Why Pragmatism cannot win the Healthcare Debate
The debate over healthcare has raged for generations. It has toppled at least one Congress, and threatens to topple another. Through all of this, the pragmatists have been largely victorious, which means: They have sold us out again. Healthcare remains a difficult issue for politicians, because of economic and moral questions that must be factored into any debate. The first failure of 'pragmatists', and the worst, in fact, has been their unwillingness to deal honestly with the American people. This has led to the abominable side-show of senior citizens, demanding in sincere indignation: "No government Healthcare! Keep your hands off our Medicare!"
From the moment one sees this abortive reasoning put forward, one very quickly becomes aware of the fact that somebody, somewhere in this argument, hasn't been playing it straight all these years with the American people. To the assembled multitude, I shall now endeavor to do so, and almost nobody will like it, but none will be able to claim I've been anything less than truthful.
There are a few concepts we must cover before we can even begin to untangle healthcare. The real question in healthcare, in the US, is not about the quality of the care, but instead how it is to be funded. No other place on the planet offers so many healthcare options. There is no place else on Earth to go if you cannot be made well in the US. One can cite some exceptional procedure or treatment here or there, but these are merely the exceptions that prove the rule. Let us not linger on the care itself, but instead turn to the meat of this issue, as it is and has been for all of the life of its public debate.
Healthcare will be rationed. This is an explicit fact. You can run circles trying to disprove it, but by any measure, healthcare, like toilet paper, or gasoline, or food, is rationed. The question is, however: "Rationed how?" Or, "By what mechanism?" or "According to what standard?" Herein lies the real argument, the true crux of the matter, and it is a tempestuous thing for politicians, because it leaves them no wiggle room. For 'pragmatists' this is certainly uncomfortable ground.
Up until the advent of the 'Great Society' programs of the late 60s, the mechanism for rationing had remained what nature decreed: The free market. The free market allocates resources in answer to only two questions, and they are interesting to consider: Who is providing a supply, and who is demanding how many units of care?
My argument, to which I will return in due course, is that this had been the most thoroughly moral thing about American healthcare financing until it was supplanted. However, let us first examine the mechanisms then created in order to set aside the natural rationing provided by the free market. Medicaid and Medicare were created to provide the mechanism for re-rationing some portion of the available care to those to whom the natural market would not provide it: The elderly, beyond their earning years and unable to afford it, just when they would need it most, and the poor, who couldn't afford it much at all. The argument was successfully advanced that the rest of us should dedicate some portion of our earnings to pay for the care of these two classes. More, the argument was successfully made that we should be compelled to do so. Herein lies the ugly nature of government programs: Coercion is the prerequisite for their enaction. This is another fact from which pragmatists readily flee. They will say "some coercion is necessary," painting the matter in terms of a necessary evil.
Suffice it to say that the concept of a 'necessary evil' is a deadly contradiction in terms, and while I shall leave that subject for another day, it is necessary that you understand the premise behind my argument here: If a thing is necessary, it means there was no other alternative. In the absence of alternatives, the only available course of action becomes amoral; questions of morality are only in play where choice is possible. No choice? No morality. No morality? No evil. This then leaves you with a solitary and much easier question: Is there no alternative, in fact?
So here we have the moral plea of leftists, and other statists, along with their 'pragmatic' friends at the center stripe: "What should be done about the poor, the elderly, and the infirm?"
This, they leave you as your sole choice, but what have they craftily ignored? They have established a premise that in the name of morality, something must be done. Really? According to what moral standard? By whose moral authority? The answer? By theirs.
You see, it was never asked if there was any moral authority to club you over the head for your wallet, or at least threaten to, on behalf of somebody who needed a bandage, an aspirin, or a hip replacement. No, it was presumed from the outset that you exist solely to serve the needs of your fellow man. Presumed by whom? Why, them, of course.
It would not have been so bad had they only decided to brow-beat you, to implore you like the ringing bell of a Salvation Army's kettle Santa, but instead, they took up arms against you, and leveled the guns of government and said: "Pay, or else. Besides, you'll feel better about it."
This is the same ploy that is being used now, as they push for some form of entrenched governmentally-redirected healthcare cost shifting. The question isn't whether we should have some form of universal care, but only what particular form it should take. In the end, they are still going to redistribute the wealth of some Americans at gunpoint, to the advantage of some others.
From there, it's a lose-lose for freedom, and the American people at large. It is the avoidance of this question that makes the so-called 'pragmatists' dishonest. It is their sell-out on the first moral premise that dooms us to failure. By accepting the statists' view of that first premise, the outcome becomes one of inevitability and certainty. They will get their way, with the help of the pragmatists, and it will be their morality that defines it.
Once you've let them get away with any claim to your wallet, by whichever moral standard, you've thrown open your wallet to all comers, with you as the beggar for your own means.
This is where the rubber meets the road in the debate over healthcare financing, and it is here we must fight it.
