Countless discussions have taken place here at Vox Nova about health care, revisiting debates about whether or not it should be provided, in any way, by the government. When I have expressed the view that, under these current (and probably collapsing) political arrangements, the government should see to it that all persons have access to health care, I’ve been charged with “not really being an anarchist.” The reasoning is that if I oppose the existence of the state, this means I should therefore believe that health care should be provided by “private” entities.
This mistaken assumption reveals to some degree the differences between anarchism and libertarianism, the latter of which tends to be the source of criticism of my intuitions with regard to health care. Anarchism has traditionally been more communitarian, where libertarianism is liberalism taken to its extreme. Both anarchists and libertarians oppose the state — actually, its debatable how much libertarians actually oppose the state — but they oppose the state for very different reasons.
Here are a few excepts from an article I found recently on an anarchist approach to social welfare. It might help to clarify some mistaken assumptions, and I am sure it will help to generate discussion. I am of the mind that the approach described here is very “Catholic.”
[A]narchists criticize the State as much for what it represents as for what it is. The State is singled out for particular attack because it is the exemplar of the top-down organization, based on power relationships, hierarchies and institutionalized violence. And it is the existence of power relationships and the systems of domination that they support, that anarchists have consistently attacked, their ultimate aim being the creation of a society—an ‘anarchy’—in which such relationships have been abolished. These power relationships are not embodied solely in the State but permeate the rest of society. In seeing the State as not something unique but rather as the supreme manifestation of a system of power relations, anarchists have recognized that the only way to dismantle the State is to construct other relationships….
[...]
Any definition of society should include an ability to take care of the welfare of its members, not just those members who have a privileged place in the social hierarchy. Welfare should be an intrinsic part of any society, therefore, not simply a functional extra. This requires that society is organized first and foremost to provide welfare. What anarchism calls for is the re-absorption of the provision of welfare into the daily lives of the citizens of the community. Welfare thus becomes not simply a function—something provided by a system or the workers in a system—but part of the everyday life of the community and its citizens.
[...]
The failure of the State to provide social welfare should not be seen as undermining the idea of social welfare itself, but of invalidating the role of the State; welfare is inextricably linked to empowerment, which is why State-provided welfare is always going to have minimal success. At the same time we should be under no illusions as to what the effects on the poor will be of the paring down of what State provision there is in the name of the market: without a viable alternative, the market simply means sink or swim, and to sink means poverty, destitution, homelessness, even death. The attempt to free welfare from the State cannot be left to the free marketeers of the Right. The need for a democratic and participatory alternative to the Welfare State has never been more urgent.
[Millet, Steve. “Neither State Nor Market: An Anarchist Perspective on Social Welfare.” In Twenty-First Century Anarchism: Unorthodox Ideas for a New Millennium, edited by Jon Purkis and James Bowen, 24-40. London: Cassell, 1997.]
Thank you, Mike. The overlap between the first excerpt and subsidarity are clearly apparent. But what should be done about states that do a pretty good job providing social welfare. Western Europe for example?
This amounts to saying that we should fight the state by making the state super-massive and powerful.
No thanks!
Michael J. – I agree with you, and your quoted article. I just come to a different conclusion. It does not follow as the only conclusions that either:
1. non-state private welfare means “corporations” or for profit groups.
2. Only government can fill the void left after eliminating those “corporations” or for profit groups.
I’ve said it before, and I’ll say it again: It is exactly things like this that should be handled by the “Church”, meaning Christians, Catholics, and affiliated charities. That to me is more “Catholic” than choosing the “state” simply because it is monolithic.
Zach – Read it again. Pay attention to the actual words and the ideas that they form. Where does it say that “we” should make the state “super-massive” and “powerful”? It says that the anti-statism of the Right (the extreme liberals, libertarians, etc.) is not the answer.
Adam – Not sure. What do you think?
Michael–
As someone who has moved from libertarianism and “anarcho-capitalism” to mutualism and voluntary socialism, I have to say I don’t think that these quotes really prove your point or even state a basic case for the compatability of anarchism and government provided healthcare.
The first paragraph explains that power relationships, domination, and institutionalized violence are not uniquely of the state, and further explains that the goal of an anarchist should be to construct other relationships. I agree. However, by cementing the state’s role in health care, we are only cementing a system of domination and power relationships involvement in health care. To actually construct other relationships would not mean to give more power to a health care system of domination run by power seeking bureaucrats. It would actually mean finding ways to empower communities to develop systems and organizations to take care of its members health care. I am not thinking of charity, as Tim above seems to indicate. I am thinking more along the lines of health care cooperatives. Actually, before the depression, many people formed health care cooperatives and put a doctor on retainer. The AMA objected to such practices because they felt that doctors were providing health care too cheaply. Also, it would be a good idea to look at the health care system and determine how government privilege helps wealthy health care providers and disadvantages the consumer.
I don’t understand how the second paragraph actually supports government run health care. It actually indicates that welfare should not be a function of the system but part of the everyday life of citizens and the community. I don’t understand how making the provision of healthcare a part of our government puts it in the “everyday life of citizens and the community.” In fact it places it further from the community, and puts it in the hand of our rulers.
The third paragraph explicitly states that state run welfare will have minimal success. Is this not admiting that government run health care will not work well? I also agree that pairing down state provision of social services is not the answer. Instead we should pair down the instruments the government uses to support the privilege of the wealthy. I disagree that the market in itself is the problem. The problem is when the wealthy use the government to maintain and expand their wealth at the expense of others. Finally, I agree that a democratic and participatory alternative to the welfare state is urgently needed. However, expanding the welfare state is not a way to actually promote an alternative to the welfare state.
What I really don’t understand about anarchists for the government provision of health is why they think this will work. If the government is really run for the interests of the wealthy (and I fully believe it is), why would it end up doing something that is not actually in the interest of the wealthy? If the government were to set up a health care system, I fully believe it is because the wealthy and powerfull benefited, and its organization would not have the betterment of the common man in mind. So, instead of expanding government control of health care, why do anarchists not instead work to find cooperative solutions?
Mike,
The excerpt states “welfare is inextricably linked to empowerment, which is why State-provided welfare is always going to have minimal success.” So it seems to be suggesting that States de facto do not provide adequate welfare. But, so far as I can figure, Western Europe does a pretty good job. In the author’s logic, either Western Europe is not made up of modern states, or states do, in fact, provide adequate welfare. I don’t see how the author can sensibly make that statement about anything other than this specific thing.
“thing” should read “state”
[...] 5) Another opportunity that appears to be within our grasp is the potential for some changes in the health care system in the united states. American for-profit health care is unambiguously demonic. Libertarian types often ask me how an anarchist could be in favor of universal health care. Such libertarians prove how little they really care about “liberty.” The way I see it, there is a hierarchy of tyrannies and not all forms of rule are equal. The tyranny of corporate capitalism is one of the worst in that it thrives on the illusion of freedom. In an ideal, utopian community, people’s health needs would be cared for, and the “systems” that provide this care would be in the hands of the people. Universal health care can be imagined and implemented in various ways in the united states. None of them would be ideal. But any of them would be better than keeping the power over life and death in the hands of corporations. The opportunity for universal health care that we seem to have represents a much needed move toward taking power away from corporations. My understanding of “liberty” does not include capitalism. (More on the topic of anarchism and health care here.) [...]