Nature and Health Care

The great eneny of nature is utility. Power finds the restrictions nature places on it obnoxious and irritating. Marketers play on this frustration when they present products with “no limits” and other meaningful language. But nature won’t give in. It always wins.

That realization enables one to anticipate developments in health care.

Whether we switch to a gigantic bureaucratic nationalized health plan or we continue to be controlled by the gigantic bureaucratic corporations (who would provide the employees of the nationalized health care plan), we should realize by now that health care is run, not by respect for human nature (i.e. the patient) but by utility.

In time, if not yet, that creates this simple application: Utilitarian health care: efficiency demands letting people who are old die sooner.

However, nature demands reverence, altogether apart from “usefulness” or cost effectiveness. And reverence is particular, not abstract, immersed in context, relationship, love. It constantly screws up the actuarial tables. That is why Burke famously and importantly said:

The age of chivalry is gone. That of calculators, sophistors, oeconomists has come.

So where does that leave us? In a bind that arose when we handed health care to the utilitarians in the first place. Follow this out.

If we don’t revere our elders, what will happen to us? Are dying parents a nuisance or part of what makes us grow up into adulthood ourselves? That would seem pretty useful. Just not utilitarian.

What cures will we never discover because the government directs the health care resources toward their arbitrary and ever changing values, which are always rooted in power politics, not nature? (This alone explains why we need to limit and define the powers offered to our government.)

If people who were invested in the ethics of health care read this blog, I would urge them to debate what nature has to say about health care priorities. But I wonder if the categories would mean anything.

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18 Responses

  1. Andrew,

    Can you recommend a book/books that would help me understand the idea of nature? I must admit I walk in the fog here.

    Thanks.

    • Put simply, the idea of nature is the notion that things have one. A human is a human is a human. So you want to figure out what makes them human. Same for a frog, justice, literature, etc.

      I’d start by getting the conference CD’s, which should be out in about two or three weeks with a bit of luck.

      Then read Life is a Miracle by Wendell Berry.

      Thomas, if you are reading this, would you please ask Herr Martin about the books he mentioned at the conference? He listed a few that I’ve seen mentioned all over.

      The most important thing is to continually ask yourself: what is that thing? what is its purpose? How should I appropriately relate to it? And humble yourself before the nature of the thing you are contemplating.

      Suzanne, I hope that is some help.

      • Thanks. When you get the list of other books let me know.

        May a thing have more than one purpose? Or is there one ultimate purpose under which others are subsumed?

      • Suzanne,

        The purpose of every particular thing is to realize itself fully – i.e. to fulfill its nature as embodied in its particular expression.

  2. I was listening to Rush Limbaugh talk about health care today while driving to the library, and I thought he could have been speaking at The Contemplation of Nature.

    • This is a very disturbing thought. Rush has no respect whatsoever for the nature of things. OK, I exagerrate, but I’d need to hear what he said to be persuaded it had insight.

  3. It seems even utilitarian health care advances the cause of nature to some degree. If what is natural to human beings is the activity of being a human being, and modern health care allows someone, say, who was born with a heart defect to grow up to be an adult rather than die as a child, then modern health care has acted for a natural good.

    The important question seems to be whether the good at which the health care aims is the natural development of human beings. Aristotle could take for granted that the aim of medicine was health; we cannot. Rather, it seems that the health care industry offers medical services in order that they might be paid for their services. Health is now a commodity, a means to a financial end. (For proof of this, remember that a the leader of a health care corporation is obligated by law to try maximize profits within the legal limits, but not to heal as many sick people as possible)

    Utilitarianism in health care is a symptom. The cause lies in human health being subsumed into the machine of global capitalism where it can only be viewed as a commodity among commodities, as much a good as pornography or oxycodine.

    Unfortunately, the conservative line maintains that universal health care should be opposed because it will lead to inefficiencies and massive expense.

    • Thomas

      Your second paragraph is really my point and response to your third. Global capitalism is a symptom of a utilitarian approach to reality. Everything is a commodity because the value of everything is assessed in utilitarian (ultimately synonymous with Pragmatic, quantitative, and barbaric) terms.

      I agree about your first paragraph too, because the fact that it exists in the real world means it will have to do something well in order to survive. But as your parenthesis in paragraph two and your third paragraph indicate, we have set up unnatural legal systems that set in motion the law of the catastrophic continuum. That is why, as your final paragraph indicates, there is no solution. We are doomed to slavery and/or catastrophe and contra the western optimistic mind, most cultures have always been slave cultures, so there is no reason to expect some sort of pendulum swing back toward freedom.

      Apart from the recovery of nature we are profoundly doomed. God have mercy.

    • It seems as though utilitarianism itself doesn’t specify the particular end it aims at. Utilitarianism is primarily an ethical position, though one derived out of a wider metaphysical view. It can aim at happiness for the greatest number, political stability for the state, and so on. Utilitarianism itself doesn’t set those ends at which it aims, this gets determined by some further consideration.

      So the aim of a utilitarian system isn’t utility. Utility is always for something, be it the common good, happiness for all, or maximal efficiency. If we say that society aims for maximum utility, we must ask: use for what, and for whom?

      Two things stand out as ends at which our utilitarian society might aim. First, the maximization of individual choice, or “freedom”. Second, the increase of power among only certain parts of society. Ultimately, in both cases, what is aimed at is not determined exactly by the system as a whole, but allows those empowered by the system to set aims for themselves. In both cases, what is aimed at is determined by an act of pure will.

      The first case may be attacked as relying on a superficial notion of freedom, the second as inherently violent and deceptive (ZIzek and Foucault both make this case from different perspectives). However, both rely on an assumption that good and evil cannot be particularly relevant to political decisions (if such things have any meaning at all), as political aims can only be determined by acts of will. Nietzsche was right, at least in a descriptive sense.

      Conservatives can be as bad about this as liberals, and it shows in the health care debate. The only objections that I have heard have to do with “doctor choice”, the negative impact on the efficiency of the health care system, or some other utilitarian objection.

      • Thomas,

        This is exactly what I’m trying to get at. Utilitarianism as an ethical system is rooted in a metaphysics of power. It doesn’t set the ends at which it aims, because it is about power. The end it aims at is the power of the person or group who uses it. But what a great way to disguise your moves.

        I contend that when we did away with nature as the standard against which actions are measured, the only substitute available to us was power. But we didn’t want to say it as baldly as Nietzsche or Thrasymachus. So we called it positivism, pragmatism, utilitarianism, etc.

        But all of these positions are variations on the one common theme of substituting the vacuum for nature.

        In the end, it’s “choose your tyrant.”

      • I think we’re getting at the same sort of thing then. Unless some order is posited that is not dependent purely upon volition we end up with either the maximized autonomy of every individual, or the institutional coalescence of power described by Zizek and Foucault.

        However, I’d be interested to see how nature itself functions as the order against which we could compare public policy (I’m thinking of nature in the Aristotelian sense, not the common concept of nature as a violent process of natural selection). Even Aristotle’s concept of nature is not without its “wills to power” or acts of violence. For example, the act of eating, the basic way in which living beings hold themselves in being, as described in De Anima, is inherently destructive.

        Nature (the principle of motion and rest) can offer a certain sort of ethics tied into a wider metaphysical view, but it doesn’t directly translate over into a ready-made contemporary political scheme (liberal/conservative/libertarian). Virtue ethics concerns itself with how to maintain the sort of stable identity that allows one to live a happy life. Most importantly, Aristotelian ethics calls for a person to most fully actualize himself as a human being; or to put it another way, to become an excellent specimen of the sort of thing one is.

        If this sort of ethics is the kind that takes heed of nature, it seems that public policy should take as its purpose providing the means necessary for everyone to most fully manifest what it means to be human. Inability to pay for medical care or a good education, for example, would be provided by the political community, which would also make laws that prevent behavior that degrades human nature. In this case, making medical care public, or passing laws ensuring some level of public morality would seem to follow directly from a “natural ethics”.

        Is that what you’re getting at, or is there another way to bring public policy into accord with nature (which would necessarily involve a certain ethical scheme)?

        • Thomas,

          I contend that we cannot be free without God for the simple reason that without God people turn to legislation to bring about change and order. Think, for example, of the Iliad and the hospitality customs (xenia) of the ancient world. If Zeus was not the defender of the host, then why would people not be “pragmatic” (i.e. gangsters).

          Loss of an awareness of nature undoes our capacity to maintain a political order grounded in nature. Yes, that’s tautologous, but it’s still important. Aristotle wanted a political order that cultivated virtue in the citizens. That is why when libertarians read Aristotle they think he is a tyrant. But remember that he wants small communities, believing that there is a natural scale for human nature beyond which freedom is impossible and beyond which human flourishing is, at best, threatened.

          I absolutely agree with your oepning sense in your fourth paragraph, and that is where you show conclusively that we are not only not a free country but that we don’t even know what freedom is, not to speak of its purpose.

          The grand political questions can only be answered by people much wiser than myself. But we’ll only get the people who have that wisdom if we root our teaching in nature because the only option to nature is utility (i.e. power) and we’ve been doing that since Machiavelli became our Lord and Master.

          We probably need to move this discussion to the front page rather than in these comments.

  4. Andrew,

    What would you consider the main factor in determining utility? Might it be that we as individuals consider pleasure the yardstick for usefulness? i.e.. My life will be better (more pleasurable) if I abort my baby, warehouse my parent, take that toy from my brother, etc. Do corporations even think corporately anymore (bottom line profit accounting) or are they just looking to provide more benefit (pleasure) to some at the expense of others? i.e. Madoff, Fannie Mae, General Motors etc…
    I am interested to hear your reply.

    • People determine utility by whatever standard they determine. It is based on their own objectives. The evil inherent in modern success literature, for example, is that it encourages you to set your goals without regard for the nature of the things with which you will work. “Admit no limits” and other diabolic ideas drive them.

      The cure for utility is propriety, which is treating things according to their nature.

      Sometimes it is appropriate to use things in a certain way. Sometimes it is not. It is always appropriate to treat things appropriately.

      And in the long run, it is more practical.

      • I would love to hear more about this as applied to modern success literature. Much of that sort of thinking is rampant among homeschoolers. I never even thought to apply the idea of nature to the subject although I have naturally despised it.

        • Cindy,

          You can see how you illustrate my point! “I never even thought to apply the idea of nature to the subject” is what long lines of us would say every day if one day it occured to us that we should! I hadn’t either, until very recently.

          But consider, in the Christian classical tradition there is a vast “success literature.” The difference is that they define success as virtue and root it in the perfection of human nature. The Bible is the ultimate example of a nature-based success text. How about the sermon on the mount?! What could be more successful than being “blessed”?

          Aristotle’s Ethics, Plato’s Apology, St. Paul’s epistle to the Romans, St. Augustine’s Confessions, Thomas Aquinas on Happiness, The Imitation of Christ; what are these books if not success literature?

          But modernist success literature is rooted in the will, in Nietzsche’s philosophy of power, in James’s psychology of Pragmatism, and with a little sorcery thrown in for good measure through Napolean Hill. But notice, it’s all about transcending limits, rather than coming to Him and resting, about feeling great instead of becoming great (i.e. virtuous), about getting rich instead of dying to yourself.

          It isn’t a success Christ would recognize. “It will have to paid for. It isn’t natural, and trouble will come of it.”

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