Bloom Briefing 17: On Healthcare and Human Rights

Welcome to the seventeenth edition of The Bloom Briefing: Notes from the Resistance. This week, there is one issue and one issue only: healthcare. As always, I'm eager for your thoughts.



What Happened

Republicans in the House voted for the Affordable Health Care Act (AHCA), which is a cruel abomination. The projections show that, should it become law, some 24 million Americans are likely to lose health insurance. Older and poorer Americans would likely be forced to pay more for health insurance. Some people with pre-existing conditions would not be able to purchase health insurance because insurance providers would be allowed to deny them coverage based on those pre-existing conditions. And, with the billions of dollars the government will take away from benefits programs like Medicare, the rich will get a massive tax cut.

This isn’t law yet. It still has to go to the Senate, where Republicans have already indicated they’re not particularly fond of the legislation. It looks like they may be more or less starting from scratch on their own bill. It seems unlikely that the House Freedom Caucus (the radical right-wing of an already far-right party) and Senate Republicans, the ostensibly moderates in particular, would be able to agree on any legislation, but stranger things have happened (see the man sitting behind the Resolute desk).

Nonetheless, the passage of the bill in the House has led to plenty of news coverage, giving ample air-time to both Republicans and Democrats to make good, bad, or misguided arguments. It strikes me that many of the critiques of Republicans this week focused on the process. There was no Congressional Budget Office score; there was no open debate. Some Republicans hadn’t even read the bill that they voted for. This critiques are valid, but they actually tend to cloud the deeper debate, which is about our shared commitments to each other on issues of health.

Foundations of Conservative Thought on the Social Safety Net

There is a strain of conservative thought which argues that legislation that compels some people to pay for other people’s benefits is inherently unjust. Such a view is grounded in some combination of four general principles:

  • Libertarianism argues that the free-market is most efficient, so policy should be designed to let people make choices.

  • Randianism (i.e. the philosophy of Ayn Rand) combines libertarianism with the belief that selfishness is moral. It sees disregard for the less prosperous as righteous because success is evidence of morality.

  • A Horacio Alger-style view of the American Dream that believes that the only way to live the American Dream is to pull yourself up by your bootstraps.

  • Outright or subconscious racism, which is seen most frequently in the argument that the majority of people getting benefits aren’t “like me”.

If you keep asking why to someone who believes that they shouldn’t have to pay for someone else’s benefits, eventually, you will hit one (or more) of these foundations.

Let’s consider, for a moment, the trope of the welfare queen, popularized by Ronald Reagan in his 1976 and 1980 campaigns for president. In conservative circles, the welfare queen is a woman, almost always a black woman, and almost always overweight, who continuously opted to support her family with welfare and food stamps and Medicaid rather than get a job. The trope was infused with racism (whether willfully or unwittingly); it was dependent upon buying in to the radical self-reliance of the America Dream; and it was based in some libertarian or Randian view of the world where benefits are either inefficient (libertarianism) or just plain wrong (Randianism). For a deeper dive on the impact of this malicious trope, this Atlantic article by Rachel Black and Aleta Sprague is excellent.

Republican arguments for the AHCA have usually focused on the libertarian suite of arguments, which remains the most palatable of these four foundations. They argue that, should the bill pass, healthcare consumers will have more choices. (This may be true for some consumers, but is certainly not for many others.)

History of Rights-Based Arguments from the Left

In response to the AHCA and Republican arguments for more market-based healthcare, Democrats have generally followed two lines of attack. The first is just to point out uniquely horrible aspects of the bill (like the fact that may lead to 24 million fewer Americans having health insurance); the second is to make a claim that denying Americans health insurance (and by extension healthcare), Republicans are denying them of a basic human right.

Progressives are used to making this second kind of argument. Since 1970, virtually all major progressive policy victories have been on equal rights protection-based grounds. By this I mean that they all say that government resources can't be used to discriminate based on protected characteristics.

Title IX (1972) was a massive boost to women’s rights in educational settings. It mandates that educational institutions have to offer the same opportunities to men and women. It is largely credited with producing American dominance in women's sports.

Gay rights is a similar story. While there is still work to do, the idea that different types of people – in this case based on sexual orientation – are entitled to the same set of protections before the law has been persuasive.

And on race, while we might not look at society today and conclude that there has been obvious progress towards racial equality, the arguments conservatives make are (mostly) no longer grounded in a belief in the natural inferiority of people of color. In short, the idea that one cannot treat a certain class of people differently from another class of people has been a successful argument.

This kind argument has been successful not because it is new and innovative but because it relies upon something about which there is already broad consensus, i.e. that discrimination against an entire category of people is bad, and extended that line of argument to more types of discrimination and more types of people. Progressives won the argument about gay rights not by saying that gay rights are human rights (though they did) but by making the case that discrimination based on love is no different than discrimination based on race or gender, and we already decided those things are not okay.

You’re probably thinking about the myriad forms of race-based and gender-based discrimination that still exist in contemporary society and wondering where I came to the notion that there’s broad consensus that this is unacceptable. My point would be simply that when progressives can point to those things, they can often motivate action. We see this with race-based differences in drug sentencing and policing patterns. By pointing to the injustice of race-based differences in the government’s execution of its responsibilities, progressives force conservatives into either outright racism (e.g., African Americans deserve to be victims of policing violence) or acquiescence.

The Challenge of Arguing for Healthcare as a Right

What makes healthcare more complicated is that the lines of access aren’t starkly drawn. If you’re poor, you have access to Medicaid. Access to Medicaid isn’t, to my knowledge, harder to obtain for folks of color than it is for others. Progressives can’t point to one class of folks who are wronged by the healthcare system, in part because the healthcare system wrongs so many different kinds of people.

Nonetheless, progressives have often relied on the same sets of arguments about healthcare that they do about other kinds of issues. They argue that healthcare is a right (as the United Nations’ Universal Declaration of Human Rights says), and that the government has a responsibility to ensure that everyone has access to healthcare. Progressives have been plugging away at this issue for a long time on those grounds but not really making a lot of progress (though there has been an uptick in the last 2-3 years).

I believe this lack of progress is partly attributable to the shallowness of an argument that says that access to healthcare is a human right. If that’s all the argument has, then conservatives can just argue that Medicaid exists for precisely this reason, and that other folks without health insurance are just exercising their right not to purchase it.

The left treats rights as if they are both natural and universal, that they exist in all times and all places irrespective of other cultural attitudes. But history teaches us that this is not true. There has not always been consensus on even the “self-evident” truths of life, liberty, and the pursuit of happiness. Athenian democracy, supposedly the exemplar on which the renaissance of democratic values was built, is famous for executing its leading intellectual for “not believing in the gods of the state” and “corrupting the youth” with his speeches. Even in democracies, rights like freedom of speech and freedom of religion are not universal.

For rights to exist in the way that mean when we refer to them as rights, there has to be general consensus that treating them as rights is good. What this means is that human rights aren’t real. They’re not things that you can point to and say, “that’s a human right,” because they change over time. Rights are simply a term we apply to shared values about what is best for society.

This is why, when progressives argue that everyone must have access to healthcare because there is a right to healthcare, conservatives can simply respond that there is not (don’t read this; it's garbage – I’m just demonstrating that this is a line of thought). A rights-based argument only works when there is consensus that the topic of discussion is indeed a right. An argument that a thing is a right is a tautology. If you have to argue that it is a right, arguing that it is a right (without something more substantive behind it) won’t be a winning argument.

If progressives want to convince the remaining 40% of Americans that the government has an obligation to ensure that everyone has access to healthcare, then an argument that healthcare is a right is just saying the opposite of what the 40% of people who don’t think that believe. Instead, progressives should focus on the ways in which a society where everyone has healthcare is morally superior to one in which some people don’t.

Empathy and Morality the Way Forward

To that end, Jimmy Kimmel’s extended monologue on his son’s birth with a congenital heart condition was arguably more effective than any arguments progressives have been able to muster. Kimmel’s raw emotion when telling the story makes a clear connection with the audience. We feel his pain. We empathize. We think how terrible it is that anyone might not be able to get medical care for their children because they cannot afford health insurance.

The argument that progressives should be making is that without healthcare for everyone, things that we don’t want to happen in our society will continue to happen. People will have to choose between eating and healthcare; people will go into bankruptcy because of necessary medical procedures; people will die unnecessarily because those who are sick will not go to a doctor for fear of being unable to pay the bill. These aren’t exaggerations. All of these things happen.

For progressives to be successful in convincing others that everyone should have access to healthcare, they should drop the language around rights, and focus on the morally bad consequences of allowing access to healthcare to be income-contingent or health-contingent. Given that people feel morality before they rationalize it, connecting via empathy is likely a winning strategy.

The conservative response to Kimmel is further evidence of the effectiveness of this strategy. Conservative pundit Jonah Goldberg was forced into logical contortions like decrying empathy to counteract the persuasiveness of Kimmel. The argument is essentially that we shouldn’t make policy based on feelings because feelings can lead us astray. But empathy, insofar as it is felt, is what undergirds our moral framework. Living among other people (i.e., in society) requires us to try and feel what they feel. To do so is virtuous and moral. Goldberg’s claim thus boils down to the idea that policy shouldn’t be made based on morality.

The absurdity of this inevitable conclusion (absurd because all policy is based on shared morality), coupled with the virtual self-parody of the headline, “The Dangers of Empathy,” should make perfectly clear how progressives' focusing on the empathy-based argument for universal healthcare puts conservatives in such a difficult spot. They either have to appear inhumanly insensitive to the plight of those without access or proffer blatant falsehoods, like the idea that nobody will be hurt by an $880B cut in Medicaid.

Conclusion

Healthcare is just one of the many issues on which moral and empathetic grounds are likely to be more persuasive than rights-based argumentation. Virtually all progressive economic issues follow the same kind of reasoning.

We should have a universal basic income (or some policy equivalent) not because people have a right to certain material conditions but because a society in which no one lives in poverty is superior to a society in which some people do.

There should be greater paid family leave because a society in which some parents are forced to go back to work within a week of birth to be able to put food on the table is wrong. Nobody should have to make such choices.

The starting point for any political argument is, explicitly or implicitly, a statement about right and wrong. When right and the wrong are explicit points of political discussion, the left tends to win the argument. When they are vague and implicit, the right often emerges victorious.



Additional Reading:

At Slate, Jamelle Bouie wrote about the dangers of forgetting history, particularly Civil War history.

At The Guardian, Lucia Graves wrote a lengthy piece about Stacey Abrams, a female African American Democrat who is running for governor of Georgia.



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