A Breach of Contract

November 2, 2011

Political Theory


Over fall break, I went home for a medical procedure on my stomach. While I usually go to Highland Park Hospital (conveniently located where I live—Highland Park, Il), I had this procedure at Evanston Hospital, a much larger city outside of Chicago.

As anyone who has frequently been to the hospital knows, you do not simply walk in and immediately go to your doctor. Before seeing a doctor, a nurse, or a technician, it is necessary to check-in as one would at a hotel. The hospital receptionists go a distance in making sure all pertinent, necessary, and required information is there: name, birth date, social security, primary physician, and, of course, confirmation of insurance.

While at the hospital “checking in”, I could not help but be aware of the problems erupting from the booth next to mine. The person to my right—a middle age, Caucasian male—was at the hospital because he, like me, needed to have a medical procedure. Unlike me, however, this man no longer had insurance. His job did not include insurance, and the bad economic times forced him to stop his insurance payments; however, he had made that day’s appointment before his insurance had ended. The hospital did not want to conduct his procedure—they felt the risk of him not paying was greater than whatever medical risk he faced.

Though I never was able to hear what procedure he was meant to have, I was able to hear the pain, resentment, and disappointment in the man’s voice when trying to argue his case. He felt that since his appointment had been made while he had insurance, then that insurance should still cover the procedure. He said that he has had to prioritize his money for feeding his family and providing a home—he could not keep up with those commitments and maintain his insurance payments.

As I left the reception area and proceeded to the Gastroenterology wing at the hospital, I temporarily let this event slip from my mind. I went through with my appointment, and I returned to school. But as our class began to explore the annals of social contract theory, the thought occurred to me that perhaps this man’s social contract had been violated. According to Rousseau, “Men cannot engender new forces, but merely unite and direct existing ones, they have no other means of maintaining themselves but to form by aggregation a sum of forces that could gain the upper hand over the resistance, so that their forces are directed by means of a single moving power and made to act in concert.” Here, Rousseau states that only through collective action can we successfully combat nature’s barriers to our advancement, defining collective action as the aggregation of individual action in effort to reach a common goal. According to Rousseau, the greatest threats to humanity are those that require action by the aggregate. In my opinion, disease and bad health have always been significant forms of resistance to the advancement of society. Only by acting together and actively undertaking the effort to prevent disease do we stop it from seriously damaging or destroying our society.

Part of our social contract, therefore, is to offer and provide every citizen the opportunity to actively engage in upholding his/her individual responsibilities and desires for the betterment of society. Yet, by denying care to the healthcare-less man mentioned above, does the hospital violate this societal contract? Or is the man’s inability to provide his own healthcare—and instead care for the other interests he deems more important—a violation of the contract because it causes him to ignore the more significant societal obligation of containing disease and illness?

Furthermore, when our daily activities require us to enter into physical contracts, the laws and other agents of government enforce them. The social contract, while abstract, requires similar enforcement. In his text the Leviathan, Hobbes’ argues that “the agreement of these creatures is natural; that of men, is by covenant only, which is artificial: and therefore it is no wonder if there be somewhat else required (besides covenant) to make their agreement constant and lasting; which is a common power, to keep them in awe, and to direct their actions to the common benefit” (pg157 pp2). Therefore, Hobbes’ believes that individuals need a greater power to enforce the promises set forth in a society’s social contract and in the promises between individuals.

This ultimately poses what I believe to be the most important question facing society—whose responsibility is it to ensure the enforcement of society’s social contracts? In my opinion, the government carries the responsibility of maintaining the authenticity of a social contract. But can the government’s intervention in these matters infringe on the contract? To me, the answer is yes. We easily see examples of where society fails to implement needed action through private activity alone and, accordingly, fails to uphold aspects of the social contract. Yet, we do not nearly as easily come to agreement on the extent to which the government can act in the name of the people. So, I pose this question for discussion—to what extent should the government be able to intervene in private affairs on behalf of the people?

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9 Comments on “A Breach of Contract”

  1. ianbaker2041 Says:

    I think that the characterization of “contract” here is a little different from what Hobbes and Locke would have been thinking of hundreds of years ago. As I’m going to assume most people know, national healthcare is a pretty new concept; it’s not even a hundred years old in the modern sense. But this post isn’t about the history of national healthcare, so I won’t get into that any further.

    As anyone who has read some of my posts and comments can gather, I’m fiscally conservative. I believe that the foundation of our nation calls for a small federal government (large compared to the state governments but small when compared to some other federal ones throughout the world), free market capitalism, and economic freedom. With that said, national healthcare costs money. Lots of it. I’ve heard the idea bounced around often about starting national healthcare on the British model. Annually, the UK spends $155 billion on National Health Service (NHS) for a population of 49 million. If the US population is 6 times that of the UK (it’s actually more than 6), then that would mean spending of $930 billion per year. Given that the US budget for FY 2010 was $3,456 billion, that would account for over a quarter of the US budget. Given that our government is already tight on cash, where this extra money would come from is anyone’s guess. More taxes on the rich, I suppose.

    The numbers only tell half the story, however. As you mention, the other half comes from a sort of national philosophy and our social contract. The way I see it, the Constitution is our living, breathing contract-the very foundation upon which our nation was built. This document, far from endorsing any of the social programs that are in place today, was written specifically to keep the government out of our business and to allow Americans to largely do as they pleased, creating their ideal lifestyle for themselves. If healthcare is part of an American’s “ideal lifestyle,” then it follows that this individual should purchase his or her own health insurance. I am not opposing the changes made to the healthcare industry; the way insurance companies were abusing the system needed to be fixed, and Obama acted within his boundaries to end that injustice. The part that isn’t within the government’s boundaries to fix, however, is the fact that not everyone has health insurance. If people want access to the top quality medical care that we have here in the United States, they need to go out and make the money to get that. Taxpayers are not obligated to, nor should they have to, pick up that tab in any way, shape, or form. Each person has to stand on his or her own feet and cover his or her own medical costs, and society shouldn’t feel obligated to modify this system at all.

  2. cobyj17 Says:

    You raise an interesting point about the role of government in society. I view health care as a right, and therefore an essential piece of the social contract between citizens and their government. You mention that government intervention can lead to an infringement of the social contract. I would argue that not intervening to make health care affordable for the over 40 million uninsured Americans is an infringement of the social contract. In response to the comment above, the United States spends 17% of GDP on health care, far more than any industrialized country. Additionally, no other industrialized country has a major proportion of their population without coverage. The constitution of the government specifies that the government should “promote the general welfare.” To say that the problem can be fixed by people going out and making more money is an oversimplification. People with faultless pre-existing conditions are being denied coverage because the government is not involved enough in regulating the system. While I agree that it is somewhat problematic for the government to force everyone to purchase health insurance, it is essential to the system being affordable. Without complete participation, healthy people would not get care, which would increase costs for the people who need coverage most. The benefits of universal coverage outweigh the liberty taken away by the government.

    The government also forces you to pay taxes toward public education if you go to a private school. Our social contract includes that people pay for things so the system as a whole can function, this is an instance where that is more true than ever.

  3. tylerhoffman1 Says:

    The author asks some intriguing questions, who’s job is it to enforce social contracts, and specifically in this case, who’s job is it to enforce healthcare contracts? While I agree that the government does is in their power to enforce some social contracts, other social contracts should be at the discretion of society to enforce. My example of a society enforced social contract, healthcare. While you present an anecdote that is an exception, if the government were to allow “free” national healthcare to everyone, there would be questions as to whether society would be better off as a whole. While some families and individuals would benefit from this system, others would take advantage of the system and live life with more risk, a concept known as moral hazard. Some social contracts, such as healthcare insurance, should be left up to the citizens to enforce, because if the government is in control, it may not act for the betterment of society as whole.

  4. Connor Baharozian Says:

    Looking at the what was going on in the hospital, one must consider not only the patient’s view, but also the hospital’s view and, more specifically, the doctor’s view. To go through with a surgery, a doctor takes a risk just like a patient. Representing the doctor, the hospital also, by association, takes a risk by allowing surgery to be performed on the patient. There are many medical legal issues at play with this case. In terms of self-interest, the patient wants to perform the surgery for his own benefit, however, the doctor and hospital only see potential risks with no compensation. Laws that require doctor’s to help people in need, I think are moral. However, the culture surrounding medicine today is somewhat appalling in terms of the amount of malpractice lawsuits. For doctor’s to perform surgeries on patients, they must have adequate compensation. I know of 3 doctors who have stopped practicing after malpractice cases. Other doctors see these cases and are therefore very hesitant to perform surgeries/operations that they don’t see as going smoothly. We must consider doctor’s and how implementing guarantees to medical service affects them. Yes, the patient should receive care, but government should set standards that protect doctor’s and hospitals as well.

  5. evanhw Says:

    First off, these are great questions that helped me question what I believe a social contract to be in this current day and age. Secondly, I thought the previous comment brings up an interesting point about procedural legalities the doctors face in this particular situation. Considering the author doesn’t state whether this man’s health problem was life threatening or not, I then looked at this man’s situation in two more definitive scenarios in hopes that theories of Hobbes, Locke, or Rousseau would become more useful.

    If this man had a medical emergency that required a doctor immediately, one could argue that Locke and Rousseau’s theory of “private property” was at risk for this man and his end of the social contract was not being upheld. The authority figure, which I believe in this case is the government, is required to provide equal protection. If this man was unjustly denied healthcare, the government would not be following the social contract whom we allow to regulate in the first place. Assuming that this is not the case however, and the man has some sort of ability to renew his health insurance or find another way to receive medical attention, I feel more compelled to side with the hospital or most importantly the laws of the government. Unfortunately, I believe in this situation Locke and Rousseau would ultimately feel that this man is accountable to uphold his end of the social contract – abiding to the laws of authority and in return receive a “civil life”. I am well aware of social inequalities throughout the world and in the U.S., however in accordance with what we have learned about the social contract theory my inclination is to side with the hospital’s ultimate decision to deny this man.

  6. bmjasper Says:

    The question that you pose is one that has been heavily debated over for centuries. As mentioned in a previous comment, the U.S. Constitution can be considered our nation’s “social contract,” which has acted to ensure the individual freedoms of American citizens since 1788. The preamble to the Constitution in Article One, section 8 states that one of the purposes of the United States of America is to promote the general welfare of its people. Thus, in order to abide by this social contract, the government is responsible for providing adequate and available healthcare to every citizen regardless of whether or not they have health insurance. Refusing to do so is a direct breach of our nation’s social contract. Congress needs to approve an amendment to the Constitution declaring that all citizens of the U.S. have equal access to all basic and necessary healthcare.

  7. rschles92 Says:

    In this economic climate it is doubtful to see free healthcare happen anytime soon. Medical companies make so much money and eliminating that from the private sector could crush economic growth in the US at a time when things are already bleak. Morally, it is a no brainer. The government should provide healthcare to all of its citizens. Education is provided for free but to survive it’s gonna cost ya. It does not really make sense. I understand conservatives like to follow the constitution closely and there is not explicit mention of providing medical care to citizens. But I think its a mistake to hold documents drafted in 1788 accountable for things like this. The world has changed so drastically that is plainly impractical to hold it to the exact word. I think the forefathers who wrote the Constitution would feel the need to provide healthcare.

  8. beaurh Says:

    The notion of universal healthcare is morally just and a very kind notion, it just pushes the boundaries for too many conservatives to ever allow it. Universalizing healthcare will greatly cut down on insurance company profits ( a major and influential industry) and also cut profits for doctors. Doctors who have paid absurd amounts for an education necessary to save lives, will be unable to pay back loans for this education because they do not earn enough. Also, paying for those who do not have insurance, should not be the problem of successful, wealthy citizens, many of whom are financially insecure as well. The social contract is an interesting topic to mention. Is it the duty of the more fortunate to cover the costs of the less? What is the role of the less fortunate in this case?
    Although I am fiscally conservative, the healthcare system should be reevaluated and like ianbaker said before, Obama has and is creating legislation to prevent insurance companies from taking advantage of struggling victims. It is upsetting that partisan strife and vastly differing ideologies is inhibiting finite progress.

  9. jeanchaw Says:

    As I was looking back at the different blogs that were posted over the semester, Breach of Contract recaptured my attention because of its focus on relationships within society. I believe that relationships are the critical issue when observing situations that incorporate social contracts. Individuals must have a relationship with their governments such that their government picks up the slacks that people cannot handle privately. In that sense, I do think that there should be some form of universal health insurance, perhaps not on an every citizen scale though.

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