The subject of my post of 7/14/15 (Pre-Medicaid ‘System’ Points to the Moral Alternative to Medicaid: A Free Market Safety Net) was the New Jersey Star-Ledger article Before Medicaid, how did doctors treat the poor? by NJ.com’s Kathleen O’Brien. In the article, O’Brien quoted a professor as saying that healthcare charity “was a totally funny system, and they would give this kind of assistance only to those they considered the 'worthy' poor." In my article comments, I said, “I would argue that [the pre-Medicaid cultural arrangement for dealing with the needy] was fundamentally a just ‘system’, precisely because it preserved the charity giver’s moral right to evaluate worthiness; i.e., the moral right to say ‘no.’” O’Brien replied to me as follows:
Lots of interesting food for thought here. However, I would add something that might change your perception of the "just" system of allowing the giver to judge the worthiness of the recipient: In the 1800s, it was very common for the latest wave of immigrants -- be they Irish, German, or later Italians -- to be the ones deemed "unworthy." One of the reasons the Catholic church got into the hospital business was that their parishioners were turned away from the existing hospitals. The same with the Jewish community -- as soon as they became established enough to be able to afford, collectively, to build a hospital, they did. However, this natural evolution of ethnic groups up the ladder of assimilation left out African-Americans, whose community never reached sufficient prosperity to build hospitals to serve its people.
First, note that, as O’Brien acknowledges, Irish, German, Italian, and Jewish immigrants overcame whatever discrimination they faced and figured out ways to take care of themselves because “as soon as they became established enough to be able to afford, collectively, to build a hospital, they did.” That’s not surprising, because those groups had a built-in advantage. They already possessed the virtues of independence, self-motivation, and courage, as evidenced by the very fact that they uprooted themselves from familiar surrounding in their homeland to travel across a vast ocean in order to settle in a strange land. Why? They were motivated by a desire for the freedom to take care of themselves, not be taken care of. And they did “become established,” thanks to the opportunity provided by the freedom accorded them in the Land of Liberty.
African-Americans had a built-in disadvantage: They had no history of independence, thanks to the legacy of slavery. To compound the problem, after being liberated from slavery, they ran into a wall of legalized discrimination, called segregation, which was instituted by the “Separate-but-Equal” doctrine imposed by the Supreme Court ruling Plessy vs. Ferguson and Jim Crow laws. But still, despite these handicaps, it’s not true that African-Americans “never reached sufficient prosperity” to take care of their own needy. Blacks progressed steadily in America before the welfare state really got going in the 1960s, observes Larry Elder. In fact, notes Elder, citing Thomas Sowell, black progress may have actually slowed after the institution of the so-called “War on Poverty.”
So, despite O’Brien’s supposition that I might change my “perception of the ‘just’ system of allowing the giver to judge the worthiness of the recipient,” the facts strengthen my belief in such freedom. Granted, leaving people free to make their own judgement about worthiness doesn’t guarantee that everyone will make just judgements, which may sometimes lead to unnecessary hardships for some of the needy. But that freedom, in addition to being an inalienable right, acted as a check on the unrestrained growth of “the needy.” Furthermore, victims of irrational discrimination have, being free individuals, an uninhibited path around social injustices. Under a rights-protecting government, who could stop them? Being on their own, they can surmount their own problems despite the prejudices. History, I believe, backs me up. In a fully free society, justice will win out over time without rights-violating government coercion. Indeed, if history teaches anything, it’s that attempting to use government coercion to rectify private, non-rights violating social injustice is usually counter-productive.
The fact of discrimination and prejudice is not an insurmountable problem for the victims, as long as government doesn’t legally impose it. For that reason, the racial and ethnic prejudice cited by O’Brien does not justify a coercive, rights-violating welfare state.
The Progress of American Blacks—Larry Elder
On America's "Social Contract," the Source of Individual Character, and Romney's 47%