basedgodtrilla asks me the following question:
[H]ow do ‘civil libertarian’ and ‘proponent of universal healthcare’ go together[?]
Civil Libertarianism is not Economic Libertarianism. It’s the difference between how much of your paycheck gets taken in taxes, and what you’re allowed to actually do with the money you keep. It’s the difference between being allowed to earn money, and being allowed to spend it on whatever you like, and to use the proceeds in whatever manner you like.
An absurd example demonstrates the distinction: if you were allowed to keep 100% of your paycheck, but 100% of possible purchases were banned by force of law or by virtue of circumstance, your ability to keep your entire paycheck is of little use to you. Now apply that logic to health insurance. being taxed less doesn’t help you when you have cancer, and your private insurance company is desperately trying to find any excuse to drop your coverage. It is little comfort to tell someone with a pre-existing condition that they are “free” to choose any health insurance they like, when those insurers are also “free” to turn them down; at which point, in the absence of EMTALA-style laws, you will then be “free” to die. And I think we can all agree that dying sort of defeats the purpose of having freedom in the first place.
First, let’s start with negative v. positive liberty. Negative liberties are those liberties which exist in the absence of any external influence. Every liberty you have in the state of nature is the full scope of your negative liberties (state of nature = absence of civic and/or governing institutions). Positive liberty, on the other hand, is liberty which exists only by virtue of an external influence. In 99% of cases, that external influence will be a law.
What is important to understand is that in the state of nature, every person is free in every way imaginable. The problem with the state of nature is that freedom without limits extends to your freedom to trespass upon the life, liberty and property of others. Some libertarians try to make a “theoretically nice” distinction here by saying you don’t actually have this liberty, but this is a misunderstanding of what “natural liberty” is. You can’t just declare by ideological fiat that natural liberty doesn’t extend to your liberty to “tread” upon others. The lion has the natural liberty to hunt the gazelle. The squirrel has natural liberty to steal eggs from a robin’s nest. Neither of these animals seem too awfully concerned with libertarian theories about the moral limitations of natural liberty. To say that humans can do less in the state of nature than the lion and the gazelle is to do violence to the very definition of natural liberty.
Under these circumstances, the diversity of humanity’s experience will create adversarial relationships by virtue of competition for scarce resources. Even if we were to assume that people are basically good, that they tend to cooperate rather than compete, and that they will form large societies without seeking to form a government, it remains the case that humanity is diverse enough that individuals will act on their biases. In doing so they might collectively create a society in which a particular group of people is systematically denied access to resources they need to thrive. When this situation occurs, and the natural process of “market” selection does not seem to be solving the problem, the creation of positive liberties through force of law generally becomes necessary to alleviate this condition.
Examples of laws which create positive liberty are the Civil Rights Act(s), the Voting Rights Act, and the Americans with Disabilities Act. Also, government programs such as Medicare, Medicaid and Social Security ostensibly increase positive liberty as well, which I’ll return to in a moment.
In order to explain why Universal Healthcare is compatible with (and in my eyes, a function of) Civil Libertarianism, you need to ask yourself what freedom actually means. If you think hard enough, you will discover that absolute “freedom” can fail to be useful when all individuals within a society exercise that freedom so as to deny you access to resources you need. When an employer refuses to hire you because you’re a woman, or a business owner refuses to serve you because you’re Black, you are, in a very real sense, being denied personal liberty. And it’s a direct result of them exercising their personal liberty to choose whether they want anything to do with you. Your inability to access certain spaces in society constitutes a very real restriction on your freedom. When this happens, the only way to preserve your actual freedom to create it positively through external influence.
When one pre-supposes civil society, it is often the case that the only way to preserve liberty in these situations is to apply the force of law. Consider the fact that the 6th Amendment guarantees you the right to legal counsel in all criminal cases. However, legal counsel costs money. So what happens if you’re too poor to afford a lawyer? Under a paradigm of negative liberty, you’re shit out of luck; negative liberties include only those to which you have access in the absence of any external influence. So negative liberty isn’t going to save you in this situation.
In the situation above, you have two options: you’re either shit out of luck, or society must create a mechanism by which the poor can have access to legal representation. That mechanism necessarily involves an exercise of State power. The freedom of poor individuals to be protected from criminal charges is thus preserved by virtue of a redistributive act: people contribute taxes to the government, which then uses those tax dollars to hire Public Defenders for poor people.
This is a textbook example of positive liberty: the government literally redistributes wealth through taxation of those with resources, and distributes it to those without, so that the freedom of the latter group can be preserved when they face criminal charges. By redistributing such wealth, it preserves the life and liberty of the indigent, who would otherwise be marginalized by virtue of their indigency.
What does all of this have to do with Universal healthcare? If you are sick or injured and can’t afford medical treatment, your position is not that different from a poor person facing criminal charges. You are in need of a service to preserve your life and liberty, but lack the resources to provide it. Other people in society, however, do have those resources. And private health insurance companies aren’t exactly giving away free MRI’s and chemo treatments during the holidays. That denial can result in an empirical loss of liberty. Let’s briefly examine the form of private insurance to explore this further.
There are generally two ways to organize a private insurance system: the first is through an employment-based system where your access to health insurance will generally depend on maintaining gainful employment. The other way to organize private health insurance is to have it be entirely the purview of the individual. Under the latter system, employers would ideally just pay their employees the difference of what it costs to provide them with health insurance, and allow them to seek coverage on their own.
But the problem with individual health insurance markets is that some people won’t qualify for coverage due to pre-existing conditions. Coverage will also be more expensive because they have no real bargaining power as a single consumer. The advantage of employer-based health insurance is that the entire company constitutes a risk pool. That pool becomes a bargaining chip through which employers can convince insurers to lower their per capita premiums, and also to cover individuals who might otherwise not be able to attain health insurance on their own.
The problem with employer-based coverage is that it often traps people in their jobs that might otherwise leave to pursue other vocations. Let say you want to leave your current job and start a business. But you also have a family with young children, and your spouse is covered through your employer. If you leave that job, your entire family will become uninsured. All of a sudden, that great entrepreneurial idea you had can’t be translated into useful economic activity, because you feel bound by the circumstances of your job.
Are you “free” in this situation?
With a universal healthcare program, you wouldn’t have to worry about your family. You could switch jobs anytime you like, and your kids would still be covered. This is part of the reason why countries like Norway can have extremely high tax rates (~45% of GDP) and universal healthcare, and yet they have a Purchasing Power Parity (PPP) that is roughly $5,000 higher than the U.S. Norway also spends less on healthcare than we do for better outcomes.
Now put this in the context of society at large with respect to civil liberties: Norway’s police officers don’t even carry weapons, and there response to terrorism was more democracy. Meanwhile, in America, the NYPD spies on American citizens, violates the constitutional rights of peaceful protesters, and brags about being able to shoot down military aircraft. The President thinks he has a right to kill me without access to the courts, the federal government deports children without even cursory investigation, the police have tanks and aerial drones, and if they fuck up, chances are they’ll be immune from liability. And if the police initiate force against me without cause, I have a legal duty to let them kill me.
In Norway, not only do the cops not have missiles, but I am free to walk into a hospital and receive medical treatment no matter who I am or how much money I have. I always have that freedom, regardless of where I work, or how much money I make. In America, that’s not the case. A lack of resources can essentially deny me that freedom. Losing my job could deny me that freedom. That doesn’t happen in a nation with universal healthcare.
That is how universal healthcare is compatible (and for practical purposes, necessary) to a functional civil libertarianism. Freedom which is “literally” maximized does me no good if I cannot practically access the resources or services I require to thrive. Even in a completely pure free market, some people are going to fall through the cracks. And the lesson of modern economies is that it doesn’t have to be this way. Creating mechanisms of redistribution, such as universal healthcare, that create a functional guarantee to certain resources, e.g. healthcare, ensures that my freedom to access them is preserved from misfortune by happenstance, or by the collective acts of other people in society, whose consequences materialize to my detriment in unforeseeable ways.
Orthodox Libertarians call this slavery. But I have yet to meet a doctor or nurse who feels their legal obligation to treat a patient regardless of ability to pay is equivalent to the yoke of a hebrew tribeseman or a plantation slave from the Antebellum South. I feel freer in a country like Norway than I ever would in America, for all the reasons stated above. And it’s due in no small part to the existence of a universal healthcare program.
UPDATE: logicallypositive has written a libertarian-oriented response to this post, which you may read at your leisure.