Showing posts with label health policy. Show all posts
Showing posts with label health policy. Show all posts

Monday, August 11, 2025

Wealth and Ethics in American Fiscal Policy

In a struggle between wealth and ethics, practically speaking the former tends overwhelmingly to win hands down, even if the form of government is at least nominally a representative democracy, but in fact an oligarchy or plutocracy. The influence of the moneyed interest both in the E.U. and U.S. is likely much stronger than most of the respective citizenries know. When the poorest of the poor are to be made worse off financially by cuts in certain government programs while defense contractor companies stand to get more, which tends to mean higher bonuses for executives (and campaign contributions for elected representatives), the skew toward the gilded and away from the most vulnerable economically can be viewed as an x-ray of sorts indicative of rule by wealth rather than by the People. U.S. President Trump’s fiscal budget enacted in 2025 is a case in point by which the questionable morality of the plutocracy or oligopoly form of government can be gleaned.

Plato laid out the following as alternative forms of government, from the best to the worst:

1.       The Ideal State (kallipolis): everyone is doing their respective jobs well; philosophers with knowledge of the good are in charge of making decisions pertaining to public policy.

2.       Timocracy: (e.g., Sparta): people who love honor, social status, and competition are in control. In other words, a military. 

3.       Oligarchy: producers (or suppliers) of goods and services (i.e., business executives and or companies) are in control. That is business runs the government.

4.       Democracy: the “mob” is in control. Direct democracy. Such “mob rule” is volatile, with enacted policies swinging back and forth. This does not include representative democracy, which is better, but not as good as having a philosopher king rule because reason should control the passions in a mind and a city.

5.       Tyranny: a tyrant is in control. This is the worst form of government, for obvious reasons, as an autocrat faces no worldly constraint in unleashing suffering and death on a population. In 2023 through at least 2025, the Israeli government was a tyranny in Gaza.

The three highest Hindu castes fit the three highest Platonic forms of government, with Brahmins, who are ideally priests (or philosophers), soldiers/generals, and merchants in descending order in Hindu society. The “mob” in Plato’s scheme corresponds to the laborers in the caste system. That business managers (including CEOs) running (and thus controlling) government are higher than direct democracy may sound strange to modern ears in the West, even in the E.U., in which Greece is a state unless the difference between well-paid modern elected representatives and a mob of mostly uneducated (i.e., unprofessional) laborers in ancient Athens is grasped. Even in modern representative democracies, complete with terms of office to buffer the momentary passions of the people—passions that can contradict a people’s long-term best interests (i.e., the public good)—corporate interests likely view themselves as superior and thus legitimately at the helm in what is known as a plutocracy, or rule by wealth. The moneyed interests could cite Plato’s hierarchy of government-types without bothering to point out that Plato had mob-rule rather than the U.S. Senate in mind as democracy. We need not pit the reasoning, albeit skewed by self-interest, of CEOs on public policy against what a disorganized mob might come up with as the public good (over partial interests), but we might want to consider whether corporations and individual CEOs should have so much monetary sway with elected representatives and their appointees that a representative democracy is de facto a plutocracy serving the relatively narrow interests of capital. The pecuniary interests of American defense-contractor companies in manufacturing and selling weapons, planes, and tanks to the U.S. Government for use in Israel as it pummeled 2 million residents of Gaza in 2024 and 2025 were not necessarily in the best interests of the United States, which might have been more accurately represented and instituted by the American electorates than business political-action-committees helping representatives get re-elected. Not that any member of Congress cares about that, of course.

Or take the “Big Beautiful Bill” passed by the Republican lawmakers in both chambers of Congress and signed by President Trump in 2025. The projected economic impacts on the different economic tiers of Americans supports Adam Smith’s fear that company managements and government officials would work together at the expense of workers and even competitive markets themselves. On August 11, 2025, the Congressional Budget Office made public its estimates “that the 10% poorest Americans will lose roughly $1,200 a year as they experience restrictions on government programs like Medicaid and food assistance, while the richest 10% of Americans will see their income increase by $13, 600 from tax cuts. Overall , American households will see more income from the tax cuts in the legislation, including middle income households, but the largest benefit will go to the top 10% of earners.”[1] Such a distributional impact could be expected in a plutocracy, even in the form of a hijacked representative democracy. Very poor disabled Americans living on Social Security (SSI) of less than $1,000 a month already faced reductions if they negotiate a good deal on rent, or a friend or relative helps out with utilities or rent. That the U.S. Defense Department budget was increased, with corporate defense contractors set to reap additional profits as a result, illustrates the questionable ethics in taking from the poorest of the poor, who cannot work, and giving more to wealthy corporations (with higher bonuses, everything else equal, going to executives). Additionally, just for added fun, roughly “2.4 million people won’t be eligible for the Supplemental Nutrition Assistance Program [i.e., food stamps] under new work requirements” for poor Americans who have not been declared disabled by the Social Security Administration.[2] Food has thusly been declared not to be an unconditional human right. As the work requirement applied to Medicaid, the government program that funds healthcare for the very poor, access to medical services—and thus good health—was also declared to not qualify as an unconditional human right.

In short, the American social contract between the federal government and its people was changed in ways that stood to make many of the poorest Americans poorer while defense contractors could make even more money from that government. The new social contract reflected a plutocracy or oligarchy in the guise of a representative democracy. Although arguably superior to mob rule, such a trajectory for representative democracy may trouble a good many people, financially or otherwise perhaps in conscience. A person need only read John Rawl’s Theory of Justice to realize that a plutocracy gearing public policy to the narrow interests of a part rather than the whole of a society is diametrically opposed, or antipodal, to a system of government and economy in which the poorest of the poor are looked to first such that they can survive and lead decent, albeit not wealthy, lives before other, increasingly better off tiers are taken into account. In a school yard, only a bully goes after the kids with the least to eat for lunch so to enrich himself and his buddies.



1. Stephen Groves, “Trump’s Tax Law Will Mostly Benefit the Rich, While Leaving Poorer Americans with Less, CBO Says,” The Associated Press, August 11, 2025.
2. Ibid.

Friday, April 5, 2019

Should Health Care Be a Right?

In the Spring of 2019, President Trump promised that a Republican alternative to "Obamacare" would soon be unveiled; the majority leader of the U.S. Senate, Mitch McConnell, quickly informed the president that the prospects of such legislation passing the Democratic-controlled U.S. House were zilch. This virtually guaranteed that health care would be play a salient role in the upcoming 2020 presidential race. The underlying question, I submit, has been whether health care ought to be a right, which the government would be obligated to ensure. Such a right would obviously not be one of those that hold government back (e.g., the right to liberty). Whether a right ensured by government or holding government back, the nature of a right is such that it is to be respected by others, whether individuals, organizations, or the state. Such respect, being an obligation, constrains those others. Hence, health care as a right has been controversial in the U.S. 
The Senior US Senator from Illinois, Dick Durbin, said the following just before one of the votes in December, 2009 on the Affordable Care Act, the health-care insurance reform legislation initiated by President Obama: “Thirty million Americans who currently don’t have health insurance  have the peace of mind of knowing that they have health insurance,” Mr. Durbin said. He added, “This is a real debate over whether or not health care is going to be a right or a privilege in America.”[1] By using the word, privilege, Sen. Durbin was implying that having access to health care on the sole basis of whether a person has money is unfair. 
If being wealthy is a good indication of being worthy of survival, then it may be assumed that health care for all, whether through private, non-profit, or government insurance, would undermine survival of the fittest. This in turn takes fit to mean strong or good. Were the humans in the financial sector before the financial crisis of 2008 strong or good? Does not fraud point to an underlying weakness? When Dick Fuld was CEO of Lehman Brothers before it collapsed, was he a strong leader or a pitiful man whose ambition got the best of him? 
In "survival of the fittest," fit has to do with fitting in with a changed environment. Such fitness, or fit, is on nature's terms rather than necessarily according to our notions of strong and good. For instance, a young drug dealer in a large city may have twelve "baby mamas." This means that the man had impregnated twelve women, who had been attracted to him on some basis that they valued. The sheer number of offspring suggests that the man was successful in reproducing himself; he thus fit well in his environment on this nauralistic basis. If survival of the fittest lies the availability of health care, should that man be covered while a poor religious man who has contributed to society without earning much money or having children should not? 

See also "Congressional Cuts to Foodstamps: Violating a Human Right?"

1. David Herszenhorn and Robert Pear, "Parties Stay United as Health Bill Clears Steps in Senate," The New York Times, December 22, 2009.

Wednesday, November 29, 2017

Sustenance: A Human Right in America?

In the fall of 2010, the following was said on Fox News: “The government should spend more on the war in Afghanistan in order to fight terrorism. The problem is that the government has gotten into entitlements.”  The latter presumably includes food stamps, public housing, Social Security, Medicare, and Medicaid.  To say that government ought to be engaged in defense and not in supplying needy citizens with food, shelter and health-care is distinct from saying that the federal government should concentrate on foreign policy and defense, while entitlements are formulated and funded by the state governments as their domestic programs. In other words, advocacy for a certain priority in government and for less government is distinct from advocacy for restoring balanced federalism.

Most Europeans in the E.U. undoubtedly view the redistributive right for sustenance resources as founded on human rights and thus as a legitimate part of government.  In contrast, Americans do not typically apply a human rights justification to entitlements for other Americans even as foreign aid may be justified in part on this basis.

For example, on June 3, 2011, Donald Trump told a forum in Washington, D.C.: "A certain Republican representative, two nights ago -– I watched on television -– Representative Cantor, who [sic] I like, said we don't want to give money to the tornado victims, . . . (a)nd yet, in Afghanistan we are spending ten billion dollars a month but we don't want to help the people that are devastated by tornadoes -- wiped out, killed, maimed, injured. We don't have money for them but we are spending ten billion dollars a month in Afghanistan. We are spending billions of dollars in Iraq where they have the second largest oil fields in the world … and we can't help people that got flooded in Mississippi that got hit horribly by tornadoes." The U.S. House Majority Leader was holding up funds for basic necessities at home as leverage in debt-ceiling negotiations with the Democrats, while allowing billions of dollars to continue to flow in foreign aid (and to the U.S. military in Iraq and Afghanistan).  Canter’s antipathy toward government aiding citizens who would otherwise be left to the state of nature represents a rather warped understanding of a social contract.

People such as Eric Canter believe that the market mechanism trumps any right to have one’s basic needs satisfied. Resources are viewed as commodities produced and distributed by private enterprise, even though the market does not guarantee that every citizen’s basic needs are met. Even so, it can be asked whether the right to survival (i.e., life) is part of the American social contract. If so, then relying on the market mechanism alone is not sufficient.

If life is not part of the social contract, then the hungry and homeless, as well as the untreated sick, are (and can legitimately behave as if) in the state of nature. As much as some of the rich do not want to be taxed so the least fortunate can survive, the prospect of the latter behaving as if in the state of nature must surely be even less palatable.

James Madison writes in Federalist #51, “the weaker individual is not secured against the violence of the stronger” in the state of nature. Nor is the weaker secured against starvation and sickness.  Without the police to protect their property, are the rich sufficiently strong to ward off the hungry and homeless? Who is the strong and who is the weak in a dog-eat-dog contest between two human beings—one with a bank account and the other with a left hook? Life, Thomas Hobbes writes, is “solitary, poor, nasty, brutish and short” in the state of nature are all equal in the sense that any one of us can be killed in our sleep. Suddenly having some of one’s tax directed on a human-rights basis may not sound so bad.

What keeps those whose survival is so tenuous from simply taking from the rich is of course the funded social contract that protects property with police force even as there is no guarantee for survival. Such a warped social contract is an aberration in terms of social contract theory.

  The social contract undergirding a political society is meant to alleviate the fear of the want of necessities (and self-defense) while working for the happiness of the members.  In other words, there is a right to shelter, food and medical care. Otherwise, the society is only marginal or partial in obviating the insecurity that exists in the state of nature.

Therefore, to say that government should merely defend citizens from the insecurity of foreign invasion does not go far enough from the standpoint of why government is instituted as part of a social contract that takes people out of the state of nature. However, to say that an empire-level government ought to be charged with protection from foreign invasion, while the individual republics are tasked with ascertaining their citizens with protection from starvation, the elements, and sickness. Without anxiety, foreign or domestic, every citizen—rich or poor—would be freed up from a basic insecurity that without a viable social contract is simply part of life.


Sources:

The Federalist, ed. Jacob E. Cooke, Hanover, N.H.: Wesleyan Press, 1961.

Sam Stein, “Trump Takes Aim at Cantor, Krauthammer, U.S. Foreign Policy,” The Huffington Post, June 3, 2011.