Health care and justice: Reply to Sasseen

Your understanding of the health care debate is truly comprehensive and thoughtful. We must always be concerned with both individual rights and the common good. You have shown the way to deal with the present crisis in a way that is consistent with the Constitution and distributive justice. I do wish to make a few points. First, whatever the requirements of the common good, the constitutional question is crucial. That is, we are a people in virtue of the Constitution, which has formed our habits and shaped our character. These have contributed mightily to a market economy which not only distributes goods and services more efficiently and more abundantly than any other society, but has aroused expectations and even enriched and thereby empowered government agencies. We now desire universal health care because we have gotten closer to it than would have been possible in the market economy's absence. We are enduring the crisis, if not the revolution, of rising expectations.

Socialists can only dream of redistributing the wealth in the presence of the hated capitalistic system that generates massive wealth to redistribute. The socialists' quarrel with capitalism is not over its productive capacity, which even Marx more than acknowledges in the Communist Manifesto, but over its alleged failure to distribute the profits fairly. We need to be sure that, in dealing with the present difficulties, we do not "kill the goose that laid the golden eggs." That may sound trite, but we are talking about preserving our constitutional system that has brought us so many economic as well as political and social benefits.

The fact that private health insurance covers so much more than homeowners' or automobile insurance indicates just how much our expectations have been aroused. Home and auto insurance covers calamities beyond the normal or "daily recurrent needs of the household." Health insurance seeks to cover practically everything related to health, including routine office visits. More than this, the government, through Medicare and Medicaid, does much the same. The result is that most of us make health care decisions on the expectation that someone else will pay--at least directly--for them (even if we pay in the end through premiums or taxes).

We are acting less like self governing citizens of a free republic than like wards of the corporate and bureaucratic state, however benevolent. Proposals to micromanage this already socially generous system or even to replace it with a government bureaucracy threaten the constitutional order which made this generous health care financing possible. This restraint takes the form of many citizens' manifest preference for practically anything but what Democrats are now proposing, which is to scrap the free market in health altogether. Our regime made us what we are, including our generous and advanced health care.

My second point concerns the dynamics of democracy. Our constitution was established to temper and moderate the demos as much as possible, consistent with the equality and liberty sought by our people, and the authority of the majority to make public policy. While it is certainly true that democracy, in some sense, always threatens our delicate constitutional order, it is also true that in the public mind (perhaps not in the "theoretic politician's" mind) our country is not merely a democracy.  Citizens cherish constitutional restraints and protections no less. I think it remains rhetorically effective, as well as true, to appeal to the Constitution as the source of our political prosperity and not merely to defer to majority rule or to acquiese in its ultimate triumph over constitutional restraints.

The Republican party is the institutional vehicle for keeping us true to our national heritage, and it is currently doing as good a job of defending us as can be expected under the circumstances. The Democratic party, or what its founders called the Democracy, is the enemy of constitutionalism. To the extent that we Republicans make that case, we make the case against unrestrained democracy. The rule of law includes a healthy and free marketplace and not just the formal laws that govern it (not to mention the infinitude of bureaucratic rules that burden it).  That is the meaning, I believe, of your distinction between regulating commerce and managing it.

Finally, however much Hobbes and Locke have in common on the state of nature and the state of civil society, their starting and ending points differ. Because the state of nature for Hobbes is "solitary, poor, nasty, brutish and short," he opts for a monarchy over a democracy to govern it. He does leave the door open in theory to a democracy, but few readers of Hobbes believe that he has high hopes for it. On the other hand, for Locke the state of nature is "inconvenient," with all sorts of unresolvable disputes that require a settled, known law to adjudicate them. His preference for democracy is not only not theoretical but explicit, and the king is reduced to a mere executive with some but not all of the monarchical powers. In short, warlike mankind needs a monarch, according to Hobbes, whereas squabbling mankind requires a large element of self government through democratic institutions, according to Locke.

Locke, if he does not prescribe duties at least makes it far more likely that men will freely assume them because they are free to accumulate goods and therefore more able to provide for themselves and others, and even to support a government without being excessively burdened. This is another way of saying that the limited government and market economy that Locke did so much to foster satisfies the demands of the common good very well indeed.

We run the risk of "throwing out the baby with the bath water." Preserving our constitutional system is the key to maintaining our public health.

On Afghanistan, Obama bends the truth curve

Three agonizing months of deliberation, analysis and internal debate in the White House and this is the best they can do?Wow. Barack Obama has made his Afghanistan decision and it stinks of pure political posturing. He's attempting to split the political baby -- as he has done so often as both a candidate and as president -- by taking a half measure designed to satisfy everyone. The "hawks" on Afghanistan get 30,000 more troops -- the very low end of General McChrystal's request -- that shows he's serious about national security. But the doves get a huge concession, too -- a strict timetable of 18 months that guarantees withdrawal just in time for the President's 2012 reelection campaign.

Sound like a coincidence? Hardly. The President knows that he must have his left-wing base (like Code Pink and MoveOn.org) energized on his behalf -- and the sight of returning troops from Afghanistan will work wonders for his campaign. In attempting to satisfy the hawks and the doves he's actually satisfied nobody -- and put our mission in Afghanistan at grave risk.

This strikes me as the essence of moral bankruptcy -- to send our troops into battle with a timeline that is unworkable, and that has been set for purely political reasons. Though the President says that the 18 month timeline is designed to spur the Karzai government into action, anyone who understands the challenge of counterinsurgency in Afghanistan knows that this is just window dressing for a politically expedient decision. The President wants an out, and wants to signal clearly to his base that he doesn't believe in the "long war" thesis of the Bush Administration. His speech yesterday at West Point in announcing the Afghan surge was notable in its thinly veiled swipes at his predecessor, and Obama can't seem to bring himself to be the leader of all America. He is partisan to the core -- and his decision to "surge and then leave" smacks of partisan politics. It's truly difficult to stomach.

Even worse, Obama seems to be bent on repeating the worst mistakes of the Vietnam War, when President Lyndon Johnson embarked on a war that had no clear definition of victory, was waged in a tightly controlled manner on the basis of political considerations, and was based on the propping up of a government that never had the full support of the people. Vietnam destroyed the presidency of LBJ, and left a dark shadow on U.S. national security policy for a generation to come. Will Afghanistan end any better?

It is hard to envision success on the basis of the Obama decision. Experts in counterinsurgency are clear that it is a long war strategy, and that it requires a sustained commitment that can last a decade or more. Though it led to decisive gains quickly in Iraq, in Afghanistan the challenge is different -- and doesn't lend itself to an 18 month victory. Afghanistan is vast, remote, mountainous and tribal. Just 10 miles out of Kabul, the Karzai government controls almost nothing. Basing success on standing up the Afghan National Government is dubious at best. And I can't see how it can be done in 18 months -- with an enemy that understands how long they need to wait to see you off at the airport.

It's difficult not to be cynical looking at this decision. The commentary this morning reflects this cynicism, and will only deepen Obama's political trouble here at home. Germany's "Der Spiegel" has a great opinion piece today that is worth reading:

Never before has a speech by President Barack Obama felt as false as his Tuesday address announcing America's new strategy for Afghanistan. It seemed like a campaign speech combined with Bush rhetoric -- and left both dreamers and realists feeling distraught...

An additional 30,000 US soldiers are to march into Afghanistan -- and then they will march right back out again. America is going to war -- and from there it will continue ahead to peace. It was the speech of a Nobel War Prize laureate.

For each troop movement, Obama had a number to match. US strength in Afghanistan will be tripled relative to the Bush years, a fact that is sure to impress hawks in America. But just 18 months later, just in time for Obama's re-election campaign, the horror of war is to end and the draw down will begin. The doves of peace will be let free.

The speech continued in that vein. It was as though Obama had taken one of his old campaign speeches and merged it with a text from the library of ex-President George W. Bush. Extremists kill in the name of Islam, he said, before adding that it is one of the "world's great religions." He promised that responsibility for the country's security would soon be transferred to the government of President Hamid Karzai -- a government which he said was "corrupt." The Taliban is dangerous and growing stronger. But "America will have to show our strength in the way that we end wars," he added.

It was a dizzying combination of surge and withdrawal, of marching to and fro. The fast pace was reminiscent of plays about the French revolution: Troops enter from the right to loud cannon fire and then they exit to the left. And at the end, the dead are left on stage.

But in this case, the public was more disturbed than entertained. Indeed, one could see the phenomenon in a number of places in recent weeks: Obama's magic no longer works. The allure of his words has grown weaker.

It is not he himself who has changed, but rather the benchmark used to evaluate him. For a president, the unit of measurement is real life. A leader is seen by citizens through the prism of their lives -- their job, their household budget, where they live and suffer. And, in the case of the war on terror, where they sometimes die.

Political dreams and yearnings for the future belong elsewhere. That was where the political charmer Obama was able to successfully capture the imaginations of millions of voters. It is a place where campaigners -- particularly those with a talent for oration -- are fond of taking refuge. It is also where Obama set up his campaign headquarters, in an enormous tent called "Hope."

In his speech on America's new Afghanistan strategy, Obama tried to speak to both places. It was two speeches in one. That is why it felt so false. Both dreamers and realists were left feeling distraught.

The American president doesn't need any opponents at the moment. He's already got himself.

Obama is out of his depth. He's a president in permanent campaign mode, who thinks that promising everything to everyone still works. What he seems to forget is that he is president now, and his decisions have consequences, and that won't be forgotten by the time he gets to his next campaign stop.

Our leader is an empty suit, without the character to be honest with the American people. His decision is based on a lie -- that we can have quick success in Afghanistan -- and he seems to think that we won't notice if it doesn't turn out ok. His health care reform is similarly based on lies and half-truths. Its as if he thinks he can bend the truth curve, and that down will suddenly be up and up will suddenly be down.

Actually, he's right about that: Obama was suddenly up, and now he's suddenly down. And it will be a long, long fall.

Hear the Show: 11/22/2009

5PM Show Open John Andrews, Kathleen LeCrone and Matt Arnold

5:30PM Guest: Tom Tancredo

6PM Guest: Bill Federer

6:30PM Guests: Jay Ambrose

7PM Guest: Jay Richards

7:30PM Guest: Dave Kopel

Is health reform a matter of justice?

(Author: Robert F. Sasseen) Is affordable healthcare for all a question of individual rights, or a requirement of the common good? The public debate in the US seems to assume that it is both. It is not my purpose here to examine what reforms are necessary or wise, but to identify some of the issues of justice implicit in the debate Is There a Natural and Individual Right to Health Care?

Most believe that the US healthcare system needs reform. Why? Because it has become too expensive and too many are left out. All seem to agree on that. So the public debate is focused on how to fix the system, not whether it needs fixing. It is asserted that 46 million Americans do not have access to health care. Strictly speaking, that's not true. Millions of them could, but choose not to purchase health insurance. But let's not quibble over the word "access." In the USA, the door to health care is open to all in the sense that no law prohibits entry to anyone. It remains open even to those who choose for whatever reason not to enter. But isn't the door effectively closed to all who choose not to enter because they can't afford to pay the cost of the care available inside the door? Don't they have an individual and natural right to the care they need? If every individual is by nature entitled to affordable health care as a matter of individual right, then is it not the duty of government to make sure that health care is available to each and all? Indeed, this is the view of some who argue for a national healthcare system established, managed, and regulated by the Federal Government. They argue that it alone is big enough, powerful enough, and wealthy enough to provide affordable (and equal?) health care for everyone.

A question of justice arises with respect to things to which I am entitled by positive law, natural right, or divine command. If there is no entitlement , my lacking a good I desire (say, a room with a view) is not an injustice. Nor would it be just to tax another to pay for that room. But what of life's necessities? Am I not entitled to food, clothing, shelter, education, and healthcare? If so, doesn't justice require that another help provide them for me, at least if I am a child, or poor and destitute through no fault of my own?

Perhaps. But first, what is the ground of that entitlement? No question of an individual right arises if there is no entitlement to the good which is lacking? Some believe that my entitlement arises from my natural right to life, liberty, and the pursuit of happiness. If I have a natural right to life, do I not also have a right to the things necessary to preserve my life and to achieve the happiness I naturally seek ? Is that not logical? Seems so. But how does my right become another's duty to help me?

Classical Liberalism (e.g., in Hobbes and Locke) struggled with that question, not quite successfully in my opinion. In that view, the duty of another to assist me arises from the transformation of my natural rights into civil rights through the "social contract" and the laws established by a legitimate government to maintain the "state of society." In the "state of nature," there are no natural duties arising from my natural right to seek the goods I need. My natural neediness is not the ground of another's duty to help me. My natural right to acquire the goods I want leads to the war of each against each. The goods we need are naturally scarce, there is no natural law, and no executive power capable of enforcing it if there were such a law. I am not naturally my brother's keeper. Thus life in that state of nature is "solitary, poor, nasty, brutish, and short." The purpose of the "social contract," and consequently the duty of government, is to put an end to that war and to establish the conditions, (primarily law and order), which are necessary for the security, peace, progress, and prosperity of society as a whole.

St. Paul once admonished the Thessalonians that "if anyone will not work, let him not eat" [2 Th. 3.10]. Fathers once admonished their children that "the world doesn't owe you a living. Neither does your neighbor. It is your responsibility to provide for yourself and your family." That was a salutary teaching consistent with the harsh facts of life, the natural rights teaching of our Declaration of Independence, and the preservation of freedom and limited government in a democratic republic.

Is Affordable Health Care a Requirement of the Common Good?

What about all those who can't provide life's necessities for themselves? What about the "widow and the orphan," the poor, the handicapped, the disabled, the defeated, the downtrodden, the "marginalized," and all those who suffer "the slings and arrows of outrageous fortune"? If they have no natural and individual right to health care, are they to be left to suffer and die?

Of course not! Compassion forbids it, as does Charity. But compassion is not a virtue, and charity is not the same thing as justice. The "Good Samaritan" aided that particular victim. He did not organize a political party to demand that government create a program to aid all victims everywhere. It is good for society to foster the development of compassion, charity, and the cardinal virtues in its members. But the question we are exploring is whether universal health care is a requirement of justice and therefore a duty of government to establish and to guarantee. Government may have that duty. But according to the originators of the modern natural rights doctrine, its foundation is not in the natural right of needy individuals to life, liberty, property, and the pursuit of happiness. That duty, however, may be inherent in the nature of society and the purpose government."

Now we wish to consider whether the provision of affordable health care for all is a requirement of the common good.

Essential elements of the common good are succinctly stated in the Preamble to the Constitution of the United States: Its purpose is "to form a more perfect union, establish justice, insure domestic tranquility, promote the general welfare, provide for the common defense, and secure the blessings of liberty to ourselves and our posterity." Health is a good thing. Sickness is a bad thing. We naturally seek the first and wish to avoid the second. Health care is necessary for both. My own health is my private good. A healthy population is a public good. An adequate system of health care open to all is a common good, part and parcel of the general welfare. It is therefore a proper function of government to promote its establishment and to govern it operation through appropriate laws.

It is necessary to make some distinctions here. The Preamble to the US Constitution does not grant the Federal Government a specific power to do anything. Its specific powers are enumerated in the body of the Constitution. Other powers (over education for example) belong to the nature of government in general, but are not included in that enumeration. They are reserved to the States or to the People (Article 10). This fact is relevant to the determination of the proper role of the Federal Government with respect to our healthcare system. It is also necessary to understand the distinction between the power to govern, to regulate, to manage, and to administer; as well as the difference between laws, rules, and regulations.

Few would deny that an adequate system of healthcare is part of the general welfare. Most would agree that it is legitimate for government to promote its development and to enact appropriate laws governing its operations. Some laws might be very controversial. For example, laws prohibiting discrimination against illegal aliens, deliberate killing, experimentation on humans, cloning, eugenic cleansing, abortion, embryonic stem-cell research, euthanasia, "mercy killing,"or doctor-assisted suicide. But few contest the right, or even the duty of government to pass laws of that nature--i.e., laws as distinguished from rules and regulations. It is a proper function of government to govern, but not necessarily to manage or administer the country's healthcare system.

It is conceivable that the common good may, in some circumstances, require the government itself to establish and manage a healthcare system, or to "nationalize" an essentially private one. Some believe that "socialized medicine" is the best way to go. But it is a question worth considering whether such a system is compatible with liberty, with the duty of government "to secure the blessings of liberty to ourselves and our posterity." There are several essential elements in the common good. It is the duty of government to attend to them all and not to sacrifice one to another. That requires prudence and moderation in the government and in the people.

Who Benefits? Who decides?

Women and children first” shouted the captain of the sinking ship. “First treat the slightly wounded” ordered the field commander in desperate and immediate need of more soldiers. (Some military doctors wanted to treat the severely wounded first, to prevent their dying.) As to the availability of health care in general, some demand affirmative action for minorities and a “preferential option for the poor” in the name of justice and human dignity. They are many and needy. A few insist that priority should be given to those who most benefit society. Others hold that equal treatment is the proper principle. They differ whether equality means equal eligibility for each person, or proportionally equal financial support “to each according to his need.” Still others take a more pragmatic approach that others reject as inadequate and insensitive. “First, don't bankrupt the country. Second, don't take over the healthcare system or usurp powers not constitutionally authorized. Respect the proper role of state and local governments, as well as private, intermediary associations. Third, require all to purchase private health insurance open to all, and remove restrictions on the insurance industry that inhibit competition and restrict its territory. (Government should be insurer of last resort for the deserving poor.) Fourth, focus health care on the condition and futures of the different age groups. Provide health education and preventive care for all; remedial and curative care for children and adults who can be restored to useful life; only palliative care for the rest--particularly for seniors running out of gas. No extraordinary procedures or inordinately expensive measures for any person who can't pay for them.“

It is impossible to avoid rationing and setting priorities so long as health care is a scarce good and the demand is virtually without limit. Such issues are in substantial part questions of distributive justice. But who is to decide? Some of them are decided in the market place by what insurers and sellers of health care can afford to offer, and buyers can afford to purchase. Some are decided by government, in the subsidies or funding it provides and in the general laws and regulations it establishes for health care. Some are decided by the doctor and patient together. Many American's prefer that rationing decisions be made as close to home as possible--between the patient and his doctor.

It is characteristically human to “want something for nothing,“ ”to have our cake and eat it too,“ to have ”third-party payers“ for the goods we want. There is never enough money to do everything we desire. Choices must be made and priorities set, not only within the world of health care but between other elements of the common good. Universal healthcare may be very desirable, but self-defense and victory in war more imperative. Government must decide among competing goods and competing “values.” The struggle for power and deliberation about what is best are the very stuff of politics. We want the People to decide, and that is why we favor democracy. “Power to the People!“"

"Justice is the advantage of the stronger“ asserted the ancient Sophist. The law declares what is just and unjust. The winner of the struggle for power is by definition the stronger and makes the laws according to the “values“ of her class or his winning coalition. It is no surprise that too often those “values“ both rationalize and favor the interests of the winners in the struggle for power. Contemporary Liberalism offers no defense against such a cynical view of justice and politics. At bottom, that is its own view.

"Don't tax me. Don't tax thee. Tax that rich man behind the tree!” If there aren't enough of those, keep borrowing or printing the necessary money until the bubble bursts and the economy collapses, hopefully sometime in the distant future. “Do not suffer today what can be put off till tomorrow.“ That appears to be the natural way of democracy.

Conclusion.

Much is at stake in this healthcare debate. The dominant opinion of justice and what it requires of government is one of the main causes of its form and policies. The view that justice requires government to guarantee or provide universal and affordable health care is a particular instance of the Marxist principle of justice. ("From each according to his ability, to each according to his needs.") The triumph of that view of justice could eventually bring in its wake the tyranny inherent in the Marxist principle, as our experience of Communism demonstrates.

Teacher's Desk: Charter Blame Game

Two recent education pieces have me thinking, and the second with much concern, because I had not thought of our misguided youth in quite the way the author presented. The first article was published in last Sunday’s Denver Post’s Perspective section under My Turn by Spencer Weiler, an assistant professor of educational leadership and policy studies at the University of Northern Colorado. It was about the so-called disparity of special-education students and other "diverse populations" in Colorado’s charter schools. As for the second piece, for the life of me, I do not remember where I read it or who the author was -- but in essence, it recited the cold, hard facts about today's youth. They are dropping out of school and not earning diplomas, but the real clinker is that many, many have criminal records. These young people are not qualified to join the armed forces and the future security of our country is significantly impeded. What a chilling thought!

Spencer Weiler in his piece, spouts statistics about charter schools in Colorado: that charter schools’ populations statistically have less free and reduced lunch students, less Hispanic populations, less African American, and less special needs students. Let’s face it, if one pools the data in such a way as he has with statewide numbers instead of comparing charter populations with their own district populations, the demographics would be far closer statistically, so in essence, his theory is fraught with misguided comparisons.

I had to truly shake my head with his comparisons because the charter schools, as well as, the Denver public high school I’ve worked all had the same diverse populations. My own high school, a Denver charter school, has a 20% special needs population, about 75% Hispanic, 20% African American, and 5% white. This is close to the Denver Public Schools’ demographics as well.

I even know of more than one district high school that refused to admit special education students. Unfortunately the student in one case and the parent in another did not want to “rock the boat,” and file suit, but had every reason to do so.

The schools Mr. Weiler commended, DSST and West Denver Prep, have culturally diverse and economically challenged populations as well and are top performing schools with high expectations, structurally sound programs, and a consistent, positive, even uplifting, school culture. Parents flock there because they want their children to succeed and they want to be partners in their students’ work and ultimate success.

It is time to stop pointing fingers, blaming charters, and teach the students enrolled in your own district schools.

Kathleen Kullback is a licensed special educator at Colorado High School Charter with an MA in Educational Leadership and Policy Studies, and is a former candidate for the Colorado State Board of Education.