David Brooks makes a very important point in his column this morning:
We think the budget mess is a squabble between partisans in Washington. But in large measure it’s about our inability to face death and our willingness as a nation to spend whatever it takes to push it just slightly over the horizon.
Health-care costs are at the very core of our fiscal crisis, and not by coincidence. Indeed, I think the cause runs even deeper than Brooks suggests.
The political philosophy that underlies our liberal democracy, and which we rightly revere, places the struggle against death at the center of politics. In most of its forms, it suggests that government exists first and foremost to protect us from death. That has generally meant protecting us from violence, but from the very beginning it also meant protecting us from nature—modernity, after all, has been a quest for power over nature, and has employed both science and politics in that inherently endless pursuit. In 1637, in his Discourse on Method (a political, or perhaps anti-political, work as much as a scientific one), Rene Descartes put plainly what many of the other early moderns also hinted at: that their new way of thinking would (among other things) serve the cause of “the conservation of health, which is without doubt the primary good and the foundation of all other goods of this life.” Strong words—and it’s especially striking that the notoriously doubtful Descartes would say that health is “without doubt” the primary good.
A glance at today’s federal budget, and at those of most modern democracies, would suggest that this view is now widely shared. In a sense, a regime built upon this view is bound to go broke paying for medicine, which is roughly what we’re doing now. Modern medicine has given us tools that the fathers of liberalism could not have imagined for pursuing the conservation of health, and we’re willing to pay a great deal for them. Case by case, it’s very hard to blame anyone for doing so; and even seen in whole, it’s hard to blame the country for doing so. But is there no way to keep that pursuit from overwhelming every other good?
In search of such a way, Brooks points to a thoughtful recent essay by bioethicists Daniel Callahan and Sherwin Nuland in the New Republic. Callahan and Nuland suggest a less ambitious kind of medicine, and a more restrained kind of public attitude about its potential. But because the roots of our attitudes about health run so deep, I think what they’re proposing would require an entirely different civilization than ours. They would be better served by pursuing a different way of thinking about economics instead. The one they seem to cling to, which is a kind of instinctive soft socialism, is pretty much the worst possible way to pursue the ends they’re after. Only markets stand a chance—because they both make expensive things cheaper (by driving efficiency) and allow people to prioritize their wants on their own (rather than through the medium of liberal public institutions, which will always have trouble prioritizing health in relation to other goods). That is basically the combination we need, but it will never be easy to attain—for reasons that run much deeper than today’s partisan politics.