Wednesday, April 6, 2011

Subsidizing grain and health

In thinking about the Paul Ryan budget, I find myself coming back to a debate I held with myself in the run up to the Affordable Care Act.  The issue is this: to what extent do I deserve a government subsidy for my consumption of health care services?  If we assume that the art of politics is simply the redirection of resources from one group to another, then certainly the ACA represents a shift in resources from the elderly to the younger (insofar as "savings" were discovered within Medicare to fund subsidies for those lacking insurance).  Under this assumption, of course I deserve the benefits from the ACA--after all, my cohort voted en masse for President Obama.

However, now the question is a bit less parochial, and instead concerns a particular group of Americans for which I have very little sympathy: senior citizens.  Do what extent do they deserve full government subsidy for their consumption of health care services?  What I like about this question is that it really makes me confront my neoliberal assumptions, particularly the idea that the government should maximize growth at the expense of full inclusion, and provide a strong safety net for the excluded.

Now, our question has morphed into something even larger: to what extent should the government subsidize anything?  How do we measure individual desert in a polity as large as ours, where determining who contributes what to the greater good is hazy at best?  When I am confronted with questions such as these, I look towards human social constants; in other words, those peculiar social arrangements that appear again and again throughout history wherever societal development is advanced enough to produce some modicum of organized government action on behalf of a particular group.

During the late Roman Republic, for instance, a conflict broke out that threatened to rip the Republic in half.  The plebeians, over time, became massively indebted as a result of land policy that benefited large holders of the patrician class.  Then, in a state of complete dependence on creditors, the plebs effectively demanded a leader that would redirect some of those resources to the debtors--a role that populist leaders like Caesar and Pompey were more than willing to fill.  Of coure, in the context of the last century BC, where people barely survived long enough to develop serious, chronic ailments, the only good worth subsidizing was food (grain).

Going back and considering ancient antecedents such as this to modern social arrangements helps me to separate the ageless from the contingent, what's human from what's merely a product of capitalism.  Back to my original question, a conservative would respond, "you only deserve health care services to the extent that you have earned health care services by participating in the economy (and participating well)."  A liberal, on the other hand, would agree that you deserve what you earn, but with the added caveat that if by dint of poor luck you fail in the economy (or are born with a condition that constrains your access and ability to participate in the economy), then you deserve government subsidy for health care.

My view, however, holds that the desire for policy to address inequality is only natural when the disparity in access to resources is obvious to everyone.  As was the case in 2009; as was the case in 1933; as was the case in 250 BC.  In sum, regardless of the fact that senior citizens today (for the most part) represent a rentier class, benefiting from multiple subsidy programs; and regardless of the fact that I am unlikely to develop a chronic condition that requires large amounts of health care services: the essence of subsidized health care points to a deeper human truth than Paul Ryan and others care to admit.



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