by Joseph Shieber

The traditional assumption in the United States has been that each person is individually responsible for their own health care. In other words, the US has a system in which the wealthy are able to afford more or better care (with the understanding that more care does not always lead to better health outcomes!), and the poor are able to afford less or no care.
There is something intuitively appealing about the idea that you should be rewarded in relation to the work that you’ve done or the results that you’ve achieved. It’s the basis of the well-known children’s fable, “The Little Red Hen”, in which the hen tries to get her fellow barnyard animals (dog, goose, etc.) to help her sow the seeds, reap the wheat, grind the grain, and bake the bread. Since none of the other animals are willing to help, when the bread is done the hen eats it all herself. In fact, the fable is so intuitively plausible that folksy free-market hero Ronald Reagan — pre-Presidency — used it himself.
The idea behind “The Little Red Hen” is so intuitively appealing that it’s not just limited to free market views. Even socialist thinkers from pre-Marxists like Ricardian socialists to later theorists like Lenin and Trotsky embraced the formula, “To each according to his works”, rather than Marx’s “To each according to his needs”.
Indeed, in a very useful paper, Luc Bovens and Adrien Lutz trace back the dual threads of “to each according to his works” and “to each according to his needs” to the New Testament. So, for example, in Romans 2:6, we see that God “will render to each one according to his works” (compare Matthew 16:27, 1 Corinthians 3:8).
In contrast, in Acts 4:35, we read that “There was not a needy person among them, for as many as were owners of lands or houses sold them and brought the proceeds of what was sold … and it was distributed to each as any had need” (compare Acts 2:45).
The deep textual roots of these two rival maxims suggests that each exerts a strong intuitive pull — though perhaps not equally strong to everyone.
Public health emergencies, however, reveal the fragility inherent in the motto of “to each according to his works” when it comes to health systems. Everyone’s health is interconnected, and that the ability of each individual to fight infection depends in part on everyone else’s having done their part. Read more »