Healthcare for all and shiny pennies
Needless to say, there is more to the disability rights debate than notions of individual rights and individual needs. Indeed, the greatest opposition to a welfare state is practicality. At this point, I concede that those who believe the middle ground between contractarianism (the philosophy that proposes society is an aggregation of individuals under contract for their mutual benefit) and utilitarianism (the philosophy that proposes that the good is rooted in maximizing the most good for the most people) is difficult to see. As of this writing, I don’t have a solution.
To understand where the tension lies, it’s best to draw out the conclusions of each. Contractarianism is essentially a tit-for-tat approach. The moment a sufficient number of the populace decides no longer to abide by the law (on some interpretations, this naturally follows from the absence of a judicial system) or refuses to contribute to the shared wealth of the community (so long as they don’t freeload) or any other number of decisions that violate the contract made between me and you et. al. — the contract is no longer valid. So, for example: say I wish to have John’s coat; understandably, John doesn’t want to give me his coat. He has very good reason for wanting to keep it and there is little I could do to convince him to give it to me. The contract states in no short order that he’s very much within his right to deny me despite my desire to have the coat. In fact, John might live in the tropics where he’ll never need such a coat and, what’s more, he could have a dozen exactly like it that he chooses not to wear AND I could live in Antarctica and have five children to feed whose lives depend on that coat — he still falls within his rights to deny me. So, I kill John and take his coat. But, naturally, I’m a sloppy criminal and am arrested post-haste and sent to prison. Now my liberty — the most valued benefit of our contract — is void since I’ve broken the contract.
However, the disabled rarely kill people (as far as I know). But suppose instead of violating the contract in an active way, I unexpectedly have a child with a disability and am unable to pay for the medical care this child requires to lead a successful and happy life (as mentioned in an earlier post) (suppose further that this disabled child, without treatment, will be incapable of fulfilling her contractual obligations to society). Who will pay? Well, in more recent years, people have come around, as they say, to the view that a child is an investment; so, although a parent may not have the means to rear a child that can fulfill the needs of society, the society can pick up the bill now for greater returns later (one return being the absence of those who yield very little or no benefit to society). There is a good deal more to this point (including the issue of how you measure benefit), but we’ll set aside contractarianism for a moment.
Utilitarianism sees no issue here, generally. The good life (the life worth having) is a finite resource which must morally be distributed to the greatest effect to the most people. Killing John and taking his coat is wrong because to do so yields more bad (whatever makes life not worth living, one might say) than good; that is, the pleasure of having John’s coat nowhere near matches the good to be had from John having his coat and being alive (if nothing else than for the sake of those who love and will miss John). The tension between contractarianism and utilitarianism comes when we look at the second iteration of John — the iteration where John has a dozen coats and lives in Ecuador and I need a coat to save my children. Contractarianism (or, at least, those versions of it that hoist desert as an essential mechanism to the contract) says it’s okay for John to keep his coats and not wear them, too. Utilitarianism, by contrast, demands that John hand over his coats since it is obvious that a great deal more good can come from my children and I having the coat than John. In fact, it would probably say that John should hand over six of his coats for my family and one other for kindling or to keep the dog warm.
The conflict regarding disability rights as well as that regarding the universalization of health care both seem to, at least partially, turn on this point. One mark against contract theory in both cases is the fact that, as John Rawls notes, it’s rather unlikely that a very good argument could be made in defense of desert of one’s natural capacities or the place one is born or to whom etc. As such, there are a good many things that people simply don’t deserve (in this light, some may argue no such thing as desert exists at all). However, this argument alone begs the question since it supposes an ethic that falls outside the contract. The best resolution seems to be to find a common ground between utilitarianism and contractarianism.
That common ground, as alluded to above, seems destined to be found within the justification of utilitarianism within the confines of the rational contractarian approach — the notion that not only children but people, in general, are investments. A reasonable contractarian could hardly suggest that supporting children to shape them in to contract abiding citizens isn’t simply good sense. It’s only a small leap to adults provided the correct incentives and structuring of the society.
The real trap, however, is that not everyone is capable of fulfilling their contractual duties to society. This is where the pennies come in.
One can think of society’s people as a rich woman’s pocket. She’s got hundreds, fifties, twenties, tens, all the way down to shiny pennies. Now, if you don’t know this secret by now, I’ll let you in on it, rich people not only make a lot of money, they hold on to most of it. That’s right, if your pockets are full of tender, it’s likely because you never take it out. Why don’t rich people take money out of their pockets? Because they love money. In fact, they love the hundreds just as much as they love the pennies. Sure, a penny or two can’t get you as much as a hundred dollar bill, but if you get enough of those pennies together, you find yourself just as rich. Except, your pockets are pretty daggone heavy. In fact, they’re so heavy that they begin to drag you down — so much so that you start having trouble strutting down the street as rich folks are want to do. At some point, you realize that dragging around these pennies just isn’t worth it — that’s not to say it’s not worth carrying around that much dough, just that it’s better to head on over to the bank and trade them in for those light and fast hundreds.
The point here is that if you want to cherish each and every individual the way an idealist might envision, you need to have the resources to support them and all that cherishing. Sadly, the easier solution is to simply trade those people in like so many pennies. Genetics and social engineering alike steadily approach a brave new world. Of course, as we know, Hitler has been down that road and very few of us are guaranteed to be in the we-gotta-keep-this-guy (and his brood) category. Additionally, it doesn’t solve the problem of what to do in the mean time before we’re all grown in test tubes and have care-free sex with everyone we know. Not to mention the fact that there’s a good deal of uncertainty in what is the good and whether getting rid of our pennies is really such an uplifting experience after all.
…P.S. I realize I didn’t heavily tie in disability and healthcare for all but I’ll take it you can piece it all together for yourself and you can tell me what you think of it. I’ve got MCAT studying to do.
P.P.S. Apologies to any philosophers whose senses are likely offended by my lack of precision/symbols.