We ought to be concerned for those who lack the ability to secure a healthy existence, but this concern should not be based on the assumption that inequality of condition is evil.

As I begin my comments on my misgivings for the term ‘social injustice,’ I must confess my admiration for the concern over the less fortunate that is reflected in the reading of those who use the term and embrace the theories behind it.  By and large, those I have read are social liberals who refuse to stand idly by while the less fortunate eke out an existence.  I am afraid that, at times, socially and politically conservative Americans have misused their principles to excuse their lack of concern for the needy in this world.

Concern for the needy is not the property of any one school of thought, and those of a more conservative persuasion are just as obligated to be concerned in ways consistent with their principles. It would be highly advisable for conservatives who embrace the free-market ideas of Adam Smith, as found in The Wealth of Nations, to read his other important work, the Theory of Moral Sentiments, the ideas of which surely found their way into his work on economics.  There is something to be learned from Moral Sentiments even if one disagrees with Smith’s particular theory of sympathy and how it develops within mankind.  What can and should be learned is that the free market as Smith conceived it was something noble because it was something very human.  Yet, it is the quality of humanness that is lacking in so many current conceptions of the free market.  Consequently, the market has turned into something of a monster.  We see extreme examples of this in the gross displays of corruption that have plagued many corporations.  We see less obvious manifestations of this in the increasingly materialistic mentality that pervades culture.  A moral infection is festering beneath the surface of contemporary, free-market ideas.  

This admission is not enough to allow me to join in the efforts of social liberals as they strive toward ‘social justice.’  I share fundamental disagreements with them that would not only radically change my solutions, but would also radically change my definition of the problem.   As I reflect on the work being done on behalf of the destitute, I find it ironic that those who are the most concerned about social justice in medicine commit their own form of injustice.  The injustice is of a more subtle nature, because it occurs, not in what they withhold, but in what they promise to deliver.  The injustice is also of a more complex nature because it affects, not only the destitute who receive aid, but also the donor nations who give it. 

It is commonly believed in liberal circles that health care is a right, and the unwillingness to do whatever it takes to provide healthcare is a form of social injustice.  Once this premise is accepted, all the other rules for the game fall into place.  Extensive resources are employed to reduce or eliminate all the obstacles that stand between the destitute world and their right to health care.  These efforts are fueled by an optimism which believes that poverty and poor health can be overcome by technology, dialogue, policy changes, and an influx of foreign funds. Much is promised and much is expected.

Before I can accept the liberal conception of social justice and a right to health care, some serious obstacles must be overcome.  While I am not yet prepared to offer my own solutions to the health care problem, the following concerns prevent me from endorsing the various liberal models.

My concerns begin with the premise that health care is a right.  While I desire equal access to the various resources that help ensure good health, I am not sure this desire elevates healthcare to a right.  A right to health care is often defended on the grounds that it contributes to the more fundamental right of equality of condition.  The justifications for claiming health care as a right vary according to the theory of equality of condition embraced. One theory, proposed by Norm Daniels, asserts that goods such as education and optimal health are non-negotiables because they most clearly provide the opportunity for every member of society to reach his or her potential. Healthcare is a right because equality of opportunity is a right. 

While the Daniels’ theory (and those like it) sounds attractive, it is fraught with ambiguity and difficulty.  The ambiguity results from the lack of consensus on what should be included in the package of health care available to all.  Various formats have been proposed for settling this matter, but few seem feasible.  Theoretically, at least, this problem could be overcome if everyone embraced similar visions and versions of equality.  But herein lies the difficulty for liberal conceptions of social justice.  On what basis are we to accept the various liberal notions of equality?  Rational arguments alone are not sufficient in a pluralistic world that embraces the multiplicity of rationalities.  One could simply ask why he/she ought to accept liberal notions over any other.  On secular, rational grounds, there is no answer.  The difficulty only becomes greater when it is realized that the desire to make humanity equal in condition ignores the variety of the natural order.  As Russell Kirk and others have noted, the push for equality is an injustice fueled by envy.  This is not to say that we should stop all efforts to provide healthcare to those who are destitute.  We ought to be concerned for those who lack the ability to secure a healthy existence, but this concern should not be based on the assumption that inequality of condition is evil.  This assumption creates expectations and attributes blame that lacks merit.  This can be seen in the comments of those who castigate the United States for its unwillingness to contribute more funds to destitute places, despite the fact it has contributed untold millions of dollars.  The expectations and blame placed upon the United States seem, in part, to be based on the faulty notion that equality of condition is a right. Therefore, an injustice is committed against more prosperous nations because of a bad idea and a right wrongly conceived.
           
There is another obstacle to my acceptance of the liberal conception of the right to health care.  My concern in this instance has more to do with the optimism of those who proclaim that poverty and extreme poor health can be eliminated.  Such optimism, as personified by Jeffrey Sachs, ignores certain realities of the human existence.  Most chiefly it ignores the concept of evil, or, as Russell Kirk would say, it ignores ‘the principle of imperfectibility.’  Life in the present order will never be perfect, nor will it be ideal.  The burden of proof is on the side of those who argue otherwise, if history shows us anything.  If it is argued that by science and technology we can overcome the caprice of nature, it should be remembered that for every noble use of technology, there exist many more misuses.  Placed in the hands of less-than-perfect people in a less-than-perfect world, technology will cause more harm than good.

As those who are parents know, it is never good to promise too much.  Before we make assertions that poverty can be eliminated by the year 2025, or in any year subsequent, we should think through the words of Kirk when he says,

To seek for utopia is to end in disaster, the conservative says: we are not made for perfect things.  All that we reasonably can expect is a tolerably ordered, just, and free society, in which some evils, maladjustments, and suffering will continue to lurk.  By proper attention to prudent reform we may preserve and improve this tolerable order.

Kirk and other conservatives do not lack optimism, but theirs is an optimism chastened by reality. They warn us to seek smaller goals that have a more realistic chance of accomplishment.  The current level of optimism ignores the imperfectibility of life, and, therefore, results in bad ideas that promise too much to those who are destitute.  Expectations are raised that can never be met. This is a form of social injustice.
           
More could be said and said better.  Those who believe that the denial of healthcare is a form of injustice should consider the ideas which serve as the foundation to this premise.  If they are bad ideas then the premise itself becomes faulty.  It is possible that social injustice results from the denial of certain ‘rights.’  It is equally as possible that social injustice results from the promise of too much – a promise that unjustly raises the expectations for those who give and of those who receive.