Health Care,  Uncategorized

Think About a Different Society

In discussions about welfare and health care reform it’s common to hear progressives insist, “I want to live in the kind of society where the poor are taken care of.” Common variants include, “Don’t you want to live in a society where the poor are taken care of?” “What kind of society allows the poor to suffer without taking care of them?” and “What does it say about a society that it would allow the poor to suffer?”

A common claim is that either we are part of a society that cares for the poor or we are not, with no middle ground. This is true in the sense that any society we are a part of either allows the poor to suffer or it does not, but we absolutely can be part of both societies which do and do not allow the poor to suffer.

The reason is that people are simultaneously part of many different societies. I’m a citizen of the United States, a voter in the State of Virginia, an inhabitant of the town of Charlottesville, an alumnus of Harvard University, a law student at the University of Virginia, and a member of Aetna’s University of Virginia Student Health Insurance Plan. All of these things could reasonably be described as “societies.”

Want to be part of a society that makes sure its sick are taken care of? Well you could push for legislation that requires all Americans to sign up for health insurance, like the ACA. Or you could sign up for an Aetna health plan, or enroll in the University of Virginia, which requires all of its students to have health insurance. Or you could start some new “society” with the relevant desired traits. In any of these situations, you would literally become part a society that ensures care for its sick members.

People who say “I want to be part of a society that takes care of its sick” overwhelmingly mean something like the ACA. They would probably be unimpressed by the incidence of insurance within the UVA community and sneer openly at the idea that Aetna represents a mutual insurance “society.” When they say they want to be part of a “society” they really mean that they want to be part of a “nation.”

But what’s so important about a nation? It’s just a geographically bounded institution with a monopoly on the scope of accepted violence. Is it really important to have your societal preferences represented by a geographical entity? Or do the smaller constituent societies not satisfy our ambitions of ideal society membership? Is it psychologically dissatisfying to be part of a small ideal society rather than a large ideal society? I don’t really think any of these hypotheses explains our preferences for national legislation. Instead I offer two further thoughts:

1. People don’t really care what sort of society they are a member of. Instead, they have preferences of universal applicability. Advocates for the ACA probably don’t really want just members of their society to be taken care of. They would also and for the same basic reasons want poor people in a totally separate society to be taken care of by their own society (people, for example, in New Guinea, or on Mars). The nation just happens to be the largest arena in which they can hope to see their preferences advanced.

2. When people focus on national society, they are often choosing not only for themselves, but also for everyone else. They determine what sort of society everyone else must be a part of, and what kind of societies they may not be a part of. The ACA does not merely allow us to live in a society where we are forced to care for the poor. It requires us to do so, and forbids us to do otherwise. The supporters of the ACA chose not merely for themselves, but for everyone else. While they could have taken part voluntarily in any number of charitable mutual insurance societies, they instead opted to coerce the participation of people who did not share their vision. I suggest that while it is entirely appropriate to work to shape a society for ourselves that suits our preferences, it is morally inappropriate to claim authority to prescribe the terms by which all of others’ societies must function.


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