The Cosmic Waiting Room (Healthy Discussion of Healthcare Policy, Part 4)

The Cosmic Waiting Room
(Healthy Discussion of Healthcare Policy, Part 4)

Let’s do an experiment. Imagine that you are in a waiting room, before all time, before all space. Very soon there will be a world and you will live in it. There will be a society and you will be part of it. I’m there, too. In fact, everyone who will ever live is there, too. But there’s a lot that you don’t know yet: You don’t know whether you will be rich or poor. You don’t know if you’ll be pretty or handsome. You don’t even know whether, once you are placed into the society yet-to-be, you’ll be a man or a woman, or what your sexual orientation or gender identity will be.  You don’t know what race you’ll be, whether you’ll be smart or stupid, talented or untalented, tall or short. You can only wonder whether your parents will be kind and nurturing or mean and neglectful. Will you be strong or weak? Will you have good health, or will fate deal you some illness? You do not know whether your parents or community will be Christian, Jewish, Muslim, Buddhist, adherents to some other religion, or atheist. In this cosmic waiting room, as you imagine what society will be like, you don’t know what your place or role or status will be.

Everyone in the waiting room faces the same uncertainty. No one knows what this society will be like, nor do they know how they will fare once they are birthed into that society. But they start talking to each other. (Work with me here — just imagine that their conversation doesn’t reveal things like gender, age, etc.). Now this is important: The one thing you and they know is this: If you wish, you may set some rules about the society-to-be, in advance. While you’re in this moment when nobody knows their future lot, you may negotiate with one another and decide a set of rules for the society yet to come, and everyone will have to live by those rules.

What would you want those rules to be?

Students of political theory will recognize the cosmic waiting room as my version of a famous thought experiment by John Rawls, who wrote “A Theory of Justice” and other books. Rawls was a professor at Harvard, and his book is probably the most important work on political theory in the past 300 years. Like so many others, I consider myself more-or-less a Rawlsian in my political theory. I encourage you to read some of his work or one of the many excellent summaries.

Here’s the basic idea: No one deserves their birth. Why should someone “deserve” benefits (that is, privileges denied to others) just because that person is born male, or white, or heterosexual, or rich? If you were waiting in that cosmic waiting room, negotiating the rules of the society-to-be, would you negotiate some rules that make sure everyone has a reasonable shot at a good life? If we want to be a “fair” society, no one should have all the rights and benefits just because of the accident of his or her birth. Instead, everyone should have a fair place and fair chance in society, no matter what cards fate has dealt at his or her birth.

For some issues, it seems fairly easy to imagine the cosmic negotiation. For example, most of us would want to create rules to make sure that the color of your skin won’t change your chances for a good life. In the waiting room, you don’t know whether your skin will be one color or another color, and you might worry that you’ll be disadvantaged by society based on the color you’re born with – even though that skin color isn’t your choice and has nothing to do with your merit. Others in the cosmic waiting room will share that worry, so you and they will likely agree that the society-to-be should disallow discrimination based on skin color.

You might also worry that you’ll be born poor, in a place where educational opportunities are limited. You’d prefer to make sure that, if you are born in such a place, at least there will be a minimum amount of education available to you, even if your parents can’t afford or won’t support it, so that you can make something of yourself and create a brighter future. Right?

The author who first envisioned the cosmic waiting room (he called it “being behind the veil of ignorance”) reasoned that most people would want to ensure a minimal set of rights that every member of society could expect. In fact, he figured we’d want this minimum to be as generous as possible – we would try to “maximize the minimum,” he argued.

My query for you today: Sitting in the cosmic waiting room, if you don’t know whether you’ll be healthy or unhealthy (or whether any particular individual person will be healthy or unhealthy), would you want to create rules that ensure everyone has a basic level of health insurance?

[Side note: I recognize that some of you believe that persons do deserve aspects of their health, and that belief will impact your reasoning about the cosmic waiting room. For the moment, try not to be distracted by that possibility – let’s stick to talking about the “big picture,” the reality that, for the most part, people do not earn their health fate.]

Some of you will predictably argue that I’m just trying to ask, in a new manner, whether health insurance ought to be a “right.” But that’s not exactly accurate. I’m asking whether reasonable people, understanding that none of us deserves either our good fortune or our bad fortune, would AGREE that fairness implies a need for basic protections for our health.

Speaking from a perspective of Christian theology and ethics, I am already committed to the idea that every child is born equal, at least in the eyes of God. Their inequality at birth is a matter of society’s inequalities, not God’s design. And because I count the blessings in my life as blessings (not necessarily that I deserve them), I do not view my brothers and sisters without all those same blessings as “undeserving” or unfavored by God. Yes, I am fortunate sometimes, but that doesn’t mean I “should” be fortunate and that others shouldn’t be. Instead, my faith tradition teaches me to be grateful for my good fortune, but it simultaneously teaches me that the less fortunate are also deserving or my care and concern, just as they are already the object of God’s care and concern.

The beauty of the cosmic waiting room experiment is that it imagines a negotiation among reasonable people, each relying on their reasonable concerns about basic fairness, to develop a basic set of rules for society. They employ reason, but they do not have to share the commitments of my faith tradition, or even the same ethical foundation. They only need to accept one premise: we don’t deserve our place at birth.

It’s sometimes difficult for us to enter into this thought experiment, because not one of us is sitting in the imagined cosmic waiting room. You already know whether you are male or female, rich or poor, healthy or unhealthy. And if you wanted to play along with the experiment, you’d have to imagine what it might be like to be something you are not. That is, you’d have to show some empathy, imagining yourself in someone else’s shoes.  If there’s anything that political discourse in recent months has shown, it’s the fact that too many people have limited ability to experience or demonstrate empathy for people unlike themselves. But I’m asking you to try. If you can think empathetically, I believe you’ll conclude, like I have, that we would all think a fair society is one that ensures at least basic healthcare for all.

Today I’m asking you what rules you might make (what you’d agree with others in the waiting room) regarding basic protections for healthcare. What do you think?

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