I have written recently on Republican objections to the supposed tyranny of the Patient Protection and Affordable Care Act of 2010. In this view, the law, by requiring that citizens obtain some sort of health insurance, robs them of their freedom to make such choices as they might wish. GOP party leaders excoriate the statute as disallowing Americans their freedom to make their own decisions. They contend the nation has never acted in this way before. But President George Washington signed the Militia Act of 1792 that required that every “free able-bodied white male citizen” between the ages of eighteen and forty-five “provide himself with a good musket or firelock, a sufficient bayonet and belt, two spare flints and a knapsack,” among other equipment. The sort of government requirement in the 2010 health care law is not nearly so novel as its opponents often contend.
As I have written earlier, too, the GOP’s construction of the issue represents a classic exposition of what the distinguished political theorist Isaiah Berlin long ago labeled “negative liberty.” The Stanford Encyclopedia of Philosophy defines negative liberty as “the absence of obstacles, barriers or constraints. One has negative liberty to the extent that actions are available to one in this negative sense.” Mitt Romney’s or Speaker John Boehner’s arguments for an unfettered right not to insure oneself against health risks is a classic brief for a liberal and negative conception of liberty in which agency, or the capacity to make a choice, resides with the individual. A citizen alone chooses whether to buy insurance and how much risk he or she will bear as that choice is made, based solely on his/her preferences. In this view, government must ensure that free space for decision is honored.
Meanwhile, the nation’s health care law, to which the GOP objects, was clearly born of another (and competing) prevailing conception of freedom in the United States, positive liberty, which, as the Stanford Encyclopedia of Philosophy observes, is “the possibility of acting — or the fact of acting — in such a way as to take control of one’s life and realize one’s fundamental purposes. While negative liberty is usually attributed to individual agents, positive liberty is sometimes attributed to collectivities, or to individuals considered primarily as members of given collectivities.” The national health care effort grew out of a desire that the collectivity help the 30 million (and growing) individuals in its midst attain health care they otherwise could not access.
The Republican Party’s objections to efforts to ensure health care access are framed as an attack on positive liberty. In this way, and apart from any discussion of the exigencies that prevent the jobless, those working for employers unwilling or unable to provide access to insurance, the poor, those of modest means and many disabled individuals from accessing health care, GOP leaders appear to argue for individuals enjoying maximal personal freedom, while saying nothing about the capacity of those so “empowered” to act on that supposed right, the purport of positive freedom claims.
That is, what is not clear in this framing is how those so affected will use their nominal freedom to obtain care. And that, of course, is the point. GOP leaders appear uninterested in conceptions of liberty that imply that individuals may realize full agency only in community, as that requires a view of governance as a guarantor of positive liberty, and that stance appears to be ideologically repugnant to the now dominant understanding of conservatism in the party.
I am fascinated by the conception of democratic society that appears to underpin such claims, which has been exported around the world in the guise of neo-liberal demands for restructuring of developing societies around similar assumptions. That is, the World Bank and IMF and many other leading development entities (including USAID) have made similar claims about agency and “making space” for supposed individual choices that bear little relationship to reality. If one is living on $1 per day and without ready access to even poorly staffed and equipped health facilities, it is extremely unlikely that “the freedom to choose” against the tyranny of government mandate/provision is likely to result in anything but a continued lack of adequate health care. The same is surely true for the uninsured in the United States and raises the question of what conditions may be necessary to permit a truly free choice in such matters. Negative conceptions of liberty sound grand, but they embody a profound paradox. They assume capabilities to act: that is, proponents of this view assume democratic agency, rather than act in any way to ensure it. In the case of health care in America, which depends overwhelmingly on employer-provided insurance to achieve such access, the upshot of such an assumption is clear: unless you work for such an employer or have the means with which to insure yourself and your family, you will be in roughly the same position of the $1-a-day hardscrabble farmer eking out a living on a few hectares of land in Uganda. Your supposed choice is both empty and cruel. It does not constitute freedom because it robs of agency rather than securing conditions to allow its meaningful pursuit. This conception imagines a society of unfettered individuals of deeply unequal means and capacities to realize their “fundamental purposes.” It begs the question: Is this sort of Hobbesian “State of Nature” the most robust vision of freedom we can afford our citizenry?