Humanity still has not come to
a consensus on what are entailed specifically within the rubric of human
rights. Even in terms of those specifics that have come to be generally held to
be human rights, such as in designated war crimes and crimes against humanity
by international agreement, the lack of de jure and de facto enforcement render
such agreement nugatory in practice. As a result, calls for human rights are in
effect calls for warring to stop. The enforcement that goes along with laws
legislated by governments render any consensus on what constitutes human rights
more substantive in practice. This is undercut, however, in empire-scale
polities of polities, such as the E.U. and U.S., to the extent that human
rights are carved out at the federal level to applied across differing
cultures. Such ideological diversity between the American member-states has
triggered drastically-different notions of just what are included as human
rights to be played out in Congress. The debate over the government-financed
health-insurance program for the poor in 2025 illustrates such a lack of
consensus, which in turn suggests that the member-states should play more of a
role in how or even whether to provide free insurance to the poor. Sometimes,
one size doesn’t fit all. In short, the matter of federalism is very relevant
up front, before matters of the proper role of government itself and of human
rights are decided. In other words, the qualitative and quantitative
differences between a union of states and a state are very relevant up
front, lest states eventually peel off in utter frustration with a
one-size-fits-all approach to policy-making to fit an empire composed of
member-states.
As the U.S. Senate considered
changes to the Medicaid program, Republican Sen. Josh Hawley acknowledged “that
the main cost-saving provision in the bill—new work requirements on able-bodied
adults who receive health care through the Medicaid program—would cause
millions of people to lose their coverage. All told, estimates are 10.9 million
fewer people would have health coverage under the bill’s proposed changes to
Medicaid and the Affordable Care Act.”[1]
Millions would be relegated to not getting medical attention or going to the
emergency rooms of hospitals mandated to treat the uninsured, who would be
strapped with unaffordable medical bills and thus bad credit-reports.
That a significant number of
poor people in the United States would lose health-insurance was known and
anticipated by the legislators. Speaking on the bill as it was taking shape in
the U.S. Senate, Sen. Hawley said, “I know that will reduce the number of
people on Medicaid.”[2]
What, then, justifies the loss of health coverage? The senator answered this
question by adding, “But I’m for that because I want people who are able bodied
but not working to work.”[3]
In other words, being able to have access to medical services should be conditional
on having a job. The conditionality itself means that health care is not a
human right because such rights are inherently unconditional.
Some or even many of Sen.
Hawley’s constituents doubtless favored excluding medical services from being included
among other human rights, perhaps in the belief that people who are able to
work but refuse to work do not deserve to be kept alive if they fall sick,
which in turn can be based on a belief that only the strong of any species
should survive. Sen. Hawley represents Missouri, when is generally
conservative. Sen. Warren of Massachusetts, on the other hand, would find that
the conditionality and thus the exclusion of medical care from human rights much
less popular in her member-state. Such a wide divide by state on this question
would be unlikely in the E.U., even between the states of Hungary or Poland and
Sweden or the Netherlands. The European notion of subsidiarity would thus be
more applicable in this case to the U.S. than the E.U., given the greater
diversity of ideology on the question in the United States. In other words,
federalizing universal healthcare would come with less ideological tensions
between E.U. citizens in different states than between U.S. citizens in
different states; there was more consensus within the empire-scale European
Union than within the American bloc.
The imposition of work
requirements as a condition for the poor having access to medical treatments
may be just fine with most people in Texas and Utah, for example, and yet be
very objectionable to most people in Vermont and Connecticut. To conflate these
various member-states as being ideologically and culturally homogenous is suboptimal
and comes with political costs as opposition pressure is likely to result where
the federal policy is unpopular; more optimal politically would be transferring
the program of Medicaid to the member-states so their respective peoples could
tailor the program—or even cancel it—according to their respective political
ideologies. The notion that policy in another state should reflect one’s own
views is anathema to federalism, and even to there being empire-scale unions of
states. Toleration within a union is thus necessary lest one size be applied throughout
and eventually republics break off in frustration, as Britain did from the European
Union due primarily to anti-federalist sentiment.
In short, finding a large gap
from consensus in Congress (or in the E.U.’s legislature) can be an indication
that a policy question would be better resolved by the member-states than at the
empire-level, given the heterogeneity between states on the question. Congress
and the federal president applying work requirements on what most people in
some states regard as an unconditional human right may be intolerable emotionally
to those people, but so too, Obamacare had been viewed as an intolerable overreach
of government to most people in some other states. Behind this chasm,
ideological and thus as emotional as cognitive, lies a basic disagreement on
just what should constitute human rights, and thus be an obligation of
government. In other words, besides different political philosophies of the
proper role of government, different moral principles are involved on the
question of whether government should pay for healthcare for the poor. In a
federal system, the matter of where such a divisive policy question should be decided
should be decided before both the proper-role-of-government and the human-rights
questions are decided, or else the federal system itself would be compromised
and thus put at risk.
2. Ibid.
3. Ibid.
