Justin Hawkins has penned a deftly executed troll of your humble correspondent. It has everything one would want from such an essay: an aggressive challenge to change my ways wrapped in a tone of respectful cordiality, the use of my own words as setup for his critique, and just enough straw-manning of my position to draw me into a real fight. Oh, and he published it at the website I founded, which is the kind of Epic Trollery that only a True Master could achieve.
In short, Hawkins thinks I’m too much of an idealist. If the coronavirus is a revelation of the true conditions of things, as I followed C.S. Lewis in arguing, then we ought to embrace a more radical form of politics—as it has disclosed our need for a single-payer, universal health-care. The disclosure of our fragility demands a more radical politics: it would be strange, Hawkins argues, if “the public policy positions we advocated on the other side of this pandemic were precisely the same as those whose deficiencies this pandemic has put in plain sight.” Given that I have said it is incumbent upon those offering counsel during these times to get their hands dirty and avoid abstractions and generalities, I ought to heed my own advice and take seriously the material conditions of injustice rather than, it is implied, retreating into a spiritualized view of politics which simply reifies the current unjust order. Hawkins wants to put into practice the idea that religion is care for the orphan and widow, and so wishes to see evangelicals take the lead in the amelioration of the injustices within our health care system.
I say there’s a bit of straw-manning here because while Hawkins sets up a sharp antithesis between us he gives no indication of why he thinks I am unwilling to decry the injustices within our present order. I know of no conservative writer on health care policy who thinks the status quo is the most just system. (I am no expert on such policy, but I have read a handful of essays down the years from various types of conservatives at National Affairs.) Hawkins acknowledges that other systems besides single-payer may serve the common good as effectively, provided that they do better than our current one: but then, why he thinks I would be uncomfortable with those other situations I have no idea. Hawkins notes the dependency of health care insurance on employment, for instance: but a decade ago, I concurred with the need to break that link
(and in so doing mused that we needed a more radical rupture from the language of rights
to reshape our imagination around health care in this country).
More fundamentally, though, I have questions about what sort of lesson we are to learn from a pandemic. Lewis’s contention is not, I take it, that a crisis like nuclear war discloses injustices: rather, it exposes the fundamental fragility and frailty of human life, which is constantly present for everyone. As long as death hangs over us, such a disclosure remains a real possibility. Our institutions and structures are designed to veil us from that fundamental, terrible fact: and they do so in better or worse ways, with lesser or greater degrees of equal treatment and justice. If we were to achieve a more just system than we have now, the revelation a crisis might wreak would still be possible: we would still be beneath the blade, waiting for it to fall. So the apocalyptic idea is, it seems to me, neither here nor there when it comes to questions of the material conditions of justice.
Yet even if it were, it’s hard for me to believe that this pandemic has exposed our need for a single-payer health-care system. (Everyone wants universal health care, I take it: the question is one of means, as Hawkins himself acknowledges.) Hawkins points to one repugnant death—though there are surely others. And there are funding problems, to be sure, that this has exposed: our current system cannot survive a pandemic, in which elective surgeries are put on hold. Yet the former problem is a chronic one for our system, while the latter is more exceptional. And, candidly, it is not at all clear to me that we should design a health-care system to survive every pandemic: attempting to develop institutions so resilient that they cannot be defeated by once-in-lifetime events carries costs of its own. If anything, our health care system has not been especially worse than elsewhere (or so it seems from my marginal reading: links to the contrary are always welcome). Italy has a single-payer system, and it practically collapsed: so does the UK, and we’re probably on par with them.
That is not to say the virus has not exposed material, structural injustices: we have heard much about the racial and socio-economic disparities in for instance, in healthcare from this disease
. The reasons for that are uncertain, but it seems plausible to think that they are a further indicator of pre-existing disparities in health and health-care across such lines. I suspect that turning this pandemic into a dispute about single-payer (which many people will do) is animated, in part, by the perception that the health care system is the “front line” for fighting the disease. It is easy to think of doctors and nurses as on the front lines, as I’ve noted before: but it is a mistake. The war is one of preventing and mitigating the spread of the disease. Doctors and nurses are not fighting it: they are curing and caring for its victims. It is a cruel feature of such work that they do so in environments where they are far more vulnerable than many of us ever will be. But their task is still responsive to pre-existing conditions, while it is on us to ensure that we do not get so many people sick that our hospital systems are overrun. The pandemic exposes disparities in the inputs
into our health care system—disparities which are reflected, to be sure, in the health care system itself. But those differences are not a feature of who is paying for the treatment, I think.
So while it’s not clear to me that Covid-19 demands a radical politics in response, it is even less
clear to me that it demands a single-payer system. Indeed, one lesson that we might learn from a pandemic is that we need to be exceedingly careful about to whom we will entrust morally fraught medical decisions—and centralizing that decision-making in a single authority risks enshrining widespread abuses. The pandemic has reminded us that health care is always limited: rationing is unavoidable. Yet the manner of our rationing matters a great deal: the UK’s standard is based on a system of evaluation that I think is deeply
morally problematic, yet it governs every hospital in the country. It is also set by—I kid you not—the “National Institute for Care Excellence
,” or NICE—which for readers who are unaware was the name of the consequentialist, technocratic overlords in C.S. Lewis’s That Hideous Strength
. And that doesn’t even get us to the question of the inevitable funding of abortions and other forms of embryo destruction such a system would lead to in the United States—a subject that I have rarely seen Christian defenders of single-payer take up.
So no, I have no plans on becoming a radical—at least not yet.