And God said, “Let there be light.” And there was light. – Genesis 1:3
The awesome majesty and power of God can be seen in this: that not only is His word law, His word is reality. He says “let there be light” and simply by saying this, there is light. He says “let the earth bring forth living creatures” and it does. Reality itself is in utter conformity to His will, and is molded to His thought.
Human beings are made in the image of God, but they are not like God in this respect. We cannot, simply by speaking, conform reality to our will. We cannot make the world a certain way simply by commanding it to be that way.
Stated explicitly, this well all seem quite obvious. Of course you can’t remake the world simply by speaking; it takes action. But unfortunately when it comes to social policy people often mistake words for action and results, and think that because we pass a law saying “there shall be x” that we have achieved x.
Take, as an example, universal health care. It is no doubt desirable that everyone receive needed health care, and we often hear that the United States is the only industrialized country in the world that doesn’t have universal health care. But what does this actually mean? Not, surely, that everyone in these countries who needs care receives it. If a person in a country does not receive needed care either because of a shortage of doctors or because a drug or treatment that would have existed under a free market system is not available, then regardless of whether that person’s name appears on the country’s health care rosters, the country does not really have universal health care.
Nor is it true to say that under a “universal” system everyone would have insurance. Massachusetts, for example, claims to have universal health insurance because the state has made having health insurance mandatory. But, as noted above, simply saying in law that everyone must have health insurance is not the same as everyone actually having health insurance. Car insurance is mandatory in 47 states, yet 14.5% of motorists in those states remain uninsured. According to census data, 31% of people without health insurance in the United States are already eligible for existing government programs.
None of this proves, of course, that any sort of health care system is or is not desirable. It may be that, while not perfect, a government run system would come closer to our goals than would some alternative system. But we must take care to evaluate any such proposal not by what it says, but by what it does, not by what it promises, but by what it delivers. We must, in short, take care that we do not confuse saying that something is so with its being so.
I think this is a poor example, because it fails to distinguish between defect in design and defect in practice. (I’ll leave aside also that many of the QOS arguments have little to do with health outcomes but promptness. The latter quality is importent, but more often the former is implied irresponsibly.) Take doors on a vehicle. My old roomate in college learned that doors were required in Illinois for his Jeep whereas he could take them off in Wisconsin. If we were to make a similar argument we would say that people are still killed in vehicles and there may even be instances where doors caused a person to die, therefore those who advocate regulating doors on vehicles are being dishonest. Of course doors are designed to keep people in vehicles and when they work as designed, they will cause fewer deaths. With universal healthcare there may be instances where people do not receive treatment, but inability to pay will not be that reason. In this country, people will not receive treatment or they may end up bankrupt absent charity if they cannot afford it, and that is by design.
What would you suggest as a better example?
Cash welfare I think works well. You have a clear primary effect, increased cash for the poor. The secondary effects are pretty well known now, and I think it has clearly been established that it is a net negative in the long run.
I’m not sure I understand your distinction between defects in design and defects in practice. Is it the distinction between trying to solve all of a problem and failing and trying to solve part of a problem and succeeding? If so, then I fail to see why a “defect by design” should be considered worse than a “defect in practice.” Suppose that by only tackling part of a problem (and leaving the other part unsolved by design) we can do a better job of reducing the problem than if we try to solve the entire problem and fail. Should we prefer the attempt to solve the entire problem on the grounds that it only fails in practice, even those it gives us worse results? That doesn’t seem plausible.
Another way of putting it is the distinction between scope and competence. I personally don’t blame the American health care system in not providing universal care because it isn’t designed to provide universal care. You have condemned universal healthcare in the past because of specific instances where the absence of care caused death. When evaluating those cases, we find that the treatments needed were within the scope of care available under the plan but weren’t provided based on reason X, Y, or Z. X may be too great a case load. Y may be poor judgement of a doctor. Z may be too little infrastructure. Each of these by the way is present in our system. We don’t look at the shortage of hospital beds in Las Vegas and say that it is impossible for a capitalist health care system to allocate enough hospital beds. We say Las Vegas has had tremendous growth, and we anticipate that hospital beds will meet population needs once we get a better handle on where Vegas is heading.
This doesn’t mean that one can’t prudently oppose universal health care. The poor definitely suffer here because one must purchase a car to reach work in most places. We don’t just give everyone cars and gas so that work options are equitable between men. With health care, one must be willing to say that it is better for people not to receive treatment or be thrown out of their homes in order to preserve the ‘freedom’ of not having to subsidize someone else’s lifestyle. There may be other ways to mitigate these harms, and they would be availabe to use in an argument. And yes, a prudence argument would address failures and expectations of failures in competence or practice.
I don’t believe I’ve ever “condemned” Universal Health Care. I think it’s a bad idea (albeit one I used to support), but I wouldn’t argue that because the system isn’t perfect therefore it is a bad idea. My argument is that in evaluating a given health care system, we need to look not at what the system promises (because such systems very often don’t live up to what they promise), but rather to how they work in practice. But that doesn’t mean I think the fact that a system doesn’t live up to what it promises is a decisive argument against the system. I wouldn’t argue, for example, that No Child Left Behind is bad simply because it actually does leave children behind. It may be that, for all its flaws and unmet expectations, the program is better than any alternative. But if you’re going to evaluate the program, you need to recognize that, whatever its benefits, it does actually leave some children behind, and if you don’t recognize this, then your hold view of the issue will be distorted. Same with Universal Health Care. Maybe some form of Universal Health Care is the best of the possible options. I’m open to that argument. But when comparing options, we need to realize that Universal Health Care won’t actually provide universal health care, or we won’t get a fair comparison.
[...] done if by “get things done” we mean passing laws or issuing government edicts. But as I’ve noted before, there is a difference between passing a law to do x, and actually doing x. Laws enacted by [...]
[...] As I’ve noted previously, there really is no such thing as universal healthcare. No government funded program, no matter how lavish, is going to pay for every treatment that could [...]
[...] As I’ve noted previously, there really is no such thing as universal healthcare. No government funded program, no matter how lavish, is going to pay for every treatment that could [...]