Thinking about the health care debate recently. It's occurred to me that the two sides--which we tend to call "liberal" and "conservative,"*--both display signs of dealing with guilt. Guilt that they have something that other people don't. This post will attempt to explain three things:
1) Where this guilt comes from, and how the two sides tend to deal with it.
2) Why the two sides seem to want the things that they do, and how this influences their policy preferences.
3) why neither of these are satisfactory solutions and why neither of them can come up with a policy that is both realistically workable and acceptably humane.
The root of the guilt I see here has to do with the fact that in today's screwed up world, the reaction of people who have stuff when confronted with people who don't have stuff is to feel guilty about having stuff. It was not always this way, but liberalism's** egalitarianism has triumphed over the past century, and we moderns feel a distinct unease when we have more than someone else. This is why liberals tend to want to "raise awareness" about things like global poverty and go on about the millions of Americans who are dying every minute because they don't have health insurance. This is also why conservatives don't want to hear about poverty and why indie movies and Michael Moore documentaries don't play very well in the heartland. It might make them feel guilty, and no one likes that. Both sides feel uneasy about this.
But I should add a caveat. Moderns feel guilty for having something more than someone else unless we feel we deserve it. Liberalism places a premium on individual merit. Here's where we start to see differences in the way people handle this guilt. Conservatives handle the guilt in ways that everyone knows about: I deserve this because I'm somehow better, i.e. bootstrapping. This shouldn't come as a surprise, but it does serve to explain why some people have stuff and others don't, while preserving the "haves" from any guilt. If I have stuff, obviously I did something to deserve it, because I wouldn't have it otherwise. So I don't need to feel bad about it, because I'm only getting what I deserve, and the people that don't have what I do must not deserve it.
Here's where I think it gets interesting. I think the liberal reaction is no less predicated on felt guilt and no less designed to mitigate that guilt. But instead of insisting that I deserve what I have because I'm special/better/white, it insists that I deserve what I have because everyone deserves what I have. Ergo, access to health care is an inalienable human right. So again, I don't need to feel bad about it because I'm only getting what I deserve, but ain't it a crying shame that some people aren't getting what they deserve.
And this is why we have policy differences. Conservatives see no particular reason to pay for health care for those that don't deserve it, and quite the contrary, have a huge incentive to cut their own costs to avoid paying for unmerited handouts. But liberals have a huge incentive to see that the benefits they enjoy are spread to everyone, because if not everyone can have what they do, it would seem to indicate that there is no right to it, i.e. they're getting more than they deserve.
Thing is, neither of these is a Christian approach. The Christian message and indeed, the entire Christian ethos is founded upon people not getting what they deserve and not feeling guilty about it. Shakespeare had the right of it:
...[U]se every man after his desert, and who should 'scape whipping? Use them after your own honour and dignity: the less they deserve, the more merit is in your bounty.
The Christian view is that the Earth's bounty and all our riches are the gracious gift of God, whose merit at bestowing bounty on us poor sinners is matchless. Nowhere in Scripture is there any suggestion that the rich should feel guilty about their riches. Nor should there be, as Scripture teaches that wealth is just as much the doing of God as poverty, so why should I feel guilty about what I had no hand in arranging?
Rather, the Christian motive for charity is not to make sure that everyone gets what they deserve, but to use God's gracious gifts with the same grace with which they were originally bestowed. So neither the liberal nor the conservative approach is an adequate way of thinking about the difference between those who have and those who don't.
But even worse, neither of liberalism's warring children can possibly succeed under their own terms. If the conservatives were to get serious about making sure that people really only get what they deserve, they'd find that they don't deserve what they have either, or, at least, there's no rigorous way of telling who deserves what/how much. If the liberals were to get serious about egalitarianism, they'd find that there's no reason to stop with health care. Talk of "living wage" is a smokescreen, as there's no logical reason to stop there.
I think this highlights an internal and, in my view, unresolvable tension within liberalism. The conservative critique of the liberal position is correct: liberals overestimate the deserving of the poor. But the liberal critique of the conservative position is also correct: conservatives overestimate the deserving of the rich. Rights regimes are fundamentally incoherent, as not only is there no way of basing them on a metaphysical foundation strong enough to support their demands, but there's no way of working them out without "creating" more "injustice" than you're trying to solve. If health care isn't a right, there's no reason to worry about who has it and who doesn't. Justice is served regardless. But if it is a right, there's no reason to be happy until every Nigerian peasant can get chemotherapy on demand.
The genius of the Christian view is that this world is not the end. The life of the world to come is the real goal, and where all our hopes are cast. It also recognizes that there are worse things than being sick or poor. Hardship is discipline, etc. So while we can mourn suffering--just because it has benefits doesn't mean this is the way it's supposed to be--we mourn because God's creation has been marred, not because justice is not being done. In addition, by focusing on heaven, grace has purpose beyond individual merit. We show grace because we have been shown grace, but grace does not mean simply giving people what we or they think they want. It means doing what, in our judgment, is best for them.
This conflicts with liberalism in a number of ways. First, it makes us take responsibility for judgments about other people, something liberalism will not permit. Second, it encompasses the idea that sometimes leaving someone in their misery is the gracious thing to do. Again, hardship is not the worst thing that can happen to you, and the point of grace is not simply to alleviate hardship. It is to bring people to the Gracious One. So if mitigating hardship will simply enable someone to continue in their selfish ways... maybe they need to spend some more time with hardship. This sort of analysis doesn't easily translate into policy language, but it does alleviate the concern that everyone always have access to the best possible treatment. We wish they could, but it's not automatically a problem if they can't.
I think the things described here are why I really can't get all that excited about the health care debate. Not only do I have no confidence that any of the proposals which seem likely to pass will provide benefits worth their costs, but none of my concerns are even remotely represented. The beast from the sea will continue in its age-old ways, and the best from the land will make it sound like the decent human thing to do, but I see the dragon behind them. Health care reform may not be a tower, but that doesn't make it any less of a Babel. And the irony of the project failing because of a lack of adequate communication would be fitting.
*I know full well that these terms as applied in this context have nothing to do with liberalism or conservatism in any rigorous way, but I shall employ them here because they're convenient shorthand which let everyone know who I'm talking about.
**Here I do mean the term in the classical sense. Both "liberals" and "conservatives" belong to the broader tradition of liberalism.Posted by ryan at March 2, 2010 9:05 AM