What You Should Think About Health Care

September 21, 2009

“Expensive medicines are always good:  if not for the patient, at least for the druggist.”

–Russian proverb

I recall, as a libertarian-minded youngster, becoming upset that media coverage of reforms advocated by Bill and Hillary Clinton referred to “the American health care system.”  I noted a fact as true today as it was then — this nation does not have a systematic approach to health care provision.  It bothered me to think that the implication of a “system” was misleading people into believing there was some sort of problem in need of a solution.

Today I remain concerned about use of the phrase “health care system.”  As a grown man with knowledge of the world that books alone cannot convey, I understand the grotesque inhumanity of American policy as relates to the provision of medical services.  It is a real and grave problem, a problem every other prosperous civilized nation has already solved within its own borders.  Arguments about the precise number of uninsured citizens only distract from the reality that tens of millions of Americans have no practical alternative to emergency medical services.

For some, this means sicknesses and injuries are only addressed in moments of desperation, with inefficient use of precious resources.  For some, this means sicknesses and injuries are endured despite protracted or even lifelong suffering.  According to [warning: PDF link] a recent Harvard study, for around 45,000 people each year, this leads to death.  Effective universal health care policy could save as many American lives as preventing one 9/11-magnitude attack every forty days!

Perhaps it is unfair to compare Republican party leaders with the leaders of Al Qaeda.  Yet the scope of preventable deaths brought about by human choices begs the question — to whom is that comparison unfair?  Are working class families caught in the gap between Medicaid and affluence somehow less innocent than the final occupants of the World Trade Center?  If expense is the real issue, why does solving the much more deadly problem of health care access warrant so much less support than the problem of terrorist attacks?

At a disturbing nexus of ignorance and irony, proponents of universal health care have been cast as villains who pose a threat to the American way of life.  That ignorance stems from some notion that it is unconstitutional for the federal government to see to the general welfare of the American people.  Never mind that the Article 1, Section 8 explicitly provides Congress with that power.  Never mind that the very first sentence of the Constitution articulates that duty as one fundamental purpose of our government.  As with so many other areas of debate, many critics of reform are unwilling to be swayed by even the most obvious facts.

If there has been any betrayal of the American way of life, it has been the institutionalization of political dogma holding that government action impedes private sector solutions.  While political leaders in the opposition party have either failed inexcusably in their duty to be informed or deliberately shirked their duty to serve the public interest, their followers are typically less villainous.  A month or so ago, one well-meaning and apparently patriotic woman shouted out that “the good hearts of the people” should be given a chance to address this problem.

As long as the problem has existed, public goodwill has had unfettered opportunity to provide relief to the sick and downtrodden.  In the early 1990s, it was already clear that philanthropy was inadequate.  In spite of enormous tax breaks for wealthy Americans in the interim, our nation has only seen more and more of our citizens uninsured or underinsured.  The notion that government cannot play a constructive role is repudiated not only by dozens upon dozens of foreign realities, but also by our own increasingly bleak public health reality.

Yet narrow interests remain zealously defended.  Some say that universal access to health care would somehow inhibit the development of new drugs and other medical technologies.  Does our nation lose nothing greater from tens of thousands of deaths (not to mention uncounted lost hours of productivity) brought about by inadequately treated medical conditions?  If medical innovation really suffers somehow from the provision of universal access, how much blood must be spilled in its name?

Yet even that is a false dichotomy.  Several European nations are each home to large thriving medical research enterprises.  Heck, even Cuba, in spite of scant national resources, manages to develop lifesaving new drugs at an impressive pace.  The idea that America, with so much raw wealth and so much intellectual capital, cannot meet the needs of its own people and still outshine the inventiveness of those other nations is a very strange assertion for a self-identified patriot to voice.

If there is any valid criticism of reformers, it would be about their widespread willingness to compromise with a political movement utterly at odds with facts.  In months of high profile public debate, few voices have been raised to ask just what profit-based health insurance actually accomplishes.  In effect, these institutions serve as private sector death panels. Somehow that term has instead achieved cultural resonance based on the fictitious and absurd rationing no public official has ever proposed to end the lives of Americans no one wishes to see dead.

Certainly there are times and places where compromise is in order.  When good faith efforts to get at the facts yield inconclusive results, bold action may be unwise.  Regarding the state of American health care today, it is only efforts made in bad faith that prevent widespread clarity about a national body count caused by a cutthroat economic paradigm applied to health care policy (not to mention monumental losses to productivity suffered by survivors of that same blight.)

Perversely, even as national media outlets are assault by propagandists, they continue to indulge purveyors of misinformation.  Again and again, transparent lies and the unrepentant dissemblers behind them are put on equal footing with provable facts and earnest informed advocates.  As with the disastrous plunge into Iraq, this critical political decision is being shaped by dialogues that equate major league national scoundrels with genuinely wise national leaders.  Yet whatever wisdom exists to promote reform, it seems unable to bring our nation anywhere near the kind of sweeping overhaul that would bring great benefit to each and every other enterprise by way of marginalizing a single parasitic industry.

Neither conservative nor libertarian thinking is without wisdom of its own.  This wisdom becomes folly when it relies on misinformation and hostile emotion.  Every day, more of our own citizens die because this particular folly continues without remedy.  If a few thousand Americans dying in 2001 justify enormous changes to our way of life, on what basis does anyone reject less dramatic change in to prevent the deaths of so many more innocent citizens?

What You Should Think About Balance

October 18, 2008

“The new integrity of the world, in our view, can only be built upon the principles of freedom of choice and balance of interests.”

–Mikhail Gorbachev

It is fair to characterize the Fox News Channel as a partisan house organ and a degenerate propaganda mill.  However, as a full-fledged cable network, it is too complex a phenomenon to be understood from a perspective that lacks all nuance and subtlety.  For example, the “fair and balanced” slogan plays into a method frequently utilized to create the perception of legitimacy.  From segments passed off as hard news to the most unapologetic of opinion programming, simply presenting some sort of clash between pundits of differing views causes many viewers to believe they have seen a balanced presentation.

In some cases, this perception is completely unjustified.  Across the continuum from subtle to blatant, there are many ways to manipulate a debate through framing the issue, limiting responses, manipulating tone, etc.  Yet there are also instances when debate both lively and legitimate occurs on that channel.  Perhaps the most impressive effort to legitimize the entire venture is a program titled Fox News Watch.  More often than not, this program approaches media analysis from a perspective that is thoughtful or even scholarly.

It was in viewing an episode of that show that I first encountered the phrase “distortion of balance.”  It is a term Neil Gabler of Fairness and Accuracy in Reporting coined in order to describe the trickery involved in legitimizing a bogus position by presenting it as the equivalent of a legitimate position.  The perception of evenhandedness obscures crucial underlying reality.

Imagine if a televised debate were conducted between one advocate for the position that the Moon is is chiefly composed of minerals while another advocate contended the Moon is an enormous mass of cheese.  The second position is unsupported by anything resembling conclusive evidence, but a sufficiently earnest pundit could well cloud the issues and leave ignorant viewers uncertain about the truth (or convinced of a falsehood.)  From Iraqi weapons programs to global climate change — areas where technical ignorance is entirely understandable among those who are not trained experts — many media outlets legitimize an entirely bogus viewpoint in the name of presenting “balanced” content.

This is not always the result of the desire to push a particular agenda.  For example, fact checking after major political debates has become a widespread practice in the media.  Yet few outlets ever dare to critique a larger number of questionable statements from one candidate than the other.  In pursuit of “balance” that comes from presented equal quantity, readers are given the false impression that an equal number of misleading statements were made by each speaker.  Unless the underlying reality actually involves equality on that plane, the end result is coverage that leaves the audience misinformed.

All this involves issues where opinions fit neatly into two mutually exclusive categories.  Especially when it comes to political issues, covering “both sides of the story” tends to be an especially clumsy oversimplification.  Popular rhetoric often falls back on extremism if for no other reason than that moderation tends to be less inspiring.  Nowhere is this more evident than resistance to economic reforms.  While filled with self-delusions of being reasonable, passionate extremists decry every little push toward moderation as a surefire way to transform the U.S.A. into a new incarnation of the U.S.S.R.

Even if one grants the dubious premise that economic planning is an anethema to civil liberties, those extremists deliberately steer discussion away from positions between capitalist and communist extremes.  Few of them could begin to articulate the technical distinctions between communism and socialism.  With that deficit of knowledge, they are able to remain earnest while spouting falsehoods that characterize socialism as an extreme position.  Being loudly mistaken is not as sinister as being loudly dishonest, but civic duty demands any loudness be preceded by a greater degree of thoughtfulness than can be seen among such extremists.

All of this feeds into the disastrous reality that America’s economic titans enjoy ample reward with no real risk.  The same system forces working families to face real risk without appropriate reward.  The structure of the ongoing bailout makes this abundantly clear, though similar public largess has been a fixture of American political history from our nation’s inception.  One of the few sound observations to emerge from popular punditry related to the economic crisis is that we live in a society that practices a very generous variety of socialism for the rich while leaving everyone else to struggle in a particularly harsh capitalist environment.

Because the wealth of this nation is made to flow uphill through systematic corruption on a scale that would make the most nefarious Politburo power broker blush, honest American citizens playing by the rules must compete for pieces of an economic pie that is already largely devoured before the competition begins.  As horrible as that sounds, its modern manifestation could be anticipated from the theories that prop up the status quo.  Trickle down economics is very much a call for the overwhelming majority of this nation’s workforce to content themselves with the scraps that fall from the tables of tycoons.  Never mind that same workforce gathered the ingredients, composed the menus, set the tables, and prepared the feasts.

Perhaps Versailles toward the end of the French monarchy is a soundcomparison.  Under Louis XVI, at times it seemed that no luxury was too excessive.  Nobles competed with one another in increasingly ostentatious displays of wealth.  Today’s gold-infused cheeseburgers and Hummer limousines showcase impractical concentrations of resources with all the enthusiasm of decadent aristocracies past.  It is true that our government does not bestow hereditary titles conveying special privileges, but the absence of those does little to distinguish our economic realities from the sort of aristocratic exploitation that sparked the American revolution.

Modern militant rabble-rousers are do not condemn the growing concentration of wealth.  Though the original American patriots stirred up trouble to undermine a power structure that took from the many too enrich the few, the undercurrent of anger in today’s political dialogue actually perpetuates blatant plutocracy.  Government conceived “of the people, by the people, and for the people,” has become government of the people, by the rich, for the rich.  Apart from predictable vehement slander against reformers, proposed reforms are denounced by deliberately muddling humanitarian social spending with authoritarian tyranny.

There is no reason the United States of America cannot find a true balance.  Of invisible pink unicorns, an economic middle ground, and Saddam Hussein’s 21st century nuclear weapons program, there is one entity that is no myth.  Giving working families a fair deal, pursuing poverty harm reduction, promoting education, and stimulating scientific innovation are all pursuits that have been proven sustainable by many governments, including our own.  U.S. policy has always been a compromise between civic minimalism and policies promoted by those with other aspirations for our nation.

Perhaps a better tomorrow could also come from a new order that ceased funneling astronomical sums of public money into private hands.  Yet no politician has come forth with a credible proposal for a reform that would actually eliminate corruption in big business subsidy.  For that matter, thirty years of Republican promises to reduce government spending have only produced a record of huge spending increases, none greater than those undertaken with the full support of the sitting President.  Yet it is not too late for our nation to address decades of social neglect with bold action to move toward a healthy economic balance.

What You Should Think About Welfare

October 8, 2008

“Children and dogs are as necessary to the welfare of this country as Wall Street and railroads.”

–Harry S. Truman

To date this year, 281 times the Sun has risen over the eastern horizon.  It appears that there are no press reports of widespread dismay about these events.  After all the history and mechanics of the Earth-Sun relationship are largely understood.  When it comes to federal bailouts of major private institutions, there is nothing secret about the mechanisms at work or the history.  Yet again and again and again, this predictable phenomenon is met with disgruntled surprise.

Of course there have been some major failures in the history of U.S. business.  The predictable mechanism at work here is invocation of the domino theory.  Dotcom ventures that did not exist a few years previously are in a poor position to claim that their failure will have devastating ripples throughout the economy.  Yet a wide variety of industries can make just such an appeal.  Industrialists cite their sprawling supply chains as if even the best of their suppliers could not weather the loss of a major buyer.  Financial service providers tally every asset and liability together and paint a picture of total loss should the institution fail.   Firms in the energy or transportation sectors sometimes couple legitimate arguments with hyperbole about theoretical disasters.

Capitalist theories hold that businesses unable to sustain themselves in market competition should cease to be.  Their employees and other assets are thought best utilized by other productive endeavors.  Some idealize those theories to the extent that it is inconceivable any practical considerations might justify intervention to prop up a failing business.  In reality, those practical considerations sometimes exist.  In reality, their absence is often no barrier to federal largess.

In fact, corporate welfare often has nothing to do with corporate distress.  Handouts in the form of tax loopholes custom-designed for a specific industry or even a specific corporation have been routine business on Capitol Hill throughout our history.  Massive subsidies for companies already turning a healthy profit are also part of that history.  Sometimes, it seems like simply having the money and influence to make the appeal is enough to insure the state will provide generous support on demand.

Yet only during confluences of bleak economic news and extraordinary increases in spending on corporate welfare is there much vocal outrage.  Supporters of officials (and the system) behind this spending are often quick to change the subject when there is no ongoing economic crisis.  Many will quietly condemn the spending, but few will take umbrage to the same extent they would if those officials took progressive stances on social issues.  It is as if all that waste and inefficiency were a small price to pay for keeping up the fight against gay marriage and gun commerce regulation.

Since the dawn of the Reagan Revolution, this ideological orthodoxy has created a situation in which big businesses are catered to with wild abandon.  Recent events create the impression that no sum is too large when it comes to spending on corporate bailouts.  Yet public sector efforts to help out individual Americans in economic distress have lost as much ground as has been gained during this time.  The blend of ideology and hypocrisy here is at the heart of the ongoing concentration of the nation’s wealth.

Our de facto aristocracy does not lack state support.  Even if maintaining England’s Civil List was not a self-funding endeavor, the costs would be a molehill compared to the mountain of federal money poured into the coffers of politically connected corporations.  Again, capitalist theory holds that this money will be used to insure optimal productivity, or else competitors will triumph.  Even a cursory survey of trends in private executive over the past thirty years renders that view preposterous.

The astronomically large flows of money from taxpayers to major corporations fund a range of “business operations” that typically include obscene compensation packages for the very executives responsible for failing to sustain their ventures through private means.  The indirect nature of public support for colossal CEO pay levels somehow causes it to have less of a political impact than initiatives that extend public support to needy individuals.  Though much of the nation does support reasonable social spending, millions of Americans continue to have contempt for the very idea of individual welfare.

To the degree that proposed social spending does nothing to make the lives of actual human beings better, it deserves contempt.  Yet to the degree that it extends real opportunity or alleviates real harms, social spending deserves at least as much consideration as that subset of corporate welfare that actually bolsters the overall national economy.  After all, sometimes giving a helping hand to a struggling business really does preserve good jobs, promote a favorable balance of trade, generate more tax revenue, etc.  Far more often, giving a helping hand to a struggling individual really does preserve good health, promote career advancement, generate more tax revenue, etc.

As the Red Scare continues to leave so many voters afflicted with a crippling political phobia, almost nothing worthwhile escapes the “socialist” brand.  The specter of some absolute economic equality far beyond even the Soviet regime’s extremes is offered up as an inevitable consequence of such modest proposals as expanding educational finance spending or raising taxes on personal incomes beyond the first quarter million dollars per year.  By denying the middle ground’s existence, ideological extremists have effectively thwarted the advance of social services for three decades.

The stagnation of purchasing power for 80% of American households during that same thirty year span cannot be pure coincidence.  While the corporate power structure siphons the nation’s wealth uphill, ordinary citizens do not enjoy better protection from danger, greater opportunity to learn, superior infrastructure, rising prestige in the world, cleaner air, safer water, etc.

In the end, this is a profoundly backward approach to acting on the U.S. Constitution’s decree that the government ought see to the general welfare.  The world is full of examples establishing that serious anti-poverty relief, generous educational subsidy, and even universal health care can be implemented to good effect without threatening useful levels of economic inequality.  Virtually no American desires a future social order in which every individual experiences the same economic outcome, but we ought to be able to rally a consensus around the idea that every American deserve a future in which fairness is the principal architect of all economic outcomes.

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 Social Minima

October 17, 2007

“If the misery of the poor be caused not by the laws of nature, but by our institutions, great is our sin.”

–Charles Darwin

Earlier today America was witness to an extremely unusual event in 21st century politics. Our President subjected himself to public press interaction in which the questions and answers were generally not orchestrated by prior arrangement. A healthy national dialog would be supported by routine exchanges of this nature. Still, this is better than nothing. Any acknowledgment of public accountability by senior executive officials is a positive thing.

In today’s press conference, repeated references were made to the fact that families with an income as large as $83,000/year would be eligible for participation in a proposed program to subsidize health care for children. Depending on the specifics of the surrounding national economy, there could be a case for arguments about excessive taxation or better use for those funds. No such arguments were offered. Instead the President justified his veto on purely ideological grounds. It was as if breaking with a particular political orthodoxy were a wrong in itself, children be damned . . . and I mean literally damned.

It is fair to argue that a typical family with $83,000 in annual income would not be part of America’s neediest population. Yet not all families are typical. Children are not immune to horrible accidents. Children are not immune to developmental disorders. Children are not immune to chronic degenerative diseases. As it is Medicaid will provide for those families with enormous medical expenses only after they spend themselves into poverty before appealing for government assistance.

So, under the status quo, giving birth to a child with cystic fibrosis or watching your child cope with severe spinal cord injury after a bus accident is reason enough to experience poverty — regardless of however hard-working family breadwinner(s) might be. How does this mesh with the notion that economic status ought to incentivize productivity? How does this mesh with an ideology that makes no distinctions between what quality of life an individual merits and what financial resources he or she controls?

Hostility toward any form of economic welfare tends to emerge from one narrow view of the intersection between economics and justice. The question is typically framed as a matter of how much unproductive freeloaders “deserve” from the pockets of those with substantial personal income. Yet this misrepresents the natures of both society and income. It rests on faulty assumptions holding that personal wealth in any meaningful concentration could exist in the absence of social support. It also fails to recognize that not all wealth is merited (e.g. senior Enron executives) nor is all poverty is a reflection of personal worthlessness (i.e. starving artists, community activists, humble clergy, etc.)

The law of the jungle may have some bearing . . . in a jungle! I do not deny that a society so bereft of resources that entire communities may be one bad harvest away from ultimate doom cannot afford to provide generous economic support to its least productive members. However, I vehemently deny that the modern United States is in any way that sort of society. Again and again public figures boast that we are the richest nation in the world. By some measures that remains true. Yet that is all the more reason not to let our social policies be shaped by thinking as if modern America is precariously balanced on the brink of national destitution.

To some degree it is all a perversion of Darwinism. Prior to the fall of the Soviet Union, there were two comparably popular interpretations of the term “social Darwinism.” West of the Iron Curtain (or, perhaps more accurately, to the political right of basic human decency) it was argued that economic systems emphasizing a competition for survival between individuals would improve national gene pools. Of course this is nonsense, since the time frame of biological evolution is wildly out of proportion with the persistence of any regime, never mind an ideologically orthodox body of economic policy. Yet it was also nonsense because it equated fitness to live with ability to gain income — without any regard whatsoever for the ethics or consequences of that activity. Is it at all sensible to go through life believing Bill Gates or Paris Hilton is thousands of times more fit to live than a typical American citizen?

Yet social Darwinism has a different resonance when taken from a Marxist perspective. After all, in nature, competition between species is as, if not more, significant than competition between individuals. A collective approach holds that the best way to promote human fitness involves working toward common goals to improve the overall quality of life enjoyed by a society. There can be no doubt that Stalin corrupted a communist superpower with outright evil that was orders of magnitude worse than the worst abuses of power by any American President. That history does very little to shed light on the merits of any economic philosophy.

Personally, I believe that we can do better in framing our economic and social policies than to be guided by half-baked pontifications on the struggles of primal beasts. However, if one perspective must be favored over another, just why should anyone favor an approach that divides America between winners and losers over an approach that unites America behind common goals? A (typically misplaced) sense of personal superiority, contempt for poor people, satisfaction from the suffering of others . . . these are not the stuff of any noble vision, especially one fit to make its way into the laws of our land.

“Social Darwinism” means different things to different thinkers. On the other hand, “social minimum” is a concept used consistently by economists and philosophers from a wide range of traditions. That term defines an economic boundary beneath which members of a society are not permitted to fall regardless of circumstances (save voluntarily eschewing material possessions, of course.) In many societies with respectable rates of economic growth, a robust social minimum guarantees all citizens material subsistence, medical care, educational opportunity, and much more.

For the most part the United States has not endeavored to uphold a lower social minimum than the rest of the civilized world. That tendency is a fairly recent phenomenon coinciding with decades of deliberately expanded class divisions. Whatever ideological wallpaper is pasted over policy, the underlying reality is that it has been framed so as to hasten the concentration of American wealth and reduce the incidence of class mobility in our society. The England our Founding Fathers rebelled against was never so obsessed with making the rich richer. One might even question if the pre-revolutionary France under Louis XVI was more moderate in its plutocracy.

There is no choice that is not a choice. Nothing in the U.S. Constitution forbids subsidized higher education or socialized medicine or even outright income redistribution. To the contrary, if we are to honor the intent of the founders’ and such utterances as Lincoln’s immortal, “by the people, for the people,” sentiment, then it is anti-American to espouse flimflam about bogus technical obstacles to obstruct any public desire to legislate change.

President Bush is correct to argue that the children’s health care bill he vetoed would expand the role of government in meeting the needs of the people. Where he and his most loyal supporters go wrong in is standing on that argument alone, ignoring all practical consequences of their actions. This only perpetuates a system that demands poverty of American families guilty of no greater misdeed than having an extremely sick child. It is shameful that such shoddy thinking is all that stands between the status quo and successful elevation of our own social minimum. After all, that same thinking also stands between genuinely desperate families and a significantly brighter future for their ill or injured children.