Freedom from Fear in the Health-Care Debate

by Valerie Elverton Dixon 11-10-2009

There comes a moment when we can say a word or speak a concept so often that it loses meaning and simply becomes sound. The concept becomes exhausted, thin, one-dimensional. Such was the case with the word and the concept of freedom during the debate in the House of Representatives on final passage of the Affordable Health Care for America Act.

The opponents kept saying that health-care legislation would take away our freedoms and lead to a “government takeover” of health care in the United States. Some dressed this argument in patriotism and in pathos. They sounded an alarm to be wary of a behemoth of federal government, a beast standing in our doctor’s doorway. They counted the number of times the word “shall” appeared in the legislation, and reminded us of the coercive power of the state to take us to jail if we break the law. I find these arguments specious.

Freedom is complicated. It is more than the ability to do what we want without interference. It exists in both positive and negative ways. The late political philosopher Isaiah Berlin writing in an essay “Two Concepts of Liberty” defines negative freedom as non-interference and positive freedom as the source of interference that compels us to do this or that. As long as individuals live in society, freedom is not absolute. The common good puts limits on individual freedom. These boundaries and requirements do not mean that custom or law has usurped our freedom.

Berlin says: “You lack political liberty or freedom only if you are prevented from attaining a goal by human beings.” The health-care legislation requires citizens to buy health insurance. If we do not, we can be fined. My question is: what goal does such a mandate prevent us from attaining? Berlin references Jean-Jacques Rousseau and the concept of the equality of sacrifice.

When we all buy health insurance, we get a tangible benefit in return. We lose the freedom not to buy health insurance, but we gain the benefit of freedom from denial of coverage for pre-existing conditions. We cooperate with our fellow citizens to help pay for health care for all. If we are able to choose not to buy insurance, our fellow citizens would have to pay the cost for our care when we need it. Be assured; we will all need care at some point.

Berlin also reminds us that to instead offer freedom to people who need food, clothing, shelter and health care “is to mock their condition.” People need their health in order to make use of freedom. The positive freedom is the freedom that comes not through coercion, but from a willingness to fit our freedom into a greater good and to understand why we ought to do it.

In 1941, President Franklin D. Roosevelt articulated four freedoms: freedom of speech and expression; freedom of religion; freedom from want, meaning “a healthy peacetime life”; and freedom from fear. God has not given us the spirit of fear. We ought not to fear our own government. In a republic, our vote is a check on the power of government. The paradox is by giving up a portion of our freedom, we will gain greater freedom.

Dr. Valerie Elverton Dixon is an independent scholar who publishes lectures and essays at JustPeaceTheory.com. She received her Ph.D. in religion and society from Temple University and taught Christian ethics at United Theological Seminary and Andover Newton Theological School.

Categories: Health, Human Rights

Lord_Voldemort

"Berlin says: 'You lack political liberty or freedom only if you are prevented from attaining a goal by human beings.' The health-care legislation requires citizens to buy health insurance. If we do not, we can be fined. My question is: what goal does such a mandate prevent us from attaining?"

There are a wide range of goals that could be thwarted by this mandate: homes not bought, businesses not started, educations delayed for lack of tuition, all because the government says you must buy this particular thing before you buy anything else.

"When we all buy health insurance, we get a tangible benefit in return. We lose the freedom not to buy health insurance, but we gain the benefit of freedom from denial of coverage for pre-existing conditions."

So now you acknowledge that we lose some sort of freedom, but that we gain an ironclad entitlement to care. But that depends on the quality of the insurance purchased, which will be driven, to no small amount, by the specifics of the "government option". I'm still very unclear as to how the government option makes financial pressures go away. Insurers will still be motivated to save money, and care costs money.

"Berlin also reminds us that to instead offer freedom to people who need food, clothing, shelter and health care 'is to mock their condition.'

Yes, and to force healthy people who want to go to school, build a home, start a business, etc, to buy health insurance they don't necessarily need is also to mock their condition.

"God has not given us the spirit of fear. We ought not to fear our own government."

I don't necessarily fear my government any more than I fear the waitress at my favorite restaurant, but that doesn't mean I'm going to hand over my health care decisions to her. Even if we ignore the "tired, thin, one-dimensional" freedom question, there's still the little matter of whether or not the government that has made a hash of flu vaccine has the competence to run a health insurance program.

"The paradox is by giving up a portion of our freedom, we will gain greater freedom."

I have yet to hear what that "greater freedom" is. Freedom from disease? Hardly. Freedom from not having access to health care? I already have access, as do the vast majority of Americans.

Ms. Dixon ignores the price tag while the "good" I'm supposed to buy consists largely of hot air. Opposition to this mandatory "deal" she dismisses as "fear". Sorry, if I'm going to trade freedoms, I want something valuable in return. That's not fear, or even an overattachment to abstract freedom. It's just not wanting to get ripped off.

LV

Anothernonymous

You already have health insurance? That's great; I do too. So does my wife, thanks to being married to me. That could change in a minute if I lost my job or worse; as a cancer survivor, she'd be toast.

Fortunately, I'm not likely to lose my job, since I have tenure, that great guarantor of academic freedom. I'm sorry if a bill that guarantees her access to health care if the unthinkable were to happen strikes you as "hot air." Personally, I can think of quite a few superfluous freedoms I would be willing to cash in to make sure it passes, and even some more fundamental ones.

BTW, I agree that the fear thing is being pushed too far, as is the freedom thing. What this is about is justice, and the measure of justice is whether you look out for people who are less fortunate - or, in this case, less lucky.

xfree9

Have you thought of why your health care is tied to employment? Doesn't it strike you as odd that you have to pay for insurance through lower wages? Doesn't it seem wasteful and poor stewardship to have less competition, less control, and fewer options for your health care? If the problem with losing insurance when becoming unemployed, there's an easy solution: don't tie insurance to employment! Imagine if we all had to go choose a plan on our own, on the open market... just like every other market, costs of insurance would go down by virtue of competition. Add to that the state governments restricting insurance companies from operating across state lines, and there's even less competition.

The problem does not lie in access to health care, but in the costs of that health care increasing over time due to increased regulation, restriction, and no competition. Big Insurance loves having no competition because it means they can charge relatively whatever they want.

Anothernonymous

"Big Insurance loves having no competition because it means they can charge relatively whatever they want."

Absolutely, but I maintain that only government is capable of fixing this problem, preferably through a single payer system that eliminates private business from the equation. The free market is an abstraction that is based on the principle of individual self-interest; it is not a dynamic force capable of doing anything to solve this problem. Free market health care, as far as I'm concerned, would be a nightmare: the ultimate apples to oranges mismatch in which a problem relating to the public good is thrown to private interest for a "solution." Sorry, but no thanks.

xfree9

Big insurance enjoys no competition because of government! That's part of the problem! I'm not prepared to debate the merits of a single-payer system, but I think you're sorely mistaken that the free market has "failed" to produce the results you want because we don't have a free market, so saying it has "failed" is a misnomer.

Mennoman

You may be right that we do not have a truly free market. We never will have one. I choose government to help out and I do not share your view that government, simply by virtue of being government, is the problem. That view is as simplistic as communists saying that free markets in and of themselves are the problem.

xfree9

I didn't say gov't is the problem by virtue of being the gov't. It is part of the problem because the reasons most people dislike our current system is because government has restricted access, competition, and over-regulated an industry that otherwise would have natural competition like any other industry, and costs would go down.

letjusticerolldown

Say you take two of the most costly and advancing sectors of the medical economy: pharmaceuticals and advanced technologies: what is the tweeking you would do that would decrease regulation and free the reigns on Pfizer, Abbott, Merck, Medtronics, and Boston Scientific to deliver more advance at lower cost for all persons?

BlueDeacon

Good point. That ain't gonna happen.

xfree9

I would first ask two questions: why is it costly? Is it because of regulation and costly procedural limitation? Is it because of protectionism?

In other words, why is the list you wrote only so long? Why aren't more companies being started and investing in capital resources to provide a less expensive solution. Protectionism plays a large role in that; those companies have no natural incentive to compete for our dollars at lower costs because most of us don't have to worry about the costs... when we don't worry about the costs, we are charged whatever they can get away with.

BlueDeacon

I would first ask two questions: why is it costly? Is it because of regulation and costly procedural limitation? Is it because of protectionism?

Neither. It's out-and-out greed.

xfree9

Totally wrong. Besides, it simply begs the question: what allowed and permitted this greed? Was it because they could get away with charging whatever because there was no competition? Blaming it on greed is not an answer, because greed is a symptom of a larger problem in economics. People are permitted to be greedy when systems are in place that allow them to be so.

xfree9

This is a great report about the benefits of healthcare when guarantees are made by the government. There's also a paragraph that mentions how companies already have to compete by lowering prices because insurance doesn't allow them to charge what they want. And, to my knowledge, this link is not a conservative/libertarian source.

squeaky

Sounds like you are arguing for a single-payer system.

Free market competition sounds like a great solution and all that, but you are assuming that the free market has morality. It does not.

The free market is based on profit, not morality. And when a system is based on profit, it appeals to greed more than ethics. As a result, to drive down costs and become more competitive, it would be most prudent for an insurance company to cover only those who will cost their system the least--those who are most healthy, in other words. this would be the most effective means of keeping costs low and outcompeting other companies, afterall.

If I were a senior citizen or someone with a lot of health issues or if I had a pre-existing condition, I'd be scared to death of such a system. It might not lead to "death panels", but a health care system based solely on the free market would absolutely lead to those who need health care most not being able to obtain it--not because they can't afford it, but because they simply will not be accepted.

The underlying problem with our health care system is that it IS profit-based.

xfree9

The free market is amoral. But under whose morals should we make decisions? Yours? Mine? What happens if immoral folks start dictating how businesses should run? Men are not angels, no matter how great some of us may be. Barack Obama may have the greatest of intentions and abilities, but he will one day not be President. Then what?

What isn't driven by profit? You cannot separate profit from stewardship because profit is an indicator that scarce resources are being used wisely. That is an ethical and moral outcome of profit-driven business. It does not facilitate greed; it channels it into productive uses rather than abusive ones.

In a truly free market, in health insurance and health care at least, it is a race to serve other people at the lowest possible cost. Retail companies drop prices to compete because they all want our money (greed); yet they have to appeal to our willingness to choose them as opposed to another provider/producer. Prices fall. This is economics 101. But in health care, because we're stuck in a paradigm of insurance and having other people pay for it, costs have risen because there is no incentive for health care providers to compete for our hard-earned income. While this is of course a moral issue, you still must provide support for why your outcome and method of achieving that outcome are the moral solution. I would contend for various reasons that a single-payer system or insurance-based system is immoral because it wastes resources, which is ultimately harmful to the environment and the economy.

BlueDeacon

Retail companies drop prices to compete because they all want our money (greed); yet they have to appeal to our willingness to choose them as opposed to another provider/producer. Prices fall. This is economics 101.

But in all this you ignore the reality of speculation, which has driven our economy especially since the late-1980s; health-care insurance costs have risen not because of lack of competition but because the focus is on profit, not services. That's the same problem with "Big Pharma," which also seeks primarily the largest possible payoff to satisfy shareholders regardless of product. Take Wall Street out of the equation and things might change.

xfree9

Speculation has its proper function in a market economy, and is not as bad as you might believe. But I agree: take out Wall Street, and things will change drastically. But again, health insurance companies have no competition, therefore no incentive to lower costs like in every other industry (other than education).

BlueDeacon

But again, health insurance companies have no competition, ...

Nonsense -- my immediate past employer offered plans from three different companies, and that doesn't even include the HMO that's run by the largest local hospital chain. However, today you can get none of them on the cheap.

xfree9

three is not competition when there are hundreds of companies in the US. Yet our state (PA) limits the number of insurance companies allowed to operate within its borders. Imagine only having only three companies making cars, or three companies making appliances, or three companies making computers.

BlueDeacon

Well, I live in the same state, and you may recall that there is an insurance commission. For good reason, I would think.