Recent events have put Obamacare at the front and center of American political consciousness–and in doing so, focused attention directly on the right to health care. Objectivists and libertarians are deeply frustrated at the acquiescience with which Americans have greeted both things–Obamacare and the right to health care. But I think this frustration conceals something from view that Objectivists in particular have failed to grasp, and need to grapple with. Americans’ acquiescence in Obamacare, and the right to health care, is explainable in large part by an unresolved tension within Objectivism itself. I don’t mean that this tension is unresolvable or inevitable. I simply mean that it’s there. Until it’s resolved, we should all brace for frustration and political failure.
Objectivism endorses all four of the following propositions:
(1) All moral agents ought (qua moral) to act in their rational self-interest.
(2) There are no conflicts of interest among rational agents acting rationally.
(3) Rights have to be understood in such a way as to allow us, in emergencies, to take actions that would be rights-violative in non-emergencies.
(4) There is no positive right to health care, i.e., no right to be provided health care by unconsenting others.
I suppose one could quarrel or quibble with whether or not Objectivism endorses this or that claim, but I think it’s clear that it endorses all four.
Suppose that I endorse (1) and (2). Then my adoption of (4) must be conditioned on my justified belief that (1), (2), and (4) are consistent. Put another way: in endorsing (1) and (2), I must be justified in my belief that the rejection of a positive right to health care is compatible not only with my pursuing my self-interest, but with anyone’s pursuing his or her self-interest at the same time. Suppose now that I am either extremely ill, or suffer a significant injury, or rationally fear the high probability of either becoming extremely ill or suffering a significant injury. I must then be justified in believing that my adoption of (4) is compatible with my medical condition and/or my fear of such a condition. I must justifiedly believe that, all things considered, I benefit by foregoing a right to be provided with precisely that health care that would relieve my illness, my injury, or my justified fear of both.
If, for example, I have cancer, then if I endorse (1) and (2), it must be demonstrable that in adopting (4), I promote my interests. There must be some benefit, such that, even if I have cancer, my rejection of the right to be provided with cancer treatment is in my interests, whereas my adoption of such a right is not. I must somehow benefit via the willingness to forego this “right” and lose out by the willingness to adopt it. This must be the case even if, in my case, the willingness to adopt the right might make it more likely that I receive cancer treatment (and live to old age), and the willingness to forego might make it more likely that I don’t (and die prematurely). And so on, across the entire breadth of illnesses, injuries, and rationally-justified fears. (I don’t mean that the person in question must actually be persuaded by the demonstration, but that the demonstration must succeed as a rational justification of the relevant claims.)
Suppose, once again, that I have cancer. Suppose that I endorse (1) and (2), but find (4) implausible. So I reject (4) in the name of (3): I have a right to health care (I tell myself) because my medical situation is an emergency. While there is, generally speaking, no right to health care–this reasoning goes–there is one in cases of life or death, i.e., where the failure to be provided with assistance would lead (in a relatively direct causal way) to premature death.
One problem here is that the parenthetical in the last sentence is vague. A second problem is that the conception of “emergency” just invoked isn’t the one Rand defended in “The Ethics of Emergencies”; her definition is much narrower, and explicitly excludes things like illness. So if the reasoning of the preceding paragraph is right, Rand’s definition of an emergency is wrong; whereas if Rand’s definition is right, then (4) cannot be rejected or modified in the name of (3). One or the other thing (or some third thing) must be the case. Either we adopt Rand’s definition of emergency, and foreclose the idea of justifying a right to health care in cases that fall outside of that definition; or we broaden the definition, and justify a narrow right to health care in cases that fall within the broadened definition; or some other option. But the stated options are exclusive.
What Objectivism needs is a full, comprehensive resolution of the apparent tension between (1)-(4). We need an account, for cases like serious medical conditions, of how it is that the rejection of a positive right to the resolution of the condition promotes the agent’s interests, whereas acceptance of such a right does not promote them.
My point is not to claim that such an account is impossible, or even implausible, but to insist that it does not yet exist. I’ve read the entirety of the existing Objectivist literature on the subject. Even the best effort on the subject–David Kelley‘s A Life of One’s Own–falls short of doing what needs to be done. (This is not to criticize the book at all, but simply to observe that it doesn’t deal with the issue I’ve described here.) If I’m right about that, no Objectivist can be justified in insisting on (4) while abstracting from its relation to (1)-(3). On the Objectivist view, insistence on (4) presupposes an adequate defense of (1)-(3).
I don’t think there is such a defense right now. That is the basic problem I have with almost all Objectivist polemics on this subject. Such polemics begin in midstream, insisting on derivative political claims while leaving the fundamental ethical ones basically undiscussed and undefended. That, it seems to me, is what explains the peculiar hysteria that seems expressed in such polemics. The more loudly its exponents insist on their claims, the more they seem to become conscious of the tension within them–and on the need to downplay that tension in the heat of argument. But that is not a sustainable strategy for political success. It’s a recipe for self-marginalization, and ultimately, self-deception.
My practical suggestion to Objectivists would be to redirect their effort and resources away from celebrations of the government shut-down (and outrage over Obamacare) and toward offering a more defensible version of the Objectivist argument with respect to (1)-(4). Virtually every political frustration we face can be traced, in some way, to our failure to do that.
Feel free to resent the coercion in Obamacare, to criticize it, and to resist it. But ask yourself all the while how much is gained by an approach to politics that demands on the one hand that we insist on egoism, and then seems to turn around and demand what look and sound like acts of self-sacrifice in the name of liberty. If we have nothing to say in answer to the question, “What’s in it for me?” we have no way of winning any argument on our own terms. It is one thing to say that a cancer patient gains by foregoing a right to health care. It is another thing entirely to say that a cancer patient’s self-interest doesn’t matter because liberty matters more. If we cannot get this distinction right, we cannot get politics right. What absolutely cannot be done is to blur the two options into one indiscernible polemical blob.
Honesty should tell us that we lack an account reconciling the Objectivist conception of egoism with the Objectivist conception of liberty. Justice tells us that we owe such an account to our interlocutors regardless of their state of physical health. Pride should dissuade us from settling for a less ambitious approach to politics. Productiveness should get us started on the job.
(Thanks to Kate Herrick and Michael Young for valuable discussion on this topic. Neither Kate nor Michael should necessarily be taken to agree with anything I’ve written here.)