Thomas Hobbes tells us that in the state of nature, as distinct from that of civil society, “the life of man [is] solitary, poor, nasty, brutish, and short.” Which is not to say the same can’t be said of some civil societies, e.g. Nazi Germany, Stalinist Russia, Apartheid South Africa, to name just a few. So libertarians and anarchists are right to point out that the state can as readily be the source of that brutishness as an escape from it. But for the purposes of today’s analysis, let’s put those cases aside. In fact here let’s confine our discussion to those polities we regard as the relatively affluent liberal democracies in the world today.
With that scope in mind, it seems to me that there are three things that mark the distinction between a civil civil society and a still-brutal one. They are the abolition of the death penalty, women’s reproductive autonomy, and single-payer healthcare. The first two cause the citizen to fear the state; the third to appreciate it.
By these measures, then, Canada, the Antipodes, and most of Europe are civil societies. The United States is not. I’ll leave capital punishment and abortion for another day. Here I want to focus exclusively on healthcare.
Single-payer healthcare was adopted in my native Province of Saskatchewan in 1962, and shortly thereafter the rest of Canada followed suit. Over the course of my life I’ve had major surgeries and other medical services that I’m sure have cost the taxpayer well over a million dollars. Let’s compare that portion of the taxes I pay for this with what I would have had to spend either out-of-pocket or for private insurance. Am I ahead of the game or behind? I have no idea. But even if I did, what’s the price-tag on not having to give the threat of bankruptcy a second’s thought? Again, no idea. But there are people, south of the 49th, who do weigh these costs and have opted to pay them directly rather than through their taxes.
Of course the same was true in my native Province of Saskatchewan prior to 1962. As I recall it was only kicking and screaming did they pay their taxes and accept the coverage. I know of no one, either in Saskatchewan, or elsewhere in Canada, or in the Antipodes, or in Europe, and no matter how independently wealthy he might be, kicking and screaming against socialised medicine today.
Is this change of heart because the above calculations are now beyond us? I suspect not. I suspect it’s because among the dividends of single-payer healthcare is a certain civility we’re no longer prepared to live without. That is, it’s not that I couldn’t pay out-of-pocket or afford the premiums. It’s that I know that others could not. And it’s not that I care so deeply about them. It’s that I want to avoid the discomfort of being surrounded by desperate people. Left to my own devices I wouldn’t pay to alleviate that discomfort. Avoiding this kind of discomfort is a collective action problem. So I welcome the state solving that problem for me.
But if I’m entitled to my judgment call on this, why isn’t the equally well-off American not entitled to his? He is. At least until the majority of American voters, as did those in Saskatchewan in 1962, decide otherwise. But I want to grant that there’s another autonomous effect of socialised medicine that may be preying on the American mind, one not to be dismissed out of hand. And that’s that socialised healthcare, though it offers us freedom from financial worry, there are other freedoms it taketh away. Such as? Such as the freedom not to wear a seat belt.
I’m using the seat belt issue here as a stand-in for that vast array of issues that arise out of the negative externalities your behaviour is imposing on the rest of us. In the absence of socialised medicine go knock yourself out! But not if the rest of us are having to bear the cost of your stupidity. So since we have skin in the game, there’s a powerful moral intuition telling us that likewise should we have a say in it. But of course one man’s modus ponens is another’s modus tollens. Or, less pretentiously, one man’s proof is another’s reductio. So whereas the stereotypical Canadian accepts the right of the state to require seat belts, his American counterpart takes it as an argument against making the taxpayer pay for the stupidity of others, including one’s own.
As I’ve already indicated, my own view, for what little it’s worth, is that paying for the stupidity of others is a burden I’m willing to take on in exchange for their paying for mine. But maybe that’s because I know, from experience, just how stupid I can be.
Categories: Social and Political Philosophy