Health, Education — and Welfare?

If you want to give your mind a workout today, pour a cup of coffee and read Patrick Deneen’s Health, Education—and Welfare?

His launching point is that

the twin crises of health care and higher education are extraordinary in their similarities. Both are regarded as necessary goods for human flourishing whose costs are spiraling out of control. Both rely on a professional class that is becoming more specialized, losing the generalist who once cared for the “whole person.” Both have seen expanding intervention by the central government which has sought to provide access to the lower and middle classes. Both are believed by many conservatives to be properly reformed by means of market-based solutions. Both are the subject of intense contemporary political debate.

And both were once almost exclusively the province of the Church, and, indeed, can trace their institutional origins—hospitals and universities—as part of the Church’s charitable ministry.

The “intense political debate” falls into fairly predictable patterns, with one side arguing for free market solutions and the other arguing for regulation and price control/subsidy combinations to assure equal access. Deneen questions both effectively, though his questioning of The Right seems more devastating to me (maybe because I’ve tended to invest in that side). Summary introduction:

[T]here is something fundamentally amiss with making provision of health and higher education contingent on market models and profit calculus, as both seem to be goods that are not subject to the same kind of calculus as automobiles and bubble gum. The very idea that doctors and teachers are or ought to act out of the motivations of self-interest, and provide services to their “consumers,” seems fundamentally contradictory to the kind of work and social role performed by each. The decline of the “generalist” in each sphere is indicative of a deeper crisis of the willingness to act on behalf of a broader conception of the good intrinsic to each profession and on behalf of the person being served, in favor of the specialization encouraged by modern canons of efficiency, productivity, profit, and rationalization.

Summary introduction to his critique of The Left view:

At the same time, the State is rightly suspected of being unable to fundamentally improve or even maintain the quality of either sphere. It is doubtless the case that it can assure access by the heavy hand of threats, but many rightly worry that, as a consequence, the quality of care and education will deteriorate as a result. The State takes on the ersatz role of “generalist,” seemingly concerned for the good of the whole. It can only pursue that good by seeking to control pricing and access while influencing the ways “care” is provided, but it fails necessarily in caring for the vision of the whole that the actors of the professions are no longer willing or able to perform.


The debate as currently constituted represents a pincer movement aimed ultimately at the re-definition of each area—as we have seen in so many areas of contemporary life. While superficially opposites, proponents of each position in fact share a fundamental hostility to the original presuppositions that had informed the foundation of both institutions—the corporal works of charity central to the Church’s earthly mission.

I wish I could say “Yeah, that’s what I’ve been thinking; Deneen just had the time to think it through and to say it better.” But that would be a big ole lie. I wasn’t thinking in these terms at all. They go to my head and make me kind of, well, Tipsy.

I don’t know where to stop quoting. In my own re-reading, I didn’t know where to stop highlighting. Deneen could have the makings of a serious book on his hands as he fleshes out this dense piece. That one would surely go on my wish list.

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“The remarks made in this essay do not represent scholarly research. They are intended as topical stimulations for conversation among intelligent and informed people.” (Gerhart Niemeyer)

Some succinct standing advice on recurring themes.