the state is obligated to provide health care (in some manner) to its citizens is to draw an analogy to the obligation of the state to defend its citizens from “enemies foreign and domestic.” While thinkers disagree about the obligations of the state, almost everyone except the anarchists hold that the state is required to provide military defense against foreign threats and police against domestic threats. This seems to be at least reasonable, though it can be debated. So, just as the United States is obligated to defend its citizens from the Taliban, it is also obligated to defend them against tuberculous.”

    Hillary Clinton campaigned for a global state thus removing the necessity of defending against foreign threats. Although a number of presidential debate articles were posted, this point of view was unexplored by Mike LaBossiere during the last federal election. Other people often see the police as an occupying self-serving army. A police state can threaten to destroy the liberties of people and the destruction of democracy, but this was not discussed.

    A humorous observation when equating the Taliban with tuberculosis, but the analogy should not be taken seriously.

    Mike LaBossiere wrote,
    “What lies behind this psychology and rhetoric is the principle that the state’s role in protecting its citizens is one of force and violence, not one of caring and curing.”

    This hits the nail on the head for the origins of political corruption. The idea of paternal control over people is becoming more dangerous as humanity matures. It is very difficult or impossible for a government to be all things to all people.

    To Aristotle, an ideal leader could fulfill the role of the caring dictator. While it was Plato who originated the concept of an ideal leader, it was Aristotle who developed the magnanimous man. He was a man who walked with a slow step and spoke with deep voice. The first of the trained ideal leaders was Alexander the Great, who attacked his neighbors for loot and plunder. The last caring dictator was Adolf Hitler, who also attacked his neighbors for loot and plunder.

    Mike LaBossiere wrote,
    “As such, it does not matter whether the cause is a human or, for example, a virus—the state’s obligation to protect citizens would still apply.”

    This is a good example. Any time the state ignores cause, the decisions could be better. Unfortunately, sometimes the state seems to feel obligated to prove by force that the law causes everything.

    Mike LaBossiere wrote,
    “One way to argue against it is to use an analogy to a family.”

    This is not the best example, but it does emphasize the point that health care is better as a local community responsibility than as a national political agenda. People will entrust their health care with someone they know, rather than an anonymous Washington bureaucrat. Obamacare has been described as a tax on the poor, and since the poor cannot pay, the bureaucratic expense is carried by national deficit.

    Medical personnel do not carry out active military accomplishments. Engineers achieve them. Likewise, public health care is not the front-line responsibility of medical personnel. Public health care is often the responsibility of municipal engineers. Engineers handle water purification, sewage, garbage collection and rat control. You can be sure that if there was an attack from biological warfare, it would be the engineering corps sent first to deal with the problem.

    The lawyers running for political office will tell the public differently. Perhaps the narrow focus of legal education brainwashes lawyers to believe everything is law (which is a self-deceiving falsehood). More public funding is given for lawyers to legislate public health care, while municipal infrastructure and the inner cities deteriorate. They don’t know or don’t care.

    Trump is not filling the government swamp positions and he is firing the deadwood. If health care is treated the same way, the American health plan might be saved. First, the temperature of the medical legislation has to be raised to Fahrenheit 451 – the temperature at which paper catches fire, and burns.

  2. Karen Lankford

    One way to look at both health care and national defense is from the perspective of a common risk pool. Since citizens can move and trade freely within a country, it makes sense for the whole country to protect each of the parts. When Japan attacked Pearl Harbor, Americans in the Midwest did not say,”Well its only Hawaii.” It could one day be Ohio that is attacked and they could have been vacationing in Hawaii.

    Most Americans take the same approach to natural disasters. There is no part of the country that is safe from these hurricanes, tornadoes, flooding, wildfires, volcanoes, and earthquakes. Any part of the country could be affected and any person could be caught up in one of these unpredictable events.

    In the same way, every person in the country is at risk of injury or illness. In the case of contagious diseases, one person’s illness actually increases the risk to others. There are not separate pools of young healthy people and old sick people. We all start out young, (and hopefully healthy), and if we are lucky to live a long life, we will all get old, and most will suffer age related health problems. A common national defense against illness makes sense, in the same way that a common defense against aggression from foreign powers, domestic terrorism, and natural disasters makes sense. We could say: “Its every man for himself”, but we could also say “We are all in this together”.

    For my part, I would prefer to pay for someone else’s antibiotics or antipsychotic medications rather than have them cough their active TB infection on me or attack me in response to messages from the voices in their heads. I would also prefer to kick in to pay for a stranger’s chemotherapy or kidney dialysis rather than step over dead bodies in the street. I am old enough to know that I am not immortal and that one day some day I could become both sick and broke and unable to pay for my own care.

    There will always be philosophical differences about how much should be done collectively and how much should be left to the individual. Most developed countries have some sort of social safety net programs that keep citizens from falling so far that they cannot get up again. In the same way that nations invest in infrastructure, many nations feel that it makes sense to invest in their people, and that investment can include investing in their health.

  3. Dennis Sceviour

    Karen Lankford wrote,
    “I would also prefer to kick in to pay for a stranger’s chemotherapy or kidney dialysis rather than step over dead bodies in the street.”

    Remember the adage “an ounce of prevention is worth a pound of cure.” Of course, the state should be involved in preventative medicine. However, the Obamacare was set up to supply treatment and access to prescriptions, and that is not the same as prevention. Although I do not have statistics available, it might be suspected that an increase in treatment programs will increase drug dependency.

    On the other hand, most States already have palliative care with access to everyone. The Obamacare was supposed to be set up to allow certain people better access to palliative care. However, would it not be better to fund hospital boards to be able to supply access to everyone, rather than to have a program for individual selective coverage?

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