[I was originally going to title this posting "America's healthcare affordability crisis," but I just kept integrating to wider and wider principles as I proceeded; the progression unfolds below.]
By this point, regular readers of this blog are most likely used to an inductively-established pattern I'm big on, namely that a great many human existential problems are primarily intellectual problems at their source. That the intellect - how (well) it is used or misused - has more primacy in human affairs than any other human characteristic, is at the very core of the doctrine I have named P/perfectivism. I think the distinction between "primary" and "only" is also well-known to Rand-influenced readers; that the intellect is the prime mover in human affairs, doesn't make it the only mover. But in terms of a correct mode of analysis of human affairs, at the greatest level of fundamentality (and that which is fundamental in any context being what philosophers are supposed to discover), I don't know of anything more fundamental for purposes of explanation than the characteristically human mode of consciousness, i.e., a conceptual or abstractive one (the key faculty of abstraction being the intellect).
And so it is by this mode of analysis that one can only truly get to the root of such a concrete issue as the USA's healthcare affordability situation.
The connection between these two things would probably be met with incomprehension or incredulity among many of today's political observers. How can something so (seemingly) abstract as the human mode of consciousness come to affect something so concretely-impacting as one's (or one's neighbors) healthcare situation?
I figured I would address this concrete issue in particular after having just had a discussion with Canadians about the qualities of its healthcare system. The basic message I took from this discussion is that Americans are very ill-informed about the ways in which their own healthcare payment and delivery system compares with others in the industrially-advanced world. Here in America a cancer diagnosis can wipe out people's life savings; that sort of thing is unheard of in a country like Canada. (How Obamacare is supposed to address that concern is not clearly spelled out as far as I know.) But to hear the American national discourse on the healthcare issue, the average American simply does not have the information (or an adequate grasp of it) to make well-considered decisions regarding policy (through direct support or indirectly through voting for leaders), even when some medical situations can be financially devastating to them under current policy. It sounds like playing with fire, doesn't it?
The way that the issue and the debates about it get framed is all too easily corrupted as long as the polity remains in the dark; we cannot expect to have an integral exchange of ideas about causes and solutions under such conditions. The healthcare affordability crisis is bad enough; this corruption of the discourse - and it has deadly consequences - is disgusting in its own right. I mean, if Americans were well-informed about the various alternative healthcare payment and delivery frameworks in place around the world, and still made the determination that, on balance, all things considered, this system is still the one to have in place, that would presumably reflect epistemically-responsible behavior. (Without some extensive analysis, it isn't all cut-and-dried, as leftist reddiots would have you believe, that transitioning over to a more "social-democratic" model would be a net improvement.) But that's not what we have here; we have a healthcare affordability crisis coupled with widespread (and deadly) ignorance as to its causes and possible solutions. That should make one pretty fucking angry, I would think.
Now, just in case this claim (as to Americans' massive ignorance in regard to healthcare systems and causes and solutions) meets with skepticism, we must take into account a wider context: Americans are demonstrably very-ill-informed about a whole range of issues. From that standpoint, that the healthcare issue falls within this range is the to-be-expected, not something that should come as any surprise. And from that standpoint, we have an all-encompassing, inductively-established pattern concerning the average American's state of knowledge and awareness. And from that standpoint, it's virtually a clear path, right on through the levels of abstraction involved in drawing wider and wider inductively-established conclusions, to the most broad, all-encompassing, abstract conclusion we can reach in this context, i.e., that the average American's state of knowledge and awareness stems from the average American's state of intellectual knowledge and awareness. That is, the average American's state of knowledge and awareness concerning things like current pop-culture (e.g., knowing precisely the differences between American Idol and America's Got Talent) is a selective and compartmentalized knowledge that can still leave the average American oblivious to other issues (e.g., politics) impacting their lives. That problem - compartmentalization - is also symptomatic of the problem for which the primary diagnosis has already been made: a lack of intellectual awareness, such as the awareness of the cognitive need to integrate the seemingly disparate areas of knowledge concerning matters that affect their lives.
In fact, I do quite firmly believe that many of the various cognitive maladies one could identify as a leading underlying cause for various observed problems can all be inductively-grouped on the basis of the primary underlying cause of all those underlying maladies, that is, the widest integration possible in this context which I have formulated in essence as: a crisis of intellectual awareness.
You'll find many amateur intellectually-minded folks on places such as reddit trying to come up with the most sense-making and at the same time the widest, most all-encompassing, most abstract causal explanation for America's existential trends. Some of them (many of them, on reddit) locate the primary problem in a corporate plutocracy's stranglehold on the political system. Stopping short of an underlying explanation for that would indicate the amateur explanation-giver's ascription of primacy to material economic factors. In the meantime, many a religious right-winger would trace the nation's existential trends to a supposedly growing secularism - a "departure from God" - and then proceed, unsurprisingly, to point to all kinds of data points purporting to support this explanatory hypothesis.
For those familiar with Miss Rand's "Censorship: Local and Express", these dueling modes of analysis can be understood in terms of a more fundamental mode of analysis which she offers: a material/spiritual dichotomy, with each side - the "liberals" on one and the "conservatives" on the other - giving primacy of emphasis to what they respectively consider to be the most metaphysically important. Miss Rand sums up the essence of this dichotomy as applied to politics here, and - now just as then - it packs lots of explanatory punch, and that being the case within the context of the yet-wider inductively-observed pattern providing a shit-ton of explanatory punch for America's - or any nation's - existential trends, that is, the pattern having to do with the prevalence of reason vis-a-vis unreason in a given culture. Consistent with Miss Rand's pattern of expertise at identifying the issues of most fundamental explanatory importance - a pattern of expertise that must characterize the philosopher qua philosopher above all else - it is the efficacy and supremacy of reason which Rand explicitly stated was the primary concern of her work, and "the essence of Objectivism."
The primacy-of-something-else amateurs are usually unaware of Rand's core emphasis on the primacy of reason because their standpoint assigns primacy-of-explanation to other things, and so their (lack of understanding) of Rand is filtered through that perspective. (That's their problem, not hers.) And so - as a slam-dunk standing-on-one-foot test of someone's level of understanding of Rand - if a person has led her/himself to believe that the primary, fundamental virtue in Rand's ethics is "selfishness," that tells you about that person's frame of reference, but not much about Rand's. "Selfishness" is, of course, not a primary - it can't be, not without some framework that tells a person what to be selfish about, or what selfishness consists in. If Rand holds - as she did - that the standard of a person's moral perfection is unbreached rationality, then that makes a good 95% of the usual interwebbed hit-pieces on Rand's egoistic ethics quite entirely worthless as facilitators of understanding. But what if these intellectually-incompetent hit-pieces are merely symptoms of the wider, more fundamental causal explanation I've offered for the nation's existential direction? Where else would the chain of explanation end? What could Rand herself provide as a more fundamental terminus qua "the essence of Objectivism" than the supremacy of reason? Rand saw that the primary key to addressing human existential challenges - the endeavor which she would call a selfish one - was to be found in how efficaciously human beings employed their reasoning capacity. Where else would the primacy of emphasis for this existential task be found?
Wouldn't Jefferson agree on that, for sure?
(The right-wing religionists who "explain" the USA's existential path in terms of a "departure from God" tend almost uniformly to speak of the country having been founded "on Judeo-Christian principles," that it was the Framers' alleged (right-wing style?) religiosity that informed the nation's founding documents. What context has to be dropped to claim such a thing? Right-wing religiosity had been abundant throughout the ages prior to the founding of America, and never managed to generate a constitutional republic founded on individual rights. That was a historical constant; did it just suddenly work out that right-wing-style religiosity in the minds of the Framers is what made the Declaration, the Constitution, the Federalist Papers, Common Sense, the American Philosophical Society, and so on a practical reality? What's a better fundamental-level explanation for all that: ages-old, right-wing-style religiosity or the very-new Enlightenment culture of learning and boundless intellectual curiosity? What's the variable of primary or greatest importance in this context? The economistic Left doesn't fare any better; their mode of explanation comes down to the economic interests that the Framers had in gaining independence from the British Crown: rather than the King exploiting these rich white land-owners, the Framers sought the political framework in which to do (capitalistic) exploiting themselves. Apparently, all the Left sees as fundamental about America is a history of conquest of economically-underprivileged and non-white peoples, and only after FDR's reforms was the Great American Middle Class made possible. Seriously. The GOP party base offers theocracy as the way to go; the Democrat party base offers FDR-style interventionism as the basic alternative. The pragmatists in both parties are at a loss as to what to do, other than to succumb to mentality prevailing in the District of Cynicism.)
The true explanation and solution - for the nation's healthcare challenges and for everything else - are right under our noses. There's one public intellectual from the last half-century that has been shouting this from the rooftops to a greater and more potent extent than anyone else. To the clueless, it would seem outright crazy that some blogger self-identifying as The Ultimate Philosopher would be touting this particular public intellectual, over and over again. But what other reasonable conclusion is there to draw? One would presume that the professional philosophical community would be all on board with this true explanation and solution and, as a consequence, go out of its way to shout the very same thing from every available rooftoop, lectern, op-ed page, manifesto, and what have you - to identify, along with Aristotle and Ayn Rand - the primacy of intellectual flourishing to human and cultural flourishing. I mean, isn't that supposed to be the very spirit animating their own profession, for crying out loud?
What we have here is a failure to integrate. It would be quite the fucking shame if this failure stemmed in significant part from the (by and large politically left-leaning) intellectual community's reactionary attitude toward the politically capitalistic nature of this leading contemporary source of the intellectualist eudaimonism staring them right in the face, now would it not. But is there some other plausible explanation for this reaction, aside from its being a politically-motivated one? Sure, their jobs might well be in jeopardy were this thinker's ideas carried out (for one thing, many would lose a lot of credibility for having failed to be Aristotelian intellectualist eudaimonists), but then job-security-motivated behavior wouldn't credibly qualify as philosophical behavior, now would it. Anyway, this is just some stuff to think about when tying our current healthcare affordability crisis to fundamental intellectual factors. Much as the intellectuals profess to hate that very crisis, whom else, exactly, do we have to thank for it, in the end analysis?
A subject to which I have been giving some thought (well, more in the way of questioning) is: In a hypothetical world populated (to a considerably greater extent than at present) by learned Aristotelian-Jeffersonian agents, just what would the general attitude toward "social welfare" issues such as healthcare payment and provision be like? If you listen to the mainstream of academic political philosophy, a majority of well-informed agents would be (tah dah!) a lot like them: leftish Rawlsy social democrats who assign a crucial role to the coercive state in matters of provision of goods - in ensuring the provision of goods, as a matter of right and social-political justice - that would foster in individuals the capability to flourish. If, on the other hand, these agents are eudaimonist libertarians, the provision of these goods would be left up to private institutions - indeed, that were we to come to such an enlightened state of affairs whereby communities were very much concerned with the cultivation of individuals' self-actualization capabilities, they would already have quality institutions in place for that very purpose, without the need for a coercive state apparatus in fulfilling that goal. What would be the dialectical resolution in debates between the eudaimonist libertarians and advocates of Rawlsy social justice? We have to assume of course that each side is amply familiar with the mindset behind the other side's views, as Aristotelian-Jeffersonian agents would be. I'm thinking that it resolves toward eudaimonist libertarianism in practice (de facto), while the Rawlsies would assert a theoretical trump card in the form of a question: However provision of these self-actualization-capabilities goods is carried out, wouldn't the enlightened agents of our hypothetical society affirm a de jure right to such goods - i.e., that provision of these goods would be guaranteed as a basic "safety net" condition of such a society? They would supplement this question with a hypothetical: If private institutions didn't prove fully sufficient at providing these goods, wouldn't the state have the rightful authority to assert coercive powers to make up the difference?
That would move the dialectic up the ladder to another level: Without begging questions, how do we determine the content of a set of compossible rights upon a eudaimonist foundation, where rights are understood to be enforceable claims based on the requirements of human flourishing? Freedom to exercise one's independent judgment is such a requirement, but so is the effective possession and use of such Maslow-hierarchical goods as food, clothing, and shelter. A Rawlsy argument would hold that the structure of a set of compossible rights is determined through a conception of moral reason presented via the "Original Position" and "veil of ignorance" devices, which would derive rights to such things as food, clothing, and shelter. The eudaimonist libertarian would object that the coercion necessary to implement this Rawlsy framework of supposed rights constitutes an unacceptable deprivation of the freedom of the talented creators, the "men of the mind," based on the principle that the freedom to exercise one's intellect in the pursuit of one's chosen ends is, in effect, morally axiomatic. The Rawlsy response might be in effect to re-assert that a conception of moral reason represented by the Rawlsy argumentative devices is a superior conception at least insofar as it better tracks pretheoretical intuitions and makes for a more satisfactory reflective equilibrium. The eudaimonist libertarian in effect (quite plausibly!) re-asserts the same thing about the freedom to exercise one's own judgment using one's own intellect. Where does the dialectic go from there?
Keep in mind that in this hypothetical enlightened society, not all the agents are sitting around in the academic classrooms; some of them have businesses to run and, besides, short of a "pure" moral rationality devoid of economic incentives, the business community has to more or less be on board with any transition to some social order or other, practically speaking, right? And, besides, what burdens are the business folk supposed to shoulder over and above doing a lot of heavy lifting, involving maximal use of their intellect, of course (remember, this is an Aristotelian-Jeffersonian dialectic we're talking about here), in making available goods and services on the market, under a rule of law that has a "socially conscious" dimension (pertaining to acts, not outcomes), etc. And, for that matter, if we are talking about some point in a hypothetical future in which the adoption of Aristotelian-Jeffersonian principles of living has snowballed in positive effect over the course of generations, just how self-sufficient would people end up being, anyway? And, for that matter, if we're going to hypothesize a dialectic between very-well-informed agents (given the presumed informational benefits made possible by advanced information-age technology), maybe the terms of any dialectic to be had at all will already be advanced well beyond our current ability to predict. Keep in mind that a hypothetical society built upon the primacy of the intellect would bring with it all-encompassing effects on people's ways of living - more all-encompassing than debates (and their existential effects) within political philosophy. Keep in mind that change in that direction occurs at the margins, but with snowballing effects at the newer and newer margins until, eventually, the whole of society is engulfed in the new intellectualist ethos (since there's no coherent opposition to be had against intellectualism, and only abundant benefit to be had by its adoption).
Such a line of hypothetical questioning ends up placing the current healthcare affordability crisis in quite a different perspective, doesn't it? I mean, whatever the hypothetical enlightened society comes up with as a solution, it's sure bound to be a lot more effective and all-encompassing than what we would be able to come up with now, wouldn't it? (This of course should not be taken as any sort of argument for not putting our best efforts into doing what we can do now, or for waiting around for everyone to be Aristotelianized/Jeffersonianized before we can solve the big problems. The whole idea is to get better and better at the margins at addressing these problems as time goes on, and actualizing a snowballing effect. If we have a deficient vision for how fallible humans could make this happen, we just use our noggins to think up a better and more workable vision and make necessary adjustments as we proceed, is all. Yes we can.)
The somewhat strange thing here is that, given my context, the very activity of discussing this subject matter is no-brainer stuff, because for me the primacy of the intellect in human affairs is no-brainer stuff (and it keeps being confirmed by observations, to the point that the novelty has begun to wear off for me); and yet, it seems no one else out there is saying it - and it's not because it's such common wisdom that it goes without saying. (How could it be, given the way the culture is right now?) I even have to ask why Rand herself didn't make the sorts of futuristic extrapolations that I have - because that's what these hypothetical discussions are: extrapolations from the initial no-brainer (to me) inductively-certain principle. And these discussions also bump up against some inherent limitations; how much further can I even go? What possibilities do I think of next, from the philosopher's armchair more or less, for how an "ultimate culture" might play out? I think I really might be speaking of an intellectual-cultural singularity here, with all that such a concept entails. There's the increasingly-well-known concept of the technological singularity, a point in the not-distant future beyond which we can make no extrapolations beyond foreseeable nearer-future trends. The futurists talking about the tech-singularity may be tech-centric enough not to be ideas-centric, else they'd be philosophers first and foremost. What do I do as a philosopher in regard to the idea of a technological singularity? I think up other possible singularities pertaining to some number of key avenues of human endeavor. The cultural singularity would, I think, take the form of a widely-adopted intellectualist eudaimonism (what other form would it take if not that?) extrapolated into the currently-unknown. Now we have two abstract-concretes, if you will, awaiting an inductive treatment: will there be a science singularity, an economic singularity, a political singularity (what would that be if not subsumed under a cultural singularity?), a media singularity, or others in addition to the technological and cultural ones? And to extrapolate, how would all these intertwine? Doesn't an accelerated intellectual progression speed up the technological one yet further, with a positive-feedback loop? What happens if/when all "sub-"singularities converge into a Big Singularity?
And that's not even factoring in the effects of people maximally Saganizing their cognition by way of optimal use of cognitive-performance-enhancing substances....
And where does the discussion even proceed from here? What are the current limits on the widest-possible, most all-encompassing philosophical abstractions? What's there left to talk about once you identify the primacy-of-intellect principle and extrapolate? My best answer right now: under consideration here is a Big conceptual file-folder which contains a whole hierarchy of sub-folders (and sub-sub-folders, etc.), all of the folders considered as (mental) units which ultimately reduce to perceptual units. And there's plenty of stuff in the sub-folders to inquire about in the meantime, before everyone has gotten on board with the primacy of intellectual principle and run with it. And I do have in mind what I want to post about next, but that'll remain a private possession for now. ;-)