Irami Osei-Frimpong

Oct 8, 2020

5 min read

Healthcare Anti-Politics

Instead of casting healthcare as a human right, we should conceive the lack of healthcare as a problem for civil, political, and family freedom. Policies are not legitimate because they affect humans; they are legitimate because they enable or degrade the modes of self-determination humans, as choosing selves relatively free from biological determination, happen to be able to engage in.

The problem with illness is that it stops us from being able to realize our freedom, e.g., fulfilling responsibilities of our free families and participating in civil society. However, if you try to justify universal healthcare as a self-standing right, without reference to how healthcare enables the realization of freedom through non-healthcare institutions, you’ll run into a few problems.

You can have an authoritarian regime, a command economy, a state enforced church promoting asymmetrical marriage, and no property rights, yet still have universal healthcare.

This is because basic healthcare is only an indirect institution of freedom. Basic healthcare can just as easily support functional oppression. Whereas self-government, civil society, a free family, free religion, and property relations are the mutually reinforcing institutions through which we realize ourselves as free individuals. Each one of the institutions of freedom listed above are so because they involve a contribution of the individuals’ free will in their production and sustenance.

But you don’t produce your illness. Your illness happens to you in that is a problem for your participating in other institutions of freedom. You need healthcare to go back to living your life on your terms. In this way, healthcare, and even environmental protection, provide the biological and psychological conditions for you to engage responsibly in meaningful institutions other than healthcare and environmental protection.

The goal of healthcare is to make health not an issue. That includes making your healthcare bill not an issue. But the goal of self-government, civil society, family, church, and property relations is to realize yourself as a self-determining individual through the attributes you give yourself through these institutions. In contrast, your dentist visit is not supposed to be meaningful in the same way. The process is determined by something other than you. (I will admit that my colonoscopy was a bit of a spiritual experience, but mostly because I choose to do it without any drugs. I was curious.)

When we confuse healthcare, a natural pre-condition for participating in institutions of freedom, for the realization of institutions of freedom themselves, we put forth an anti-politics. We put forth a politics where the aim is to remove the problem, rather than realize ourselves through how we engage it.

It’s a politics where the goal is not to govern in a way that grows other people’s capacity to govern, but a politics where the aim of politics is to get rid of the problem of the freedom of others and to go back to thinking about mimosas.

This is one reason why healthcare politics is particularly attractive for the set of people who aren’t interested in self-government or democratizing power. These same people think the UBI — another form of “progressive” anti-politics — leads to freedom.

In contrast, a proper healthcare politics addresses the provision of healthcare as a civil and political institution, not its standing as a “human right.” (By the way, “human rights” are dubious designations for a variety of reasons. We can talk about civil rights and political rights, but “human” is a natural attribute based on a biological species. There are no rights in nature. Just try to serve a tiger a formal petition not to eat you.)

Here is how this works:

The universal healthcare you want is not going to be provided by nature. Nature’s universal healthcare is the immune system. Instead, you want doctors and nurses, drugs, clean buildings with adequate plumbing, and you want all of these provisioned for you by other civilians participating in their civil responsibility. So while you didn’t choose and produce yourself as a cancer patient as an institution of freedom; your oncologist did choose to realize herself as a cancer doctor through an institution of freedom in civil society. In this way, the health industry is a one-sided institution of freedom: for the practitioners, but not for the patients. In the same way that carpentry is a one-sided hobby for the carpenter, not the wood. (Elective procedures are a bit more complicated.) Healthcare is immediately a civil rights issue for the healthcare practitioners who are realizing themselves in plying their trade as civilians, so the conditions of their relationship with their patients are the conditions of their civil freedom. However, healthcare is indirectly a civil rights issue for the patient because illness merely presents and obstacle, not an enable condition, to civil freedom.

For the patient, healthcare becomes a civil issue when the patient has to pay the healthcare bill and manage healthcare debt. But again, this is not a situation of freedom because the patient did not choose the illness and is coerced by circumstances into this debt. The civil oppression is in the debt or refusal of service in our commodified healthcare system, not in the aliment.

The debt is a civil wrong because it negates your status in civil society. Instead of participating in civil society, chasing your self-selected interests and producing for the market as a free individual — deciding what job to take and organization to join — the overwhelming prospect of a healthcare bill determines which job you take. In this way, the tyranny of bad healthcare politics isn’t ground in nature, it’s ground in how an illness can determine how you participate in civil society or how it affects your ability to participate freely in your family.

The goal is to rescue your civil, political, and family freedom back from nature, while will figuring out how to provision or conscript healthcare practitioners in a way that realizes their civil, political, and family freedom.

Yet casting this issue as a human rights issue puts a natural designation, “human,” front and center in a way that abstracts the issues of social, political, and family freedom that legitimize public healthcare solutions through how healthcare is tied to the realization of those institutions of freedom, not biology.