My question for Ron Paul: Autonomy and health care

Earlier this year at the Tea Party debate, Wolf Blitzer asked Ron Paul if a person who chose not to buy health care should be left to die. Paul responded that this person’s friends and community could support him and pay his bills. Many in the audience seemed to be all right with letting this person die.

Conservatives and libertarians both express a strong commitment to autonomy, which they sometimes refer to as freedom. The new health care law is unacceptable they say, because it requires individuals to purchase insurance. People should not be required to purchase insurance, but they should be responsible for the consequences if they do not have insurance. Of course, this scenario is rarely a problem for anyone, and Blitzer asked the wrong question.

I would want to ask a different question. I want to know about the person who has worked all her life and been successful. After 20 or 30 years, she decides to expand her opportunities by starting her own business. Remarkably, her business is profitable in its first year. She can afford to buy insurance, but she cannot buy adequate coverage because she has preexisting conditions that every major insurance carrier refuses to cover. When she contracts a serious illness, she is driven into bankruptcy because of medical bills that are astronomical but quite common. Should our country let her die? Should she be permitted to slide into bankruptcy?

Autonomy is not quite as simple a question as it apparently seems to Republicans and libertarians. Philosopher Isaiah Berlin described two types of liberty: one is negative and the other is positive. For conservatives, it is imperative that individuals not be forced to do something they may not want to do and no government intrusion is acceptable. This is negative liberty. For liberals, such liberty is meaningless if one is unable to make the choices he or she desires, which is positive liberty.

Describing the liberal view of positive liberty, Berlin says,

“It is true that to offer political rights, or safeguards, against intervention by the state, to men who are half-naked, illiterate, underfed, and diseased is to mock their condition; they need medical help or education before they can understand, or make use of, an increase in their freedom. ”

While conservatives will not force someone to purchase insurance, liberals want to ensure that everyone has the option to have health care. Everyone who needs health care and cannot obtain it becomes a liberal in an instant.

The number of uninsured in the United States is said to be around 50 million, but many more than that have inadequate insurance. Unfortunately, most people do not realize they are underinsured until it is too late. Many people only learn that their treatment will not be covered by insurance after they have received the treatment. What kind of autonomy is this? What is the value of liberty if it leaves one with no options to avoid bankruptcy, untreated illness, and death? Is this really what we want to be?

The Value of Simplicity

Many political, social, and religious movements advocate simple living as a way of reducing demand for financial resources, increasing spiritual awareness, and placing fewer demands on environmental resources. For some, simplicity is a matter of interior design or architecture that emphasizes a lack of clutter and distraction. For examples, consider some Buddhist monasteries and temples, and meeting houses of the Religious Society of Friends. Architects design buildings to help people focus on their own thoughts and revelations while meditating or praying. Some practitioners will extend simplicity of design to clothing, gardens, and other spaces. In some ways, this first concern focuses on the benefits to the individual, especially with regard to spiritual growth. The spiritual growth of the individual should then provide benefits for others or for the universe as a whole, or so some believe.

Another argument for simple living focuses primarily on what is good for others. By living simply, we can leave more resources for current inhabitants of the world, including animals, and for future generations. Our commitment to simplicity also takes us out of competition with our neighbors. We no longer struggle to have the best clothes, homes, or cars. If everyone practiced this type of simplicity, it is argued, we could feed the world’s hungry and provide medical care for the world’s sick. People as diverse as Buddha, Jesus, and philosopher Peter Singer have argued for simplicity as a moral imperative.

These two arguments for simplicity cannot be separated. The spiritual growth or enlightenment of the individual should benefit others and be aimed, ultimately, at relieving suffering and providing comfort. The benefit of meditation and prayer is not to be a sense of calm or relaxation. The goal is to be a better person, not to feel better. I should perhaps qualify this last sentence and say that I believe the goal of meditation and prayer should be to become a better person rather than a more relaxed person. A feeling of calm can help one see reality with greater clarity, but calm in itself is not the end goal of meditation. Right thought is necessary to produce right action, and right action is driven by compassion for all that suffer, which is to say all that live.

The Religious Society of Friends (Quakers) has a long and rich tradition of simplicity (known as the “Testimony of Simplicity”). From the inception of the tradition, Friends met in unadorned buildings, wore plain clothing, and waited in silence to be inspired by the “light within.” The benefits of simplicity were described in the 17th century by Quaker William Penn:

“Personal pride does not end with noble blood. It leads people to a fond value of their persons, especially if they have any pretense to shape or beauty. Some are so taken with themselves it would seem that nothing else deserved their attention. Their folly would diminish if they could spare but half the time to think of God, that they spend in washing, perfuming, painting and dressing their bodies. In these things they are precise and very artificial and spare no cost. But what aggravates the evil is that the pride of one might comfortably supply the needs of ten. Gross impiety it is that a nation’s pride should be maintained in the face of its poor. ”

It was important to Penn that the money saved on adornments could be used to help those in need. Recently, pride has come to be seen as a virtue, but William Penn obviously considered pride to be a sin that encumbered any attempt to achieve justice or moral goodness.

Another Quaker, Richard Gregg, was equally clear on the value of simplicity in 1936. He said:

To give a concrete instance of what I mean by unity and disunity, it would be consistent with a real awareness of human unity if I should invite into my house for a meal and a night’s lodging a starving man who has knocked at my door. But if my rugs are so fine that I am afraid his dirty shoes may ruin them, I hesitate. If I have many valuable objects of art or much fine silverware, I also hesitate for fear he may pocket some of them or tell men who may later steal them from the house. If my furniture and hangings bespeak great wealth I mistrust him lest he hold me up; or perhaps if I am less suspicious and more courageous and more sensitively imaginative, I fear lest the contrast between his poverty and my abundance will make him secretly envious, or resentful, or bitter, or make him feel ill at ease. Or perhaps he is so very dirty that I fear he has vermin, and I am revolted by that thought and am so far from him humanly that I do not know how to deal with him humanely. In this case it is clear that my lack of simplicity acts as a barrier between him and me. The prolonged lack of simplicity of our whole society has increased the distance between his thoughts, feelings and ways, and mine, and so adds to the social barrier. That troubles me.

It is clear that Richard Gregg saw acquisition of “things” to be a problem. While forced poverty is not the goal of simplicity, detachment from items of material value is a goal of simplicity. Attachment to expensive housing, artwork, clothing, or other ornaments interferes with one’s ability to act morally. The money saved can be used to help the plight of those suffering in the world, and the lack of attachment to ornaments frees one from being “owned” by one’s own property. It also means that one does not need to live in debt or with obligations to others. It means one is not required to ask for gifts from others who may or may not be dishonorable. In this sense, simplicity is both a form of liberation and a method for helping to liberate others from poverty or extreme suffering. The teaching on simplicity by Friends is rather unambiguous.

A 2001 New York Times article describes how the Live Oak Friends Meeting in Houston, Texas came to build a $1.5 million meeting house based on the principles of simplicity. The article notes that the 100 members of the meeting raised $500,000 through internal efforts and the remaining $1 million came from donations from “individuals, corporations and foundations making contributions to a nonprofit corporation set up for the purpose of the project.” The article does not specify who the individuals, corporations, and foundations were or whether they were screened for social responsibility.

The meeting house was designed by architect Leslie Elkins, but the cost is due largely to the James Turrell “skyspace” integrated into the meeting house. Turrell is a Quaker artist who uses light as his medium. The skyspace is like an open-air atrium with a retractable roof. When the skyspace is open, there is simply an open square in the center of the ceiling. Anyone can look at a section of the sky at any time for no cost at all, of course. Turrell creates an aesthetic experience of light in the sky in the same way my favorite composer, John Cage (influenced by Taoism and not a Quaker), creates an aesthetic experience of silence for audiences. The value of the art, as Taoists would say, lies in what is not there.

At Turrell’s insistence, any trees that obstructed the view through the skyspace were cut down. Turrell’s art, and the skyspace, attract visitors from around the world. Visitors may view the skyspace for free but donations are accepted. At the insistence of the artist, photography is not allowed as the rights to any images of the skyspace are retained by James Turrell.

Due to the expense of repairs to the skyspace and the cost of the building, the members of the meeting are understandably concerned with protecting the investment in this work of art. When I say “understandably,” I mean to imply that Richard Gregg, for example, would understand.

The meeting house follows simplicity by design. Does it fulfill the testimony of simplicity as described by William Penn and Richard Gregg? Could $1.5 million be better spent? Does the skyspace serve a greater purpose of promoting social justice and environmental sustainability in the world? I think the questions are worth considering, even six years after the fact.

Randall Horton