Can Health Care Be Local?

[Cross-posted to In Medias Res]

Wichita, KS

Over the past couple of weeks, I’ve written a few things on the current debate over health care reform. A couple of smart commenters on those posts got me thinking–or rather, forced to the front of my mind a question I was already thinking about: if, when it comes to public policy, I’m continually balancing between my socialist/egalitarian/establish-a-just-and-equal-context and my localist/populist/empower-communities-in-their-differences sides, on which side do I think that efforts to reform health care should come down on? National coverage, or local control? Baseline justice, or state-level variety? And might there be some ideal way for it to straddle both?

I have, for a long time, basically been of the mind that populism–which I take to mean politically and economically empowering people in the places they live–and egalitarianism–which I take to mean arranging politics and economics so that all people enjoy basically equal recognition and opportunities–while clearly different ideological projects, overlap more than they diverge. What they have been common, as a starting point if not as an ultimate goal, is solidarity and a grounding in “affectivity.” As I put it in the above-linked post, nearly five years ago:

It is affection, specifically that which arises from and depends upon a shared life, a defined (and therefore somewhat limited) life, that makes possible real social concern, a concern which is not restricted to a needs-tested distribution of a few select goods (which at best can only result in the just treatment of those who accept the terms of choice which the market–and those who are lucky/hard-working/well-connected enough to dominate it!–imposes), but which actually seeks make the distribution of and decisions about goods a component of one’s participation in the community. Not for nothing did late 19th-century populism often merge with socialism, and not for nothing are social democrats today often the most responsive to the diverse demands of distinct communities, whether in neighborhood design, public schooling, welfare provision, or a dozen other areas. To talk about populist justice means to talk about “the people” not in the abstract, whether behind a veil of ignorance (John Rawls) or as individual choosers confident in their holdings (Robert Nozick), but to begin where they live, in their various (culturally or historically or religiously defined) communities. The goal is not some rigorously Marxist collectivizing of the material and economic and social life of all communities in the name of uniting everyone’s species-being….[but rather to] limit and constrain the meritocracy in the name of civic equality….by granting recognition and opportunity to communities and people’s identities as they are.

I don’t want to pretend that I had figured out answers to all the questions I’m taking on today a half-decade ago: I hadn’t (and no doubt I will continue to work on these same and new questions far into the future, whatever I might happen to conclude today). But I do feel some confidence in saying that the “conservative” (or maybe better, the “communitarian“) essentials of any populist or localist or socialist alternative to modern liberal capitalist/consumerist/individualist lifestyles and destinies can be, by and large, much benefited by certain broad egalitarian actions–by certain progressive compromises, you might say.

Page 1 of 6 | Next page