essays and articles by david g allen

Shapiro Brings Clarity to the Welfare State, Health Care


Is the welfare state justified?

Finally, there is a lucid answer to that question. I say lucid, because, in the past, the answer always has been given from the perspective of the bleeding-heart liberal or the "eat-cake" conservative.

The lucid answer that I refer to comes from the pen of Dr. Daniel Shapiro, professor of philosophy at West Virginia University. He has done a remarkable service for society with the publication of his new book "Is the Welfare State Justified?" (Cambridge University Press, 2007).

On seeing the book's cover, the first question I wanted Dr. Shapiro to answer was: Is the welfare state justifiable?

He dutifully answered me by defining the two most important social welfare programs that we have -- health care and retirement income. This is the first time that I have read anything regarding health and old age benefits wherein the author bothered with definitions. How novel!

Each of us will succumb to illness or injury in our lifetime, and we have come to expect medical care when we need it. The option of not helping the ill or the injured was settled long ago. We cannot stand idly by and watch others suffer.

Hippocrates offered pain relief to his patients by having them chew on willow bark. Today, the same drug (aspirin) is available over the counter. You may think my example as trivial. However, I chose aspirin for a reason. Going from doctor-prescribed herbs to self-medicating patients represents, at least in my mind, the quantum leap that has landed us in our current health care dilemma.

Once upon a time, there was one Hippocrates. Hence, health care was rationed as he could see only a limited number of patients. Today, we have Docs-in-a-Box available 24/7. Yet we believe health care is rationed too stringently. Is it?

Dr. Shapiro discusses the aspect of rationing health care in a thorough manner. But before diving in, he takes special care to educate the reader about what we refer to as private health insurance and government health care. We have neither private (market health insurance) nor government insurance (national health insurance). We have a hodgepodge system of health care options cobbled together as a result of federal and state legislation and state insurance regulations.

Make no mistake -- health care is rationed now and will continue to be rationed. Dr. Shapiro describes how both systems (market and national insurance) ration care and then makes his recommendation for the best plan.

"Is the Welfare State Justified?" also delves into the sources of retirement income. If we live long enough, we'll need some form of income subsidy. Should government (the taxpayer) bear the expense of old age benefits? Or should individuals (and their families) bear this responsibility?

Once again, the author points to a system that is neither a national plan nor a market plan. Our retirement plans have resulted from years of meddling with the tax code. And like my aspirin example, "if it feels good at the time, then chew on it" seems to be the way our government has dealt with the regulation and taxation of old-age income.

In the past 50 years, health care and retirement income have come to be viewed as entitlements. We know that Social Security and Medicare are bankrupting this nation. The situation is only going to get worse.

Medicare and Medicaid have survived this long on the kindness of cost-shifting their respective burdens to group health insurance policyholders. Social Security is failing based solely on demographics. We cannot tax today's youth enough to keep the Baby Boomers on the golf course.

Policymakers could right the ship in time before it sinks if they would consider Dr. Shapiro's analysis and recommendations. Because his arguments are based on the philosophy of social welfare, and not on the partisan politics of entitlements, Dr. Shapiro succeeds in understanding how to overhaul the welfare state.

By coincidence, I began reading "Is the Welfare State Justified?" just after re-reading "Theory of the Leisure Class" by Thorstein Veblen. Though written a century ago, Veblen understood exactly where society was headed. He coined the term "conspicuous consumption." High-priced goods and services sometimes are referred to as Veblen goods, meaning that people desire them more as their price increases. Thus, do you wonder why increases in health care costs outpace the general inflation rate?

I can only hope that our policymakers will read Dr. Shapiro's book. His insight on the philosophy of the welfare state outclasses anything that I have read prior.



"Is the Welfare State Justified?" originally appeared in the February 8, 2008 issue of the West Virginia State Journal.



Copyright 1990-2008  David G. Allen