Abortion, Health Care, Autonomy
It is no accident, as the Marxists say, that most Americans now call themselves pro-life at just the time a national health system seems likely to materialize. The roots of pro-abortion ideology and the opposition to health reform are identical. The withering of one branch implies the withering of the other.
It has already become a commonplace in certain circles to observe that Baby-Boomer America (roughly, America since the 1970s) has been the theatre of Right and Left Libertarianism. The McGovernites and Goldwater Girls went to the prom together, and both have been tripping each other in their slow-dance through the institutions ever since. Right Libertarianism deals mostly with economic issues; it might be stated as the principle that the only legitimate duties that human beings can owe one another are contractual. Left Libertarianism is often called “autonomy,” usually in connection with bodily autonomy and most especially with a core-constitutional right to abortion on demand. Libertarianism in either sense is an atomizing force. It not merely tolerates but strives for incompetent government. Both poles seek this by defining public power in a way inadequate to the needs of public order. The effect, and sometimes the goal, is to undermine respect for the state and patriotism itself.
As ironies of history go, it is not particularly remarkable that these polarities of the same ideological structure are considered the defining features of Conservatism and Liberalism; in this case, of a conservatism that defunds and destabilizes the intermediating structures on which historically defined forms of conservatism depend, and of a Liberalism that reiterates the Progressive Republican mores of the 1920s. It is also not particularly remarkable that both poles of autonomy tend to create situations that are self-limiting. Left Libertarianism is essentially an anti-natalist ideology that was invented to mitigate the global famine of the 1970s that Paul Ehrlich warned about in The Population Bomb. The famine did not materialize, but the ideology worked: the segments of society that most thoroughly internalized it tend to maintain fertility rates below replacement level. The short explanation for why pro-life sentiment now increases over time is simple Darwinism. The end of Right Libertarianism, in contrast, comes not with a whimper but a bang. This kind of autonomy ideology promotes business and technological upgrades of all sorts, except for the upgrades to public order that the other upgrades have made necessary. Right Libertarianism has an uncanny knack for adopting history's economic tar-babies just before they ignite. We are seeing that now in connection with the medical-insurance industry.
The Age of Autonomy floated on a sea of fraud, which both Right and Left characterized as choice. As Supreme Court Justice Ruth Bader Ginsburg recently noted, it really was widely understood at the time Griswold and Roe v. Wade were decided that they were population-management measures with some well-understood eugenic implications. The emphasis on “choice” was a somewhat belated reformulation of the matter, one apparently internalized by the Justice herself. In any case, “choice” is a useful rhetorical device for situations where the speaker wants the audience to do something that would be very difficult to defend on its merits. The strategy is to extol the exercise of liberty rather than the effect the speaker intends from that exercise.
The rhetoric of the anti-reform argument in the current medical-industry controversy is identical: the issue is said to be “choice,” particularly in the care of one's own body. The use of the term in this context is even more inapposite than it is with regard to abortion. In the latter case, the choice is misdirected by a policy that was not designed with the chooser's best interests in mind, but at least the exercise of the chooser's will has some real effect on her condition. In the case of medical insurance, the discretion of the insured is much more constricted. Approval for every drug, the license of every practitioner, and the content of every insurance policy is already defined by a public authority at the state or federal level, and has been since the early 20th century. The two chief effects on individuals of nationalizing the minimum standards for this regime (which is what the Obama Administration is proposing) would be to restore job mobility for salaried workers and to allow wages to rise again, rather than all new money for personnel going into premium increases. That would be an increase in “choice” by any reasonable standard.
It is true that a substantial fraction of the population has been persuaded that they have a Roe-like liberty interest in insurance contracts whose terms are, for all practical purposes, changeable at will by the insurer. Again, this is a self-limiting situation. We are having this discussion because insurance premiums are rising a upwards of 10% per year in an industry that already takes up almost a fifth of the economy. Such things do not continue. The tar baby is already smoking. The only unaccountable thing is why the Republican Party insists on clinging to it long enough for ignition to occur.
It will not have escaped readers that a comedy of unintended consequences will attend the resolution of this issue. The bulk of the Democratic Party, and perhaps even a majority of the nation who are keenest on medical reform, are also dedicated to Left Libertarianism, to autonomy. This is, however, quite inconsistent with medical reform, as are other ideas favored by many Democrats. The Democrats still have not taken it on board, for instance, that a national health system requires a low-immigration regime, and indeed a zero illegal-immigration regime. This is for the same reason that a rule making everyone eligible for insurance despite pre-existing medical conditions requires everyone to pay premiums: to do otherwise risks the moral hazard of people applying for insurance only when they are already sick.
More important, it will be very difficult to make arguments of the “don't tell me what to do with my body” variety while overseeing a regulatory system that does just that. It is a very good bet that we will see Left Libertarians insisting on public support to keep private insurers in business, because those insurers will be able to fund abortions when public entities will not. Conversely, cultural conservatives will realize that the advance of public authority means the retreat of Left Libertarianism; at any rate, it can mean that, if cultural conservatives can embed their ideas in a broader program that makes life more secure for average citizens.
Best of all, the successful enactment of reform will mark the end of the Boomer insistence on America the Incompetent. This insistence took several forms, but its characteristic expression was the attempt to separate the state from the nation. The Left began this tradition with the insistence that they love America, despite the fact the federal government's chief activity was to bayonet babies. The Right picked up the theme, with flag bunting added, all the while declaring the federal government to be a parasitic racket incapable of nation-building at home or abroad. In this competition, the Right was perhaps the more ridiculous, since a faction of it sought to compensate for the political deficit occasioned by the unraveling of the social-safety net with the promotion of a popular military. In a way, this policy was the American equivalent of the European Central Bank: the latter is a central bank without a government, the former an army without a state.
We cannot do the New Deal a second time. That was a strategy for a less educated, less wealthy, and more isolated society than we have today. As several writers have already suggested, however, it would be quite possible to revive the genius of that era: cultural conservatism legitimated by risk-limiting transfer mechanisms in which the payors are self-evidently the beneficiaries.
It's a simple as that. Please get busy.
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The comments above were, of course, occasioned by President Obama's address this week to a joint session of Congress on the health-care controversy. It was a good speech, I thought, though I do think the plan has too many moving parts. Not all observers take quite the same view of the president, however. Consider these remarks by Damian Thompson, blogger for the Telegraph of London and Editor of The Catholic Herald:
If I was a fundamentalist Christian (which I'm not) I'd be asking myself: is it just me, or are we living in a time of unusual prophetic fulfilment?
1. The US has elected a President before whom all nations bow down (or at least they do according to his grovelling sycophants in the American media and the BBC). A man of great oratorial skills yet possessing a smoothly anonymous personality…
2. Technology now allows the state to monitor every inch of our neighbourhoods AND our bodies, without us even being aware of the fact…
3. The United Nations wants a new global currency to replace the dollar, as the Telegraph reports today
This, surely, is the clincher. I mean, how many Signs of the Times do you need before you decide it's time to take a fresh look at the last few pages of the Bible?
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Yes, he is kidding, mostly, but this is the sort of posting that makes you check YouTube for clips of the Archbishop of Canterbury snake-handling.
