Healthcare Justice Politics and Sustainability


The US Supreme Court is in the middle of its deliberations over the health care mandate, triggering a flow of media attention. One headline in the NYTimes caught my attention. It reads “If Health Law Is Overturned, What Will Liberals Do?” It really is of little consequences in this matter what liberals do, but the decision would have a huge impact on those who would be left out. It should read “If Health Law Is Overturned, What Will the Uninsured Do? It is patently premature to prejudge what the Court will finally do and say, but I will do it anyway. As usual, I do see a connection to sustainability.

The gist of the arguments, apart from the legalistic precedents, revolve in part on the meaning of freedom. Freedom is being voiced by the conservative Justices as the absolute right of an individual to ignore the existence of and connections to others living in their common socio-economic system, loosely defined as the nation. This stance is diametrically opposed to the central idea of flourishing as a property of the whole system. It reinforces the dominant cultural meaning of what it means to be human that is a primary cause of the lack of flourishing today. The blindness to and ignorance of everyone’s embeddedness a system dependent on caring cannot but generate more inequality and unhealthy conditions for the less fortunate whether by chance of birth or other circumstances. Only in the eyes of some transcendent being are we all the same at birth; the reality is quite different, as indices of social mobility demonstrate.

Freedom to ignore thy neighbor is the opposite of caring and expels love from the family of man (and beast). Love is the context for consensual and non-dominating social coordination of action predicated on the acceptance of the legitimacy of others to exist. And without consent and non-domination, freedom cannot exist, except perhaps for a single being on a deserted island. Ironic, hmm. My favorite biologist, Humberto Maturana, argues that love is the primary human emotion, springing from our evolution as a social animal. When love is absent, the humans involved become diminished and suffer from various ills. The whole debate over health care is a metaphor for a choice of the kind of human beings we will be: Being (acting out of care) or Having (acting only out of utilitarian decisions). If we make the wrong choice, Having, for whatever reasons—ideology, ignorance, fear—our species and our world will move further from sustainability-as-flourishing.

Following still the line of questioning reported in the news, if freedom as the unshackled right to ignore the world we inhabit prevails, we will have, or perhaps own is a better word, some thing called freedom. Erich Fromm claimed we have moved from “being,” the basic human mode of living to a “having” mode.“ He expanded on this saying, “having and being are two fundamental modes of experience, the respective strengths of which determine the differences between the characters of individuals and various types of social character.” Having creates human beings that bring both an existential and real sickness to the world.

By taking a stand that health care is nothing but an economic commodity and should be delivered entirely by the “free market,” the Justices who argue this way are expressing a cold-hearted and cynical view of this necessity. We provide food stamps to those that cannot afford to purchase what they need to survive in the not-so-free market. It could be (would be) argued by this side that people are free not to use food stamps. That’s true enough, but we also have a strong moral abhorrence of suicide which is exactly what a prolonged period of being “free” from sustenance would produce. We do not allow the needy in this matter to rely only on the charity of others, as experience shows that food banks and community kitchens are woefully inadequate to the task.

But with health care, the arguments twist and turn. The only essential difference I see here is that we need to eat everyday, but our need for health care often comes at unexpected times. With no “health care stamps” at hand, we force the needy to rely, like Blanche DuBois, on the “kindness of strangers.” You and I are those strangers because eventually we pay for the care of those who cannot. We justify this by passing the moral buck to the health care professions for whom refraining from caring for those in need is repugnant and not acceptable. The costs, and there always are costs involved, are paid by all those who are paying for their health care whether directly or through insurance. There has never been much of an outcry against this practice because the idea of caring for the sick has been part of the moral center of our and other cultural traditions for a very long time.

The centrality, but mistaken importance, of freedom in this case can be traced through the Constitution to the Declaration of Independence’s ringing words: inalienable rights to life, liberty, and the pursuit of happiness. These are not equal; without life, presumably a healthy one, there cannot be liberty or happiness. Several of the Justices claim to be originalists looking for the intent of the framers of these documents as a guide to decisions being made some 300 years later. The moral core of those earlier men is clearly evident in the words that guide our Nation. The Court’s substitution of the market for the moral community may be legitimated by the Justice’s reference to some abstruse legal doctrine, but it completely lacks the more fundamental moral core that holds the nation together. I have often quoted Robert Heilbroner, a respected economic historian, who noted the basic failure of free markets to deliver moral goods. His quote I find most graphic is, “a general subordination of action to market forces demotes progress itself from a consciously intended social aim to an unintended consequence of action, thereby robbing it of moral content.” Enough said.