Thomas Halper

Life and Death in a Welfare State: End-Stage Renal Disease in the United Kingdom

The uniquely parsimonious approach to treatment of end-stage renal disease patients in the U.K. was initially developed under the imprimatur of the nations medical elite and sanctioned by the central government. Public value for public money and an equitable balance of scarce resources among many social and medical claims still guide the National Health Service. But these clinically dominated allocative decisions are imperfect, often counter-productive, and, ultimately, political. There is a marked dissonance between compassionate and bureaucratic themes.

Pleasantville? The Suburb and Its Representation in American Movies

The authors study the representation of the U.S. suburb projected by movies and trace the development of these suburban images from the early movies of a century ago through the 1990s, noting how films have influenced and reflected public discourse on suburbs. Suburbs have evolved, becoming more varied and complex, more self-sufficient and more interdependent, the dominant mode of U.S. residential living, and the most widely embraced path to the “good life.” Yet postwar intellectuals have long dismissed the bourgeois utopia as inauthentic consumption centers and conformity factories. Moviemakers have taken these critiques to heart, initially with friendly satires and later with aggressive, often vicious attacks.The authors study the representation of the U.S. suburb projected by movies and trace the development of these suburban images from the early movies of a century ago through the 1990s, noting how films have influenced and reflected public discourse on suburbs. Suburbs have evolved, becoming more varied and complex, more self-sufficient and more interdependent, the dominant mode of U.S. residential living, and the most widely embraced path to the “good life.” Yet postwar intellectuals have long dismissed the bourgeois utopia as inauthentic consumption centers and conformity factories. Moviemakers have taken these critiques to heart, initially with friendly satires and later with aggressive, often vicious attacks.

The Double-Edged Sword: Paternalism as a Policy in the Problems of Aging

Paternalism--coercive or deceptive interference in a citizens life for his own good--is much in evidence in our policies regarding the aged. Some argue that paternalism is an unwarranted denial of individual liberty, ,for doubtful societal gain. Others contend that freedom has but instrumental value, and the aged cannot always use it effectively to aid in pursuit of their own happiness. The philosophical and political choices made on behalf of the aged must be understood as imperfect compromises.

Rights, Reforms, and the Health Care Crisis: Problems and Prospects

I am not sure that health care can profitably be discussed in the context of rights. For one thing, it is a term of many and shifting meanings, and thus virtually guarantees some degree of misunderstanding and confusion. For another, the very uttering of “rights” carries tones of ethical seriousness, if not outright superiority, that gives its advocates a substantial and unearned advantage in debate. Contemporary political scientists, as a result, have tended to feel more comfortable with “claims” (cf. [82]). Yet “rights” is what this book is about, and so “rights” must set the terms of the discussion.

POLITICS AND POLITICIZATION: AN EXERCISE IN DEFINITIONAL BRIDGE-BUILDING

POLITICAL scientists, like oversexed rabbits in a cage, are suffocating in the results of their own rhetorical fecundity. We speak here, however, not of a proliferation of concepts and hypotheses, but merely of definitions. Our most basic word, ‘politics’, has nearly as many definitions as there are political scientists. No matter how derivative his usage of the term, each writer feels called upon to supply his own unique definition, perhaps in the hope that the egoism which had heretofore produced such a multitude of formulations would end, as future political scientists, noting his exquisite turn of phrase, would defer to him.’ Maybe when political science becomes more quantitative, he thinks to himself, the unit of ‘politics’ will be named after me, just as in physics the unit of resistance was named after Ohm, the unit of current after Ampbre, and the unit of inductance after Henry.2 The result is a confusion which is made inescapable when different people use the same words, but do not really speak the same language. From the outside, the spectacle appears ridiculous. Platoons of chemists do not seek to discover ‘what is a chemical? nor do battalions of astronomers seek to discover ‘what is a celestial body?’ Yet whole armies of political scientists compete to tell us ‘what is politics?-a question very few ask except in order to provide an excuse for offering their own response. Moreover, since definitions can be neither true nor false, arguments over them appear unseemly when laid aside more conventional disagreements over the validity of facts or explanations. Consider these assertions :3 Politics . . . is the making of decisions by public means . . . Politics [is] the most inclusive process by which social conflict is regulated in the community. Politics refers to government action and anything designed to affect it.

Rights Talk and Rights

This is an age of rights. Though often deplored by all variety of ideologues (e.g., T. Smith; MacIntyre, 64; Tushnet; Pollis and Schwab), rights discourse, like Sherman’s army, has marched relentlessly on, overwhelming everything in its path. The American concern with rights, however, is hardly a new thing. The General Assembly of Maryland in 1638 declared that all free persons of the province “Shall have and enjoy all such rights, liberties immunities, privileges and free customs within the province as any natural born subject of England” (W.H. Brown, 41); in 1641 the Massachusetts colony legislated no less than seventeen “rights, liberties, and privileges” (Collections, 216-19); and in 1677 West New Jersey issued a charter prominently featuring rights (Boyd, 83–89). In short, America’s aggressive preoccupation with rights is a theme sounded since the society’s earliest days. As one scholar declared, “No thread runs through the tangle of American politics more clearly than rights” (Zuckert, Republic, 10). In controversy after controversy—gun control, same sex marriage, sexual harassment, above all, abortion—rights continue to frame and dominate current discourse. An academic and former presidential national security adviser, looking beyond this nation’s borders, called rights “the single most magnetic idea of the contemporary time” (Brzezinski, 256).

The American Political and Constitutional Context

Textually, the Constitution on positive rights is “voiceless as fear in a wide wilderness” (Keats, 281). Indeed, the original Constitution—what Gladstone famously called “The most wonderful work ever struck off at a given time by the brain and purpose of man” (Gladstone, “Kin”, 185)—made no mention of rights at all. Rights appearednot among the six justifications in the Preamble nor in any subsequent article. Nor did the original Constitution contain a bill of rights, which in any case, some of the Framers opposed. One might agree with Hamilton that the Constitution, with its intricate checks and balances, rendered a bill of rights “unnecessary” (Hamilton et at., 557);1 or one might conclude that the existence of the Constitution presupposes a belief in the right of the people to rule themselves. Still, the literal silence of the Constitution speaks volumes. Had they so chosen, the Framers could have instructed the national or state governments to secure certain positive rights, naming them, describing them vaguely or precisely, leaving no doubt that their existence was intended. Many state constitutions have taken this path;2 the United States Constitution, which is clearly not averse to imposing obligations of other kinds on the national government,3 did not. Instead, the Bill of Rights is expressed mostly in a series of prohibitory commands4—as is the Fourteenth Amendment5—which are classic statements of negative rights.

Broad Positive Rights

In general, positive rights are directed at three goals: to guarantee minimal levels of benefits for those too poor to be able to purchase them themselves; to protect the general populace against eventualities—sickness and injury, unemployment, old age—that they may lack the means or the foresight to address on their own; and to offer certain benefits to everyone, without mention of conditions or limitations, in the interest of furthering equality, justice, self actualization, or other important ideals (see, e.g., Felice; Susser; P. Unger; Outka).

Narrow Positive Rights and Libertarian Alternatives

Broad positive rights, painted with bold strokes and bright colors, may be counted on to draw crowds and get attention. But when we turn from advocacy to analysis, we are more likely to encounter a narrower version of positive rights, usually construed as an individual’s right to a reasonable or minimum level of a given benefit. This narrower view, though often argued with passion and vigor, has the advantage of appearing more practical than the broader view. Its aims are more modest, and its rhetoric usually softer voiced or technocratic. From the perspective of the advocate of broad positive rights, however, this aura of practicality is mere illusion. To imagine that piecemeal reforms can fundamentally alter the status quo is to surrender to fantasy, to accept the premises cynically spun by those in power, to sabotage the rationale for basic change. Yet these debating points, to those focusing upon narrower rights, are self refuting; for they are the talk of purists, and purity is unobtainable in an imperfect world, and in any case, incompatible with a spirit of toleration and compromise that free and prosperous societies require. An outsider committed to neither position may wonder what the fuss is about, since in his or her eyes the differences are not very great simply because the narrower view tends to be not very narrow.

Some Final Words

Americans imagine themselves a practical people. This is the land of know-how, can-do, getting-things-done, doing-what-works. Its honors and rewards go to leaders and problem solvers. Its philosophy is prone to address self improvement or corporate management, and is more likely to invoke the clergy or football coaches than Aristotle or Kant. Theoretical concerns are apt to be dismissed as unimportant and irrelevant, pretentious and boring.