People in Britain are outraged any time they hear about the National Health Service agreeing to cover the costs of certain medical prescriptions in one region but not others. They denounce the injustice of “postcode lottery”. After all, it is supposed to be a ‘national’ health service. It was established to ensure no citizen, rich or poor, would have to worry about having enough money to cope with sickness. But now budget constraints are increasingly leading to talk of rationing. How are we to decide who should get what when there is not enough to go round?
I have just learnt from a friend in America that Oregon has earlier in 2008 adopted, of all things, the lottery as the mechanism to deal with their healthcare crisis. 600,000 people in that state – 17% of the population – have no health insurance. The state wants to help them but due to ‘budget constraints’, it can only afford to cover the health insurance of 24,000 of its citizens. So all those without health insurance are invited to enter a lottery draw and a lucky 4% of them would be given a lifeline. The rest would have to accept their fate.
But budget constraints on government spending are always the results of decisions on what are to be prioritised. This is not just about decisions around building more bombs and fewer hospitals, but about how much revenue should be raised for the public good and how much should remain in the hands of private individuals. Those who subscribe to meritocracy would maintain that individuals who have the skills and drive to make money for themselves deserve to keep their hard earned wealth. The state’s role is to remove any barriers from people from realising their potential, and the rest should be left to individuals who apparently always know better than society’s collective wisdom regarding what to do with their money – be it about smoking, alcohol abuse, funding for medical research, or neglect of vulnerable children.
The problem with meritocracy is that it is not so easy to define anyone’s potential or what constitutes a barrier for the state to remove. Your genes, the upbringing received from your parents, your family’s socio-economic position, the neighbourhood/country in which you’re born, any serious sickness or disability you have to contend with, the quality and commitment of your teachers, the restrictions on your mobility to find better opportunities to flourish, all these can enhance your potential, or place virtually insurmountable barriers to success.
We actually have a choice. We could leave everything as it is. There will always be those born with multiple advantages, and those trapped by one misfortune or another. Let them get to the top, or sink to the bottom as events unfold, and from time to time let the state step in and offer the unlucky ones, or say 4% of them a helping hand to ease their burden a little. But overall we should not interfere with the Lottery of Life.
Or we could put an end to this gambling culture. Why deceive people into thinking they all have a fair chance to get on in life when the odds are stacked against many of them, with only a very few winners taking home the entire jackpot. Instead we should be honest and let people know that the only responsible way of living together is to have a system whereby those who have already handsomely won the gene code lottery and many besides should contribute a sufficient share to help deliver what is necessary for the public good. Those who have the misfortune to seek medical or other help through no fault of their own could then count on getting the support they need without undue constraints.
