Health care debate: Two views of liberty

  • Updated: July 3, 2012 - 6:53 PM

In the health care debate, there are two distinct views of liberty.


Sarah Palin

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'Obama lies; freedom dies." That was Sarah Palin's tweeted response to last week's Supreme Court decision upholding President Obama's Affordable Care Act. Ultimately, the ruling turned less on lofty principles than on a narrow interpretive distinction. But as Palin's tweet suggests, the court's decision ultimately bears on broader questions about our national ideal of freedom.

To appreciate this point requires a brief excursion into political philosophy.

In concluding his defense of the Affordable Care Act, Solicitor General Donald B. Verrilli Jr. argued that access to health care would "unshackle" citizens from the "disabilities" of bad health, thus giving them "the opportunity to enjoy the blessings of liberty." In response, representing the states contesting the law, Paul D. Clement dismissed this argument, noting "that it's a very funny conception of liberty that forces somebody to purchase an insurance policy whether they want it or not."

Clement's response nicely captures the essence of a broad-based conservative attack: Health care reform restricts individual choice through government intervention, and any government restriction on individual choice is an assault on individual freedom. Freedom, on this view, simply means freedom from government interference, and government interference, therefore, is at best a necessary evil to be minimized wherever possible.

This understanding of liberty can be most easily traced to the 17th-century English philosopher John Locke. In his Second Treatise of Government, Locke became the architect of modern liberal democracy by identifying individual liberty as the guiding value of society and by characterizing the primary threat to liberty as the arbitrary interference of government in individuals' lives. In Locke's view, freedom is, in effect, the freedom of being left alone.

But in a landmark 1958 essay, "Two Concepts of Freedom," the philosopher Isaiah Berlin pointed out that "to offer political safeguards against intervention by the State to men who are half-naked, illiterate, underfed, and diseased is to mock their condition; they need medical help or education before they can understand, or make use of, an increase in their freedom." For those who do not have reliable access to basic social goods, the primary enemy of freedom is not government interference but, rather, the lack of resources that are necessary conditions of valuable choice.

Nothing illustrates the significance of this distinction better than health care. Those without good health care are likely at one point or another to confront crippling economic, physical and psychological consequences. Access to adequate and affordable health care is therefore essential to the possession of genuine, fulfilling possibilities in life.

In addition, the quality of our health care is determined by large-scale economic and technological forces far beyond the control of any individual. When individuals confront skyrocketing insurance costs or an ill-equipped hospital, they face a tyranny, not of government, but of the messy social dynamics that define our health care system.

Governments do many things poorly that private institutions can do better. But the essential role of government has always been to manage precisely the kinds of social challenges that require resources and coordination on a massive scale. When governments succeed in these tasks, they promote freedom through interventions that facilitate real choices for citizens.

In carrying out these interventions, governments engage in coercion through laws that interfere with individual decisions, as the Affordable Care Act would do. But in these cases the freedom to be left alone would be no real freedom at all, since the goods produced by government interference are essential to the possibility of valuable options in life. That is the point that Sarah Palin is missing.


Michael Fuerstein teaches political philosophy at St. Olaf College in Northfield, Minn.

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