It is often have pointed out — in response to suggestions that such matters be funded via charity or other non-governmental organizations — that if there is not a single, government run, consistent program to provide benefits such as unemployment insurance and health care to those who need them, there is no guarantee that people will receive the benefits that they need.
This does not surprise me. One of the reasons why we set up bureaucratic social programs is because we don’t want to accept the level of inconsistency and unfairness that can result from organically developed community systems of mutual obligation.
Some have, however, taken this argument farther and suggested that it is simply impossible for needs such as health care, unemployment, etc. to be provided through any system other than a large government run one, which spreads the risk across millions of people (and allows nearly unlimited deficit spending.) It’s all very well to want personal mutual obligation to take care of things, I’m told, but you simply can’t deal with some issues that way.
I disagree. It is possible to take care of all of these things at the community level through mutual obligation. And there is a test case which we can look at to see how that looks. The Amish applied to congress to receive an exemption from social security.
They do not pay into it and cannot receive benefits. They also avoid Medicare and Medicaid, and do not purchase health or homeowners insurance. They do this not primarily because such things are not mentioned in the bible (as is their motivation for avoiding many modern technologies) but because they believe that it is their duty to care for the elderly and the sick directly through the community. They do use modern medicine, but they pay out of a self-administered community mutual aid fund.
This can be especially rough on them, because after having a number of generations in a fairly closed community, some Amish groups suffer from increased incidence of genetic diseases. (Things are made further difficult, as the WSJ article linked describes, because many hospitals refuse to give the Amish the same prices that they give standard insurance companies.)
I think we could generally agree that the Amish have us beat when it comes to maintaining a solid community and sense of mutual obligation.
Now lest anyone get the wrong idea, I’m not saying that society as a whole should drop all safety net programs and live like the Amish. They manage to pull off what they do because they have a long community history and a religious commitment to sticking to what they’re doing. And I think what they’re doing is, in regards to community mutual obligation, right. However, the country as a whole is massive, religiously and ideologically diverse, and has no history of enforcing that kind of community commitment. If we tried to provide health care the way the Amish do, it would not work.
But since I think they do have something rather close to the right model, if we believe that community and mutual obligation are virtues, we should when changing our system seek options that are more like it rather than less like it. And always try to gauge how our well intentioned attempts to provide services for everyone will effect social cohesion.
The problem is, the quick and dirty solution is much, much easier. Our national government is so big and so powerful that its easy to convince ourselves that if we bring it into play and throw money at a problem, we can fix the problem and let our consciences rest easy. Because federal programs can be so big that they touch everyone in the country, it seems much simpler to say, “We should have national single payer health care” than it is to try to push hundreds of thousands of communities (which are hard to even define in any rigorous sense) to take responsibility for caring for all their sick members.
Encouraging millions of people to behave virtuously is a very difficult job, and will never meet with complete success this side of eternity. Massive government effort can sometimes ammeliorate some of the social ills resulting from people not being systematically virtuous — at at the same time it reduces people’s incentive to be virtuous. (Indeed, not only reduces the incentive, but to an extent removes the opportunity and obscures the need.)
The difficulty (which we spend a great deal of energy in the political sphere fighting it) is deciding where to strike the right balance between making sure that the worst suffering in society is avoiding, while not removing the need for community obligation. Because sadly, given our tendencies towards selfishness, if our need for community is removed, we will often fail to practice it.