What You Should Think About Philanthropy

December 26, 2007

“He who moves not forward, goes backward.”

–Johann Wolfgang von Goethe

It is practically an article of faith among political conservatives that reducing the economic footprint of government creates space for private entities to more effectively solve the problems of our times. Faith is an appropriate term for it, as anything from the most casual glance to the deepest analysis of evidence fails to support that belief. In open societies where government is comparatively paternalistic, philanthropic efforts have not simply faded away. As societies embrace more cutthroat economic practices, private entities do not surge forth to heroically improve the overall quality of life.

The idea that reducing or abandoning social spending liberates the private sector to actualize superior solutions is another of those popular political convictions that is nice, neat, simple, and wrong. Being nice, neat, and simple, it is an idea that does not require much thinking to grasp. Yet in world that is not consistently nice, often untidy, and rarely simple, much thinking is required to formulate insights containing useful solutions to actual social problems. “Tax cuts create growth” seems to many like a shortcut to wisdom, but it is more typically a bold movement into the realm of folly.

No doubt a society does well to allow private citizens, acting alone or in groups, to use private resources in philanthropic ways. At least in the United States, taxation has nothing whatsoever to do with levels of philanthropic activity. After all, even morally ambiguous activities like supporting a political movement or a religious institution are tax deductible. Clearcut instances of charity, like supporting pediatric cancer hospitals or donating toys to orphans, also enjoy this status. This means no tax burden at all is imposed on resources dedicated to philanthropic endeavors. For some reason that fact rarely gets in the way of opinions many libertarian thinkers espouse about charity.

In reality, rates of taxation have little real impact on the willingness of affluent citizens to finance charitable projects. It can be argued that very low rates may heighten personal luxury to such extremes as to promote more giving. Then again, it can also be argued that very high rates may spur more giving as a means for the “oppressed” upper class to assert more control over their personal incomes. At best this situation is a wash, and the impact is trivial when moving through a reasonable range that is neither very low nor very high.

However, actual social spending certainly can have an effect on philanthropy. In instances where a society abstains from pursuing a political response to a severe and miserable manifestation of deprivation, charitable funds will naturally be drawn into those voids. For example, hospitals that provide free care to children suffering from cancer or severe burns or some other condition that cannot be treated inexpensively tend to be well-funded charities. Few Americans are cold-hearted enough to take the position that gravely sick or injured children ought be forced to come up with the money for their own medical bills. The end result is thriving charitable organizations dedicated to serving those needs.

What would happen if this broad consensus of support for serving those needs was addressed as a matter of public policy? Would the nation be brought to ruin for all the waste and fraud involved in empowering government to provide this sort of medical care? While that notion is ridiculous, what is less ridiculous is the notion that those same charitable impulses presently funding St. Jude’s hospitals and the Shriners organizations might instead be directed elsewhere. An official response to problems virtually no American seeks to perpetuate is not only a fine example of democracy in action — it is also an authentic means of liberating private philanthropists.

It is not as if sponsors and activists working to alleviate the most severe forms of preventable human misery do not also have loftier ideals. Yet for decades, it seems as if the American way of life has been perversely redefined so as to place these burdens on the shoulders of the private sector. To hear pundits from the right spell out their economic agenda, it is as if all citizens have a patriotic duty to demand government inaction when it comes to childhood trauma patients or adults with debilitating mental illnesses.

Clearly no such duty exists. The best arguments for it stink of Red Scare poisons. Even the sitting President refers to such policies as socialist, with the implication that being able to hang that label on them is explanation enough as to why they ought be obstructed at every turn. Unfortunately, beholden to their corporate paymasters, the very Democrats who maneuvered the President into a veto on public funding of health care for severely sick or injured children were unable to step up and defend this eminently good component of socialism.

Obviously there is a role in any healthy national economy for individual action. Most critiques of socialism and/or communism are muddled to the point where the problems of political authoritarianism (no meaningful elections, brutal secret police, widespread official censorship, ubiquitous domestic surveillance, etc.) are blamed on economic collectivism. Yet it is also possible to construct sound critiques, particularly when it comes to extremes of large scale communal economics. Be it because private entities are potentially more nimble and responsive or because economic freedom is a quality of life issue, it would be unwise to nationalize the entire American economy.

Yet it is no less foolish to embrace the idea that the entire American economy ought to be privatized. As nimble and responsive as they might be, private entities also tend to produce piecemeal responses to social problems. They are also at least as prone to corruption as public sector institutions. Be it primary education or interstate highways or coordinating aviation logistics, some activities really are best overseen by government because universal standards and mandatory funding get better results than moody individualism possibly could.

For most issues one may rightly debate whether involuntary taxation or voluntary donations are the right way to finance endeavors to serve the public good. Yet in each instance where involuntary taxation fails to become public policy, demand increases for voluntary donations. If an activity is highly controversial or if its ability to serve the public good is dubious, then a society may do well to avoid government action. When there is widespread consensus that a particular need should be served and a particular course of action will get the job done, then there is good reason to take the burden out of the hands of philanthropists and fold it into the public sector.

Some would say that this oppresses the rich, but does it really? Do wealthy Americans want to live in a society where children may be raised without access to a basic education? Do wealthy Americans prefer living among the contagion that comes from limited access to basic medical care? Would wealthy Americans be better off living in a society where goods and employees were all forced to rely entirely on toll roads? It does take some thinking to see the wisdom of collective action, but that level of thinking should not be beyond the reach of a typical civic-minded American.

The more that the public sector does to decisively satisfy needs that pretty much everybody agrees should be satisfied, the more individuals and private foundations will be able to direct their means toward other needs. This produces more pilot programs to test the effectiveness of new ideas, more pet projects to accomplish forms of good not universally recognized, more private action to influence and elevate civic discourse, etc.

It is true that America would thrive all the more if the private sector were less constrained in its ability to address social problems. What is untrue is the notion that government action is a barrier to that activity. In reality, it is irrational hostility toward government action that generates troublesome obstacles for social progress. If we seek to go forward as a nation, then we must advocate a healthy partnership between private and public institutions. Depicting progress as a struggle in which the private conquers the public ultimately makes both less effective.  This diminishes our capacity to solve today’s problems and blocks useful efforts to anticipate the problems of tomorrow.

What You Should Think About Socialized Medicine

October 4, 2007

“Children are like wet cement. Whatever falls on them makes an impression.”

–Dr. Haim Ginott

Of all the episodes of American history that might be preserved by nostalgia, it is downright tragic that the Red Scare should survive into the 21st century. Not even the actual “Reds” Americans were made to fear lasted as long as the negative emotions inflamed by the likes of Joe McCarthy and Richard Nixon. Yet even now we see the most progressive public figures with a shot at the White House running scared from latter day redbaiters.

The term “socialism” is lobbed about like a grenade. It causes panicked flight with comparable haste too. While the rest of the civilized world becomes healthier, taller, more productive, etc.; my own people expose millions of children to risk of lifelong disadvantage simply to honor the lottery of birth. While the rest of the civilized world takes (mostly) sensible measures to reduce workplace absenteeism, preventable disability, and preventable death; the unthinking hatred of socialism that pervades our political culture generates huge obstacles to similar progress here.

These discussions bring to mind the truism, “there is no choice that is not a choice.” Such a statement goes beyond ironclad fact and into the realm of truth emergent from logic alone. Of course every choice is a choice, but what does that mean? Well, I would be surprised if most Americans in the upper income ranges actually would choose to live in a society with more contagion, more misery, and more death . . . all in the name of reduced taxes.

A false narrative holding that America’s wealthy are of one mind in opposition to socialized medicine feeds into the popular lie by which such policies are characterized as oppressive. To obstruct these initiatives has every bit as much impact on the freedom of people who want to live in a healthier society as supporting health care reform may impact the freedom of people who desire lower taxes. What I mean by “there is no choice that is not a choice” is that inaction thwarts the will of those who desire action no less than action thwarts the will of those who desire inaction.

All too often, critics of socialized medicine carry on as if secret police and state sponsored torture were at the bottom of some slippery slope that begins with taxpayer funded treatment for pediatric cancer patients. Now that recent history shows us the sort of personalities and policies that actually do nudge free peoples in the direction of fascism, a “tyranny of the majority” critique condemning social justice in medical care becomes all the more bizarre. Yet that criticism remains strong today, with far-reaching implications.

Both Hillary Clinton and Barack Obama have chosen to craft their health care proposals with an eye toward protecting the parasitic profiteers of the insurance industry. Because the existing situation enables many organizations to generate gargantuan piles of revenue without contributing any good or service of identifiable value to society, to challenge the status quo is to guarantee zealous lucrative support for one’s electoral rivals. Bribing a do-nothing industry into going along with overdue social change may not be as costly as maintaining a large scale military presence in Iraq, but it is still much more costly than taking direct action to address the medical needs of American citizens.

You don’t need your own car to be glad we have public highways, and you don’t need to be a plaintiff to be glad we have civil courts. Why then do so many people seem to swallow the argument that society as a whole would not benefit from measures that would much improve our standards of public health? Like so many other problems with a political dimension, a contributing cause is deliberate misinformation. When a patient has a long wait for an American doctor, it is accepted as good the physician was industrious enough to book a tight schedule. When a patient has a long wait for a Canadian doctor, it is regarded as a snafu “proving” the inferiority of government bureaucracy.

Yet American health care is already entangled in layer upon layer of complex bureaucracy. Corporations and governments are both organizations. I so wish the past several years had deprived all Americans of the myth that “government ought to be run more like a business.” The private sector has no monopoly on effective management, and federal programs are only run as badly as the leaders charged with operations or oversight manage to run them. If anything, people still enamored with a warped “corporations always do better than government” philosophy should be kept far from the halls of power, because that belief is a barrier to sound thinking in those jobs.

The purported advantages of the private approach — consumer freedom, self-optimizing efficiency, resources concentrated in the hands of the most effective healers — are largely phantoms of rhetoric. Shopping around is downright stupid in an emergency medical situation, and little enough of it occurs in matters of routine or elective health care. Market oriented thinking fails us in large part because the nature of illness and injury combine with the complexities of modern medicine to squelch the kind of unconstrained behaviors that drive a truly free market. Then there is the old saw about corporate research, as if producing yet another brand name cholesterol reduction pill or heartburn remedy was the alpha and omega of medical innovation.

The recent veto of a federal effort to better unite America’s children with America’s health care resources may be a bold stance based on principle, if one assumes irresponsible ignorance pervades the White House. In the alternative, it was a cruel stance based on the notion that sicklier American children are a small price to pay for perpetuating bogus narratives born out of the Red Scare. In the end, the entire nation pays dearly. Lack of access to preventative care creates additional need for curative care while lack of access to curative care promotes disability and death.

In light of all this, what should you think about socialized medicine? If you are actually thinking, then you will compare what is real over here to what is real abroad and recognize the opportunity for huge gains in public morale and public health. Long term economic growth tends to follow from sustained gains in those areas. The insurance industry funds robust misinformation campaigns that go far beyond financing the political campaigns of today’s redbaiters. If you remain rational and do not succumb to the fear they spread, there is much good to see in this idea.

I personally advocate socialized medicine because I believe a measure of taxation is reasonable for the purpose of alleviating preventable misery amongst America’s working poor, not to mention children of poverty as well as indigent folks. I understand pragmatic questions about the importance of caring for those who are not likely generate much future personal income. I find it distasteful to place such a low value on human life, but I also offer a better response than distaste.

Even someone who was fanatically dedicated to overall growth should align somewhere near my position. Proper treatment for children means a more capable workforce in the next generation. Proper treatment for today’s workers means more productivity in the near future. Even proper treatment for retirees, prisoners, and vagrants will tend to be less costly than cleaning up the public messes unchecked desperation or tragedy tend to produce. Like it or not, the reality is that we are all in this economy together. The sooner we recognize that reality, the sooner we can take action to capitalize on opportunities for a better future.