Paying for health

A person's income determines his/her access to many things he wants and needs: food, clothing, transportation, housing, entertainment, and the internet, for example. And people who have higher income are able to consume more of all of these categories than people with lower income, if they choose to. More affluent people shop for food at Papa Joe's or Whole Food; live in larger and more luxurious homes; buy their clothing from boutiques rather than Penny's or the thrift shop; and drive multiple handsome cars. Poor people can't afford the luxury end of these forms of consumption. And in some way our culture has judged that these sorts of inequalities of consumption are a legitimate and fair part of a market economy; if you judge that inequalities of income are justifiable (perhaps with some limits on extremes), then you pretty much have to support the idea of inequalities of consumption as well.

But what about goods that have a price but that are essential to living a decent human life? Food certainly falls in this category; if 30% of society could literally not afford to purchase enough calories to provide 2200-2900 calories per day for adults and 1800 calories for children, then we would probably have a different idea about the fairness of a market for food -- the principle that says "to each according to his/her earning capacity" doesn't seem very convincing in circumstances where it leads to malnutrition or starvation. In other words, if the normal workings of a market economy left a significant segment of the population without the ability to purchase enough food for subsistence, we would surely judge that this isn't a fair or socially just way of distributing income and food. And there is an important point to be noted here: there is hunger in America, and the system of producing goods and income isn't fully satisfying the subsistence needs of the whole population. (This is exactly what makes it compelling that our government needs to provide food assistance for the very poor, through food stamps or targeted income supplements.) So there is an important issue about the justice of current actual distributions of such basic goods as food, clothing, or shelter across the U.S. population.

But push a little deeper and consider the "market for health care". Supporting one's current healthy status is a costly effort; repairing the body in times of traumatic injury or serious illness is even more costly; and our society leaves a lot of the allocation of health care services to private purchasing power. Health insurance is the primary vehicle through which many Americans provide financially for their health care needs. Some people have insurance provided or subsidized through their employers; some families purchase health insurance through the private market; and many families lack health insurance entirely. Upwards on 47 million Americans are uninsured, including 20% of adults and 9% of children (CDC link). And this includes a wide range of Americans, from the extremely poor to the working poor to the solidly middle class.

It is clear that access to doctors, hospitals, nurses, and prescription drugs is a critical need that everyone faces at various points in life. It is obvious as well that one's future ability to live and work productively and to enjoy a satisfying life is conditioned by one's ability to gain access to health care when it is needed. It is also clear that uncertainty about the availability of health care is a major source of anxiety for many, many people in U.S. society today. So it is self-evident that decent health care is one of our most basic and unavoidable needs.

So what do people do when they lack health insurance and serious illness or injury occurs? This isn't a mystery anymore; families go into debt to doctors and hospitals, they face bankruptcy, they find some limited sources of free care (free clinics, pro bono doctors' services), and they forego "optional" treatments that may well extend the length or quality of life. And it is evident that this pattern results in very serious harms and limitations for people in these groups. People who have the least access to health care through our basic institutions may be expected to live shorter lives and to suffer more.

And what about people at the high end of the income spectrum? How do they relate to the problems of health? Here too the answers are fairly well known: they are able to seek out the best (and most expensive) specialists, travel to national centers for specialized treatment, and undergo advanced diagnostic tests that are not covered by insurance. (Here is a news story from CNN on boutique health care.) The affluent aren't able to assure their health through expenditure -- but they can certainly improve their odds.

In other words, ability to pay influences the quality and extent of health care that an individual or family is able to gain access to; and the health status of the family is affected by these variations in quality and access. So, to some meaningful extent, our social system places health care in the category of a market good.

But here is the question I'm working around to: what does justice require when it comes to health care? Is it right to look at health care as just another consumption good like shoes -- affluent people wear Gucci and poor people wear Dollar Store, but everyone has his/her feet covered? Or is health care in a special category, too closely linked to living a full human life to allow it to be distributed so unequally? (Norm Daniels has spent most of his career looking at this issue, from the points of view of philosophy and concrete policy reform. See Just Health: Meeting Health Needs Fairly for some of his findings.)

It seems a bitter but unavoidable truth that there are very substantial inequalities in the provision of health care in our society. One person's likelihood of surviving a devastating cancer may be significantly less than another person's chances, simply based on the second person's ability to pay for premium health care services. Further, it seems unavoidable that these extreme inequalities are flatly unjust in any society that believes in the equal worth of all human beings. And where this seems to lead is to the conclusion that some system of universal health insurance is a fundamental requirement of justice.

Paying for health

A person's income determines his/her access to many things he wants and needs: food, clothing, transportation, housing, entertainment, and the internet, for example. And people who have higher income are able to consume more of all of these categories than people with lower income, if they choose to. More affluent people shop for food at Papa Joe's or Whole Food; live in larger and more luxurious homes; buy their clothing from boutiques rather than Penny's or the thrift shop; and drive multiple handsome cars. Poor people can't afford the luxury end of these forms of consumption. And in some way our culture has judged that these sorts of inequalities of consumption are a legitimate and fair part of a market economy; if you judge that inequalities of income are justifiable (perhaps with some limits on extremes), then you pretty much have to support the idea of inequalities of consumption as well.

But what about goods that have a price but that are essential to living a decent human life? Food certainly falls in this category; if 30% of society could literally not afford to purchase enough calories to provide 2200-2900 calories per day for adults and 1800 calories for children, then we would probably have a different idea about the fairness of a market for food -- the principle that says "to each according to his/her earning capacity" doesn't seem very convincing in circumstances where it leads to malnutrition or starvation. In other words, if the normal workings of a market economy left a significant segment of the population without the ability to purchase enough food for subsistence, we would surely judge that this isn't a fair or socially just way of distributing income and food. And there is an important point to be noted here: there is hunger in America, and the system of producing goods and income isn't fully satisfying the subsistence needs of the whole population. (This is exactly what makes it compelling that our government needs to provide food assistance for the very poor, through food stamps or targeted income supplements.) So there is an important issue about the justice of current actual distributions of such basic goods as food, clothing, or shelter across the U.S. population.

But push a little deeper and consider the "market for health care". Supporting one's current healthy status is a costly effort; repairing the body in times of traumatic injury or serious illness is even more costly; and our society leaves a lot of the allocation of health care services to private purchasing power. Health insurance is the primary vehicle through which many Americans provide financially for their health care needs. Some people have insurance provided or subsidized through their employers; some families purchase health insurance through the private market; and many families lack health insurance entirely. Upwards on 47 million Americans are uninsured, including 20% of adults and 9% of children (CDC link). And this includes a wide range of Americans, from the extremely poor to the working poor to the solidly middle class.

It is clear that access to doctors, hospitals, nurses, and prescription drugs is a critical need that everyone faces at various points in life. It is obvious as well that one's future ability to live and work productively and to enjoy a satisfying life is conditioned by one's ability to gain access to health care when it is needed. It is also clear that uncertainty about the availability of health care is a major source of anxiety for many, many people in U.S. society today. So it is self-evident that decent health care is one of our most basic and unavoidable needs.

So what do people do when they lack health insurance and serious illness or injury occurs? This isn't a mystery anymore; families go into debt to doctors and hospitals, they face bankruptcy, they find some limited sources of free care (free clinics, pro bono doctors' services), and they forego "optional" treatments that may well extend the length or quality of life. And it is evident that this pattern results in very serious harms and limitations for people in these groups. People who have the least access to health care through our basic institutions may be expected to live shorter lives and to suffer more.

And what about people at the high end of the income spectrum? How do they relate to the problems of health? Here too the answers are fairly well known: they are able to seek out the best (and most expensive) specialists, travel to national centers for specialized treatment, and undergo advanced diagnostic tests that are not covered by insurance. (Here is a news story from CNN on boutique health care.) The affluent aren't able to assure their health through expenditure -- but they can certainly improve their odds.

In other words, ability to pay influences the quality and extent of health care that an individual or family is able to gain access to; and the health status of the family is affected by these variations in quality and access. So, to some meaningful extent, our social system places health care in the category of a market good.

But here is the question I'm working around to: what does justice require when it comes to health care? Is it right to look at health care as just another consumption good like shoes -- affluent people wear Gucci and poor people wear Dollar Store, but everyone has his/her feet covered? Or is health care in a special category, too closely linked to living a full human life to allow it to be distributed so unequally? (Norm Daniels has spent most of his career looking at this issue, from the points of view of philosophy and concrete policy reform. See Just Health: Meeting Health Needs Fairly for some of his findings.)

It seems a bitter but unavoidable truth that there are very substantial inequalities in the provision of health care in our society. One person's likelihood of surviving a devastating cancer may be significantly less than another person's chances, simply based on the second person's ability to pay for premium health care services. Further, it seems unavoidable that these extreme inequalities are flatly unjust in any society that believes in the equal worth of all human beings. And where this seems to lead is to the conclusion that some system of universal health insurance is a fundamental requirement of justice.

Paying for health

A person's income determines his/her access to many things he wants and needs: food, clothing, transportation, housing, entertainment, and the internet, for example. And people who have higher income are able to consume more of all of these categories than people with lower income, if they choose to. More affluent people shop for food at Papa Joe's or Whole Food; live in larger and more luxurious homes; buy their clothing from boutiques rather than Penny's or the thrift shop; and drive multiple handsome cars. Poor people can't afford the luxury end of these forms of consumption. And in some way our culture has judged that these sorts of inequalities of consumption are a legitimate and fair part of a market economy; if you judge that inequalities of income are justifiable (perhaps with some limits on extremes), then you pretty much have to support the idea of inequalities of consumption as well.

But what about goods that have a price but that are essential to living a decent human life? Food certainly falls in this category; if 30% of society could literally not afford to purchase enough calories to provide 2200-2900 calories per day for adults and 1800 calories for children, then we would probably have a different idea about the fairness of a market for food -- the principle that says "to each according to his/her earning capacity" doesn't seem very convincing in circumstances where it leads to malnutrition or starvation. In other words, if the normal workings of a market economy left a significant segment of the population without the ability to purchase enough food for subsistence, we would surely judge that this isn't a fair or socially just way of distributing income and food. And there is an important point to be noted here: there is hunger in America, and the system of producing goods and income isn't fully satisfying the subsistence needs of the whole population. (This is exactly what makes it compelling that our government needs to provide food assistance for the very poor, through food stamps or targeted income supplements.) So there is an important issue about the justice of current actual distributions of such basic goods as food, clothing, or shelter across the U.S. population.

But push a little deeper and consider the "market for health care". Supporting one's current healthy status is a costly effort; repairing the body in times of traumatic injury or serious illness is even more costly; and our society leaves a lot of the allocation of health care services to private purchasing power. Health insurance is the primary vehicle through which many Americans provide financially for their health care needs. Some people have insurance provided or subsidized through their employers; some families purchase health insurance through the private market; and many families lack health insurance entirely. Upwards on 47 million Americans are uninsured, including 20% of adults and 9% of children (CDC link). And this includes a wide range of Americans, from the extremely poor to the working poor to the solidly middle class.

It is clear that access to doctors, hospitals, nurses, and prescription drugs is a critical need that everyone faces at various points in life. It is obvious as well that one's future ability to live and work productively and to enjoy a satisfying life is conditioned by one's ability to gain access to health care when it is needed. It is also clear that uncertainty about the availability of health care is a major source of anxiety for many, many people in U.S. society today. So it is self-evident that decent health care is one of our most basic and unavoidable needs.

So what do people do when they lack health insurance and serious illness or injury occurs? This isn't a mystery anymore; families go into debt to doctors and hospitals, they face bankruptcy, they find some limited sources of free care (free clinics, pro bono doctors' services), and they forego "optional" treatments that may well extend the length or quality of life. And it is evident that this pattern results in very serious harms and limitations for people in these groups. People who have the least access to health care through our basic institutions may be expected to live shorter lives and to suffer more.

And what about people at the high end of the income spectrum? How do they relate to the problems of health? Here too the answers are fairly well known: they are able to seek out the best (and most expensive) specialists, travel to national centers for specialized treatment, and undergo advanced diagnostic tests that are not covered by insurance. (Here is a news story from CNN on boutique health care.) The affluent aren't able to assure their health through expenditure -- but they can certainly improve their odds.

In other words, ability to pay influences the quality and extent of health care that an individual or family is able to gain access to; and the health status of the family is affected by these variations in quality and access. So, to some meaningful extent, our social system places health care in the category of a market good.

But here is the question I'm working around to: what does justice require when it comes to health care? Is it right to look at health care as just another consumption good like shoes -- affluent people wear Gucci and poor people wear Dollar Store, but everyone has his/her feet covered? Or is health care in a special category, too closely linked to living a full human life to allow it to be distributed so unequally? (Norm Daniels has spent most of his career looking at this issue, from the points of view of philosophy and concrete policy reform. See Just Health: Meeting Health Needs Fairly for some of his findings.)

It seems a bitter but unavoidable truth that there are very substantial inequalities in the provision of health care in our society. One person's likelihood of surviving a devastating cancer may be significantly less than another person's chances, simply based on the second person's ability to pay for premium health care services. Further, it seems unavoidable that these extreme inequalities are flatly unjust in any society that believes in the equal worth of all human beings. And where this seems to lead is to the conclusion that some system of universal health insurance is a fundamental requirement of justice.

Demystifying social knowledge

There seem to be a couple of fundamentally different approaches to the problem of "understanding society." I'm not entirely happy with these labels, but perhaps "empiricist" and "critical" will suffice to characterize them.  We might think of these as styles of sociological thinking.  One emphasizes the ordinariness of the phenomena, and looks at the chief challenges of sociology as embracing the tasks of description, classification, and explanation.  The other highlights the inherent obscurity of the social world, and conceives of sociology as an exercise in philosophical theory, involving the work of presenting, clarifying and critiquing texts and abstract philosophical ideas as well as specific social circumstances.

The first approach looks at the task of social knowing as a fairly straightforward intellectual problem. It could be labeled "empiricist", or it could simply be called an application of ordinary common sense to the challenge of understanding the social world. It is grounded in the idea that the social world is fundamentally accessible to observation and causal discovery.  The elements of the social world are ordinary and visible. There are puzzles, to be sure; but there are no mysteries.  The social world is given as an object of study; it is partially orderly; and the challenge of sociology is to discover the causal processes that give rise to specific observed features of the social world.

This approach begins in the ordinariness of the objects of social knowledge.  We are interested in other people and how and why they behave, we are interested in the relationships and interactions they create, and we are interested in institutions and populations that individuals constitute. We have formulated a range of social concepts in terms of which we analyze and describe the social world and social behavior -- for example, "motive," "interest," "emotion," "aggressive," "cooperative," "patriotic," "state," "group," "ethnicity," "mobilization," "profession," "city," "religion." We know pretty much what we mean by these concepts; we can define them and relate them to ordinary observable behaviors and social formations. And when our attention shifts to larger-scale social entities (states, uprisings, empires, occupational groups), we find that we can observe many characteristics of each of these kinds of social phenomena.  We also observe various patterns and regularities in behavior, institution, and entity that we would like to understand -- the ways in which people from different groups behave towards each other, the patterns of diffusion of information that exist along a transportation system, the features of conflicts among groups in various social settings. There are myriad interesting and visible social patterns which we would like to understand, and sociologists develop a descriptive and theoretical vocabulary in terms of which to describe and explain various kinds of social phenomena.

In short, on this first approach, the social world is visible, and the task of the social scientist is simply to discover some of the observable and causal relations that obtain among social actors, actions, and composites. To be sure, there are hypothetical or theoretical beliefs we have about less observable features of the social world -- but we can relate these beliefs to expectations about more visible forms of social behavior and organization. If we refer to "social class" in an explanation, we can give a definition of what we mean ("position in the property system"), and we can give some open-ended statements about how "class" is expected to relate to observable social and political behavior. And concepts and theories for which we cannot give clear explication should be jettisoned; obscurity is a fatal defect in a theory.  In short, the task of social science research on this approach is to discover some of the visible and observable characteristics of social behavior and entities, and to attempt to answer causal questions about these characteristics.

This is a rough-and-ready empiricism about the social world. But there is another family of approaches to social understanding that looks quite different from this "empiricist" or commonsensical approach: critical theory, Marxist theory, feminist theory, Deleuzian sociology, Foucault's approach to history, the theory of dialectics, and post-modern social theory. These are each highly distinctive programs of understanding, and they are certainly different from each other in multiple ways. But they share a feature in common: they reject the idea that social facts are visible and unambiguous. Instead, they lead the theorist to try to uncover the hidden forces, meanings, and structures that are at work in the social world and that need to be brought to light through critical inquiry. Paul Ricoeur's phrase "the hermeneutics of suspicion" captures the flavor of the approach.  (See Alison Scott-Baumann's Ricoeur and the Hermeneutics of Suspicion for discussion.) Neither our concepts nor our ordinary social observations are unproblematic. There is a deep and sometimes impenetrable difference between appearance and reality in the social realm, and it is the task of the social theorist (and social critic) to lay bare the underlying social realities. The social realities of power and deception help to explain the divergence between appearance and reality: a given set of social relations -- patriarchy, racism, homophobism, class exploitation -- give rise to systematically misleading social concepts and theories in ordinary observers.

Marx's idea of the fetishism of commodities (link) illustrates the point of view taken by many of the theorists in this critical vein: what looks like a very ordinary social fact -- objects have use values and exchange values -- is revealed to mystify or conceal a more complex reality -- a set of relations of domination and control between bosses, workers, and consumers.  With a very different background, a book like Gaston Bachelard's The Psychoanalysis of Fire makes a similar point: the appearance represented by behavior systematically conceals the underlying human reality or meaning.  The word "critique" enters into most of Marx's titles -- for example, "Contribution to a Critique of Political Economy."  And for Marx, the idea of critique is intended to bring forward a methodology of critical reading, unmasking the assumptions about the social world that are implicit in the theorizing of a particular author (Smith, Ricardo, Say, Quesnay).  So Capital: Volume 1: A Critique of Political Economy is a book about the visible realities of capitalism, to be sure; but it is also a book intended to unmask both the deceptive appearances that capitalism presents and the erroneous assumptions that prior theorists have brought into their accounts.

The concepts of ideology and false consciousness have a key role to play in this discussion about the visibility of social reality.  And it turns out to be an ambiguous role.  Here is a paragraph from Slavoj Zizek on the concept of ideology from Mapping Ideology:

These same examples of the actuality of the notion of ideology, however, also render clear the reasons why today one hastens to renounce the notion of ideology: does not the critique of ideology involve a privileged place, somehow exempted from the turmoils of social life, which enables some subject-agent to perceive the very hidden mechanism that regulates social visibility and non-visibility? Is not the claim that we can accede to this place the most obvious case of ideology? Consequently, with reference to today's state of epistemological reflection, is not the notion of ideology self-defeating? So why should we cling to a notion with such obviously outdated epistemological implications (the relationship of 'representation' between thought and reality, etc.)? Is not its utterly ambiguous and elusive character in itself a sufficient reason to abandon it? 'Ideology' can designate anything from a contemplative attitude that misrecognizes its dependence on social reality to an action-orientated set of beliefs, from the indispensable medium in which individuals live out their relations to a social structure to false ideas which legitimate a dominant political power. It seems to pop up precisely when we attempt to avoid it, while it fails to appear where one would clearly expect it to dwell.

Zizek is essentially going a step beyond either of the two positions mentioned above.  The empiricist position says that we can perceive social reality.  The critical position says that we have to discover reality through critical theorizing.  And Zizek's position in this passage is essentially that there is no social reality; there are only a variety of texts.

So we have one style that begins in ordinary observation, hypothesis-formation, deductive explanation, and an insistence on clarity of exposition; and another style that begins in a critical stance, a hermeneutic sensibility, and a confidence in purely philosophical reasoning.  Jurgen Habermas draws attention to something like this distinction in his important text, On the Logic of the Social Sciences (1967), where he contrasts approaches to the social sciences originating in analytical philosophy of science with those originating in philosophical hermeneutics: "The analytic school dismisses the hermeneutic disciplines as prescientific, while the hermeneutic school considers the nomological sciences as characterized by a limited preunderstanding."  (This text as well as several others discussed here are available at AAARG.)  Habermas wants to help to overcome the gap between the two perspectives, and his own work actually illustrates the value of doing so.  His exposition of abstract theoretical ideas is generally rigorous and intelligible, and he makes strenuous efforts to bring his theorizing into relationship to actual social observation and experience. 

A contemporary writer (philosopher? historian? sociologist of science?) is Bruno Latour, who falls generally in the critical zone of the distinction I've drawn here.  An important recent work is Reassembling the Social: An Introduction to Actor-Network-Theory, in which he argues for a deep and critical re-reading of the ways we think the social -- the ways in which we attempt to create a social science. The book is deeply enmeshed in philosophical traditions, including especially Giles Deleuze's writings.  The book describes "Actor-Network-Theory" and the theory of assemblages; and Latour argues that these theories provide a much better way of conceptualizing and knowing the social world.  Here is an intriguing passage that invokes both themes of visibility and invisibility marking the way I've drawn the distinction between the two styles:

Like all sciences, sociology begins in wonder.  The commotion might be registered in many different ways but it's always the paradoxical presence of something at once invisible yet tangible, taken for granted yet surprising, mundane but of baffling subtlety that triggers a passionate attempt to tame the wild beast of the social.  'We live in groups that seem firmly entrenched, and yet how is it that they transform so rapidly?'  ... 'There is something invisible that weights on all of us that is more solid than steel and yet so incredibly labile.'  ...  It would be hard to find a social scientist not shaken by one or more of these bewildering statements.  Are not these conundrums the source of our libido scindi? What pushes us to devote so much energy into unraveling them? (21)

What intrigues many readers of Latour's works is that he too seems to be working towards a coming-together of critical theory with empirical and historical testing of beliefs.  He seems to have a genuine interest in the concrete empirical details of the workings of the sciences or the organization of a city; so he brings both the philosophical-theoretic perspective of the critical style along with the empirical-analytical goal of observational rigor of the analytic style. 

Also interesting, from a more "analytic-empiricist" perspective, are Andrew Abbott, Methods of Discovery: Heuristics for the Social Sciences, and Ian Shapiro, The Flight from Reality in the Human Sciences.  Abbott directly addresses some of the contrasts mentioned here (chapter two); he puts the central assumption of my first style of thought in the formula, "social reality is measurable".  And Shapiro argues for reconnecting the social sciences to practical, observable problems in the contemporary world; his book is a critique of the excessive formalism and model-building of some wings of contemporary political science.

My own sympathies are with the "analytic-empirical" approach.  Positivism brings some additional assumptions that deserve fundamental criticism -- in particular, the idea that all phenomena are governed by nomothetic regularities, or the idea that the social sciences must strive for the same features of abstraction and generality that are characteristic of physics.  But the central empiricist commitments -- fidelity to observation, rigorous reasoning, clear and logical exposition of concepts and theories, and subjection of hypotheses to the test of observation -- are fundamental requirements if we are to arrive at useful and justified social knowledge.  What is intriguing is to pose the question: is there a productive way of bringing insights from both approaches together into a more adequate basis for understanding society?

Demystifying social knowledge

There seem to be a couple of fundamentally different approaches to the problem of "understanding society." I'm not entirely happy with these labels, but perhaps "empiricist" and "critical" will suffice to characterize them.  We might think of these as styles of sociological thinking.  One emphasizes the ordinariness of the phenomena, and looks at the chief challenges of sociology as embracing the tasks of description, classification, and explanation.  The other highlights the inherent obscurity of the social world, and conceives of sociology as an exercise in philosophical theory, involving the work of presenting, clarifying and critiquing texts and abstract philosophical ideas as well as specific social circumstances.

The first approach looks at the task of social knowing as a fairly straightforward intellectual problem. It could be labeled "empiricist", or it could simply be called an application of ordinary common sense to the challenge of understanding the social world. It is grounded in the idea that the social world is fundamentally accessible to observation and causal discovery.  The elements of the social world are ordinary and visible. There are puzzles, to be sure; but there are no mysteries.  The social world is given as an object of study; it is partially orderly; and the challenge of sociology is to discover the causal processes that give rise to specific observed features of the social world.

This approach begins in the ordinariness of the objects of social knowledge.  We are interested in other people and how and why they behave, we are interested in the relationships and interactions they create, and we are interested in institutions and populations that individuals constitute. We have formulated a range of social concepts in terms of which we analyze and describe the social world and social behavior -- for example, "motive," "interest," "emotion," "aggressive," "cooperative," "patriotic," "state," "group," "ethnicity," "mobilization," "profession," "city," "religion." We know pretty much what we mean by these concepts; we can define them and relate them to ordinary observable behaviors and social formations. And when our attention shifts to larger-scale social entities (states, uprisings, empires, occupational groups), we find that we can observe many characteristics of each of these kinds of social phenomena.  We also observe various patterns and regularities in behavior, institution, and entity that we would like to understand -- the ways in which people from different groups behave towards each other, the patterns of diffusion of information that exist along a transportation system, the features of conflicts among groups in various social settings. There are myriad interesting and visible social patterns which we would like to understand, and sociologists develop a descriptive and theoretical vocabulary in terms of which to describe and explain various kinds of social phenomena.

In short, on this first approach, the social world is visible, and the task of the social scientist is simply to discover some of the observable and causal relations that obtain among social actors, actions, and composites. To be sure, there are hypothetical or theoretical beliefs we have about less observable features of the social world -- but we can relate these beliefs to expectations about more visible forms of social behavior and organization. If we refer to "social class" in an explanation, we can give a definition of what we mean ("position in the property system"), and we can give some open-ended statements about how "class" is expected to relate to observable social and political behavior. And concepts and theories for which we cannot give clear explication should be jettisoned; obscurity is a fatal defect in a theory.  In short, the task of social science research on this approach is to discover some of the visible and observable characteristics of social behavior and entities, and to attempt to answer causal questions about these characteristics.

This is a rough-and-ready empiricism about the social world. But there is another family of approaches to social understanding that looks quite different from this "empiricist" or commonsensical approach: critical theory, Marxist theory, feminist theory, Deleuzian sociology, Foucault's approach to history, the theory of dialectics, and post-modern social theory. These are each highly distinctive programs of understanding, and they are certainly different from each other in multiple ways. But they share a feature in common: they reject the idea that social facts are visible and unambiguous. Instead, they lead the theorist to try to uncover the hidden forces, meanings, and structures that are at work in the social world and that need to be brought to light through critical inquiry. Paul Ricoeur's phrase "the hermeneutics of suspicion" captures the flavor of the approach.  (See Alison Scott-Baumann's Ricoeur and the Hermeneutics of Suspicion for discussion.) Neither our concepts nor our ordinary social observations are unproblematic. There is a deep and sometimes impenetrable difference between appearance and reality in the social realm, and it is the task of the social theorist (and social critic) to lay bare the underlying social realities. The social realities of power and deception help to explain the divergence between appearance and reality: a given set of social relations -- patriarchy, racism, homophobism, class exploitation -- give rise to systematically misleading social concepts and theories in ordinary observers.

Marx's idea of the fetishism of commodities (link) illustrates the point of view taken by many of the theorists in this critical vein: what looks like a very ordinary social fact -- objects have use values and exchange values -- is revealed to mystify or conceal a more complex reality -- a set of relations of domination and control between bosses, workers, and consumers.  With a very different background, a book like Gaston Bachelard's The Psychoanalysis of Fire makes a similar point: the appearance represented by behavior systematically conceals the underlying human reality or meaning.  The word "critique" enters into most of Marx's titles -- for example, "Contribution to a Critique of Political Economy."  And for Marx, the idea of critique is intended to bring forward a methodology of critical reading, unmasking the assumptions about the social world that are implicit in the theorizing of a particular author (Smith, Ricardo, Say, Quesnay).  So Capital: Volume 1: A Critique of Political Economy is a book about the visible realities of capitalism, to be sure; but it is also a book intended to unmask both the deceptive appearances that capitalism presents and the erroneous assumptions that prior theorists have brought into their accounts.

The concepts of ideology and false consciousness have a key role to play in this discussion about the visibility of social reality.  And it turns out to be an ambiguous role.  Here is a paragraph from Slavoj Zizek on the concept of ideology from Mapping Ideology:

These same examples of the actuality of the notion of ideology, however, also render clear the reasons why today one hastens to renounce the notion of ideology: does not the critique of ideology involve a privileged place, somehow exempted from the turmoils of social life, which enables some subject-agent to perceive the very hidden mechanism that regulates social visibility and non-visibility? Is not the claim that we can accede to this place the most obvious case of ideology? Consequently, with reference to today's state of epistemological reflection, is not the notion of ideology self-defeating? So why should we cling to a notion with such obviously outdated epistemological implications (the relationship of 'representation' between thought and reality, etc.)? Is not its utterly ambiguous and elusive character in itself a sufficient reason to abandon it? 'Ideology' can designate anything from a contemplative attitude that misrecognizes its dependence on social reality to an action-orientated set of beliefs, from the indispensable medium in which individuals live out their relations to a social structure to false ideas which legitimate a dominant political power. It seems to pop up precisely when we attempt to avoid it, while it fails to appear where one would clearly expect it to dwell.

Zizek is essentially going a step beyond either of the two positions mentioned above.  The empiricist position says that we can perceive social reality.  The critical position says that we have to discover reality through critical theorizing.  And Zizek's position in this passage is essentially that there is no social reality; there are only a variety of texts.

So we have one style that begins in ordinary observation, hypothesis-formation, deductive explanation, and an insistence on clarity of exposition; and another style that begins in a critical stance, a hermeneutic sensibility, and a confidence in purely philosophical reasoning.  Jurgen Habermas draws attention to something like this distinction in his important text, On the Logic of the Social Sciences (1967), where he contrasts approaches to the social sciences originating in analytical philosophy of science with those originating in philosophical hermeneutics: "The analytic school dismisses the hermeneutic disciplines as prescientific, while the hermeneutic school considers the nomological sciences as characterized by a limited preunderstanding."  (This text as well as several others discussed here are available at AAARG.)  Habermas wants to help to overcome the gap between the two perspectives, and his own work actually illustrates the value of doing so.  His exposition of abstract theoretical ideas is generally rigorous and intelligible, and he makes strenuous efforts to bring his theorizing into relationship to actual social observation and experience. 

A contemporary writer (philosopher? historian? sociologist of science?) is Bruno Latour, who falls generally in the critical zone of the distinction I've drawn here.  An important recent work is Reassembling the Social: An Introduction to Actor-Network-Theory, in which he argues for a deep and critical re-reading of the ways we think the social -- the ways in which we attempt to create a social science. The book is deeply enmeshed in philosophical traditions, including especially Giles Deleuze's writings.  The book describes "Actor-Network-Theory" and the theory of assemblages; and Latour argues that these theories provide a much better way of conceptualizing and knowing the social world.  Here is an intriguing passage that invokes both themes of visibility and invisibility marking the way I've drawn the distinction between the two styles:

Like all sciences, sociology begins in wonder.  The commotion might be registered in many different ways but it's always the paradoxical presence of something at once invisible yet tangible, taken for granted yet surprising, mundane but of baffling subtlety that triggers a passionate attempt to tame the wild beast of the social.  'We live in groups that seem firmly entrenched, and yet how is it that they transform so rapidly?'  ... 'There is something invisible that weights on all of us that is more solid than steel and yet so incredibly labile.'  ...  It would be hard to find a social scientist not shaken by one or more of these bewildering statements.  Are not these conundrums the source of our libido scindi? What pushes us to devote so much energy into unraveling them? (21)

What intrigues many readers of Latour's works is that he too seems to be working towards a coming-together of critical theory with empirical and historical testing of beliefs.  He seems to have a genuine interest in the concrete empirical details of the workings of the sciences or the organization of a city; so he brings both the philosophical-theoretic perspective of the critical style along with the empirical-analytical goal of observational rigor of the analytic style. 

Also interesting, from a more "analytic-empiricist" perspective, are Andrew Abbott, Methods of Discovery: Heuristics for the Social Sciences, and Ian Shapiro, The Flight from Reality in the Human Sciences.  Abbott directly addresses some of the contrasts mentioned here (chapter two); he puts the central assumption of my first style of thought in the formula, "social reality is measurable".  And Shapiro argues for reconnecting the social sciences to practical, observable problems in the contemporary world; his book is a critique of the excessive formalism and model-building of some wings of contemporary political science.

My own sympathies are with the "analytic-empirical" approach.  Positivism brings some additional assumptions that deserve fundamental criticism -- in particular, the idea that all phenomena are governed by nomothetic regularities, or the idea that the social sciences must strive for the same features of abstraction and generality that are characteristic of physics.  But the central empiricist commitments -- fidelity to observation, rigorous reasoning, clear and logical exposition of concepts and theories, and subjection of hypotheses to the test of observation -- are fundamental requirements if we are to arrive at useful and justified social knowledge.  What is intriguing is to pose the question: is there a productive way of bringing insights from both approaches together into a more adequate basis for understanding society?

Demystifying social knowledge

There seem to be a couple of fundamentally different approaches to the problem of "understanding society." I'm not entirely happy with these labels, but perhaps "empiricist" and "critical" will suffice to characterize them.  We might think of these as styles of sociological thinking.  One emphasizes the ordinariness of the phenomena, and looks at the chief challenges of sociology as embracing the tasks of description, classification, and explanation.  The other highlights the inherent obscurity of the social world, and conceives of sociology as an exercise in philosophical theory, involving the work of presenting, clarifying and critiquing texts and abstract philosophical ideas as well as specific social circumstances.

The first approach looks at the task of social knowing as a fairly straightforward intellectual problem. It could be labeled "empiricist", or it could simply be called an application of ordinary common sense to the challenge of understanding the social world. It is grounded in the idea that the social world is fundamentally accessible to observation and causal discovery.  The elements of the social world are ordinary and visible. There are puzzles, to be sure; but there are no mysteries.  The social world is given as an object of study; it is partially orderly; and the challenge of sociology is to discover the causal processes that give rise to specific observed features of the social world.

This approach begins in the ordinariness of the objects of social knowledge.  We are interested in other people and how and why they behave, we are interested in the relationships and interactions they create, and we are interested in institutions and populations that individuals constitute. We have formulated a range of social concepts in terms of which we analyze and describe the social world and social behavior -- for example, "motive," "interest," "emotion," "aggressive," "cooperative," "patriotic," "state," "group," "ethnicity," "mobilization," "profession," "city," "religion." We know pretty much what we mean by these concepts; we can define them and relate them to ordinary observable behaviors and social formations. And when our attention shifts to larger-scale social entities (states, uprisings, empires, occupational groups), we find that we can observe many characteristics of each of these kinds of social phenomena.  We also observe various patterns and regularities in behavior, institution, and entity that we would like to understand -- the ways in which people from different groups behave towards each other, the patterns of diffusion of information that exist along a transportation system, the features of conflicts among groups in various social settings. There are myriad interesting and visible social patterns which we would like to understand, and sociologists develop a descriptive and theoretical vocabulary in terms of which to describe and explain various kinds of social phenomena.

In short, on this first approach, the social world is visible, and the task of the social scientist is simply to discover some of the observable and causal relations that obtain among social actors, actions, and composites. To be sure, there are hypothetical or theoretical beliefs we have about less observable features of the social world -- but we can relate these beliefs to expectations about more visible forms of social behavior and organization. If we refer to "social class" in an explanation, we can give a definition of what we mean ("position in the property system"), and we can give some open-ended statements about how "class" is expected to relate to observable social and political behavior. And concepts and theories for which we cannot give clear explication should be jettisoned; obscurity is a fatal defect in a theory.  In short, the task of social science research on this approach is to discover some of the visible and observable characteristics of social behavior and entities, and to attempt to answer causal questions about these characteristics.

This is a rough-and-ready empiricism about the social world. But there is another family of approaches to social understanding that looks quite different from this "empiricist" or commonsensical approach: critical theory, Marxist theory, feminist theory, Deleuzian sociology, Foucault's approach to history, the theory of dialectics, and post-modern social theory. These are each highly distinctive programs of understanding, and they are certainly different from each other in multiple ways. But they share a feature in common: they reject the idea that social facts are visible and unambiguous. Instead, they lead the theorist to try to uncover the hidden forces, meanings, and structures that are at work in the social world and that need to be brought to light through critical inquiry. Paul Ricoeur's phrase "the hermeneutics of suspicion" captures the flavor of the approach.  (See Alison Scott-Baumann's Ricoeur and the Hermeneutics of Suspicion for discussion.) Neither our concepts nor our ordinary social observations are unproblematic. There is a deep and sometimes impenetrable difference between appearance and reality in the social realm, and it is the task of the social theorist (and social critic) to lay bare the underlying social realities. The social realities of power and deception help to explain the divergence between appearance and reality: a given set of social relations -- patriarchy, racism, homophobism, class exploitation -- give rise to systematically misleading social concepts and theories in ordinary observers.

Marx's idea of the fetishism of commodities (link) illustrates the point of view taken by many of the theorists in this critical vein: what looks like a very ordinary social fact -- objects have use values and exchange values -- is revealed to mystify or conceal a more complex reality -- a set of relations of domination and control between bosses, workers, and consumers.  With a very different background, a book like Gaston Bachelard's The Psychoanalysis of Fire makes a similar point: the appearance represented by behavior systematically conceals the underlying human reality or meaning.  The word "critique" enters into most of Marx's titles -- for example, "Contribution to a Critique of Political Economy."  And for Marx, the idea of critique is intended to bring forward a methodology of critical reading, unmasking the assumptions about the social world that are implicit in the theorizing of a particular author (Smith, Ricardo, Say, Quesnay).  So Capital: Volume 1: A Critique of Political Economy is a book about the visible realities of capitalism, to be sure; but it is also a book intended to unmask both the deceptive appearances that capitalism presents and the erroneous assumptions that prior theorists have brought into their accounts.

The concepts of ideology and false consciousness have a key role to play in this discussion about the visibility of social reality.  And it turns out to be an ambiguous role.  Here is a paragraph from Slavoj Zizek on the concept of ideology from Mapping Ideology:

These same examples of the actuality of the notion of ideology, however, also render clear the reasons why today one hastens to renounce the notion of ideology: does not the critique of ideology involve a privileged place, somehow exempted from the turmoils of social life, which enables some subject-agent to perceive the very hidden mechanism that regulates social visibility and non-visibility? Is not the claim that we can accede to this place the most obvious case of ideology? Consequently, with reference to today's state of epistemological reflection, is not the notion of ideology self-defeating? So why should we cling to a notion with such obviously outdated epistemological implications (the relationship of 'representation' between thought and reality, etc.)? Is not its utterly ambiguous and elusive character in itself a sufficient reason to abandon it? 'Ideology' can designate anything from a contemplative attitude that misrecognizes its dependence on social reality to an action-orientated set of beliefs, from the indispensable medium in which individuals live out their relations to a social structure to false ideas which legitimate a dominant political power. It seems to pop up precisely when we attempt to avoid it, while it fails to appear where one would clearly expect it to dwell.

Zizek is essentially going a step beyond either of the two positions mentioned above.  The empiricist position says that we can perceive social reality.  The critical position says that we have to discover reality through critical theorizing.  And Zizek's position in this passage is essentially that there is no social reality; there are only a variety of texts.

So we have one style that begins in ordinary observation, hypothesis-formation, deductive explanation, and an insistence on clarity of exposition; and another style that begins in a critical stance, a hermeneutic sensibility, and a confidence in purely philosophical reasoning.  Jurgen Habermas draws attention to something like this distinction in his important text, On the Logic of the Social Sciences (1967), where he contrasts approaches to the social sciences originating in analytical philosophy of science with those originating in philosophical hermeneutics: "The analytic school dismisses the hermeneutic disciplines as prescientific, while the hermeneutic school considers the nomological sciences as characterized by a limited preunderstanding."  (This text as well as several others discussed here are available at AAARG.)  Habermas wants to help to overcome the gap between the two perspectives, and his own work actually illustrates the value of doing so.  His exposition of abstract theoretical ideas is generally rigorous and intelligible, and he makes strenuous efforts to bring his theorizing into relationship to actual social observation and experience. 

A contemporary writer (philosopher? historian? sociologist of science?) is Bruno Latour, who falls generally in the critical zone of the distinction I've drawn here.  An important recent work is Reassembling the Social: An Introduction to Actor-Network-Theory, in which he argues for a deep and critical re-reading of the ways we think the social -- the ways in which we attempt to create a social science. The book is deeply enmeshed in philosophical traditions, including especially Giles Deleuze's writings.  The book describes "Actor-Network-Theory" and the theory of assemblages; and Latour argues that these theories provide a much better way of conceptualizing and knowing the social world.  Here is an intriguing passage that invokes both themes of visibility and invisibility marking the way I've drawn the distinction between the two styles:

Like all sciences, sociology begins in wonder.  The commotion might be registered in many different ways but it's always the paradoxical presence of something at once invisible yet tangible, taken for granted yet surprising, mundane but of baffling subtlety that triggers a passionate attempt to tame the wild beast of the social.  'We live in groups that seem firmly entrenched, and yet how is it that they transform so rapidly?'  ... 'There is something invisible that weights on all of us that is more solid than steel and yet so incredibly labile.'  ...  It would be hard to find a social scientist not shaken by one or more of these bewildering statements.  Are not these conundrums the source of our libido scindi? What pushes us to devote so much energy into unraveling them? (21)

What intrigues many readers of Latour's works is that he too seems to be working towards a coming-together of critical theory with empirical and historical testing of beliefs.  He seems to have a genuine interest in the concrete empirical details of the workings of the sciences or the organization of a city; so he brings both the philosophical-theoretic perspective of the critical style along with the empirical-analytical goal of observational rigor of the analytic style. 

Also interesting, from a more "analytic-empiricist" perspective, are Andrew Abbott, Methods of Discovery: Heuristics for the Social Sciences, and Ian Shapiro, The Flight from Reality in the Human Sciences.  Abbott directly addresses some of the contrasts mentioned here (chapter two); he puts the central assumption of my first style of thought in the formula, "social reality is measurable".  And Shapiro argues for reconnecting the social sciences to practical, observable problems in the contemporary world; his book is a critique of the excessive formalism and model-building of some wings of contemporary political science.

My own sympathies are with the "analytic-empirical" approach.  Positivism brings some additional assumptions that deserve fundamental criticism -- in particular, the idea that all phenomena are governed by nomothetic regularities, or the idea that the social sciences must strive for the same features of abstraction and generality that are characteristic of physics.  But the central empiricist commitments -- fidelity to observation, rigorous reasoning, clear and logical exposition of concepts and theories, and subjection of hypotheses to the test of observation -- are fundamental requirements if we are to arrive at useful and justified social knowledge.  What is intriguing is to pose the question: is there a productive way of bringing insights from both approaches together into a more adequate basis for understanding society?

Food security

Food security is a crucial aspect of life, both for a population and a household. By "food security" specialists often mean two different things: the capacity of a typical poor household to secure sufficient food over a twelve-month period (through farm work, day labor, government entitlements, etc.); and the capacity of a poor country to satisfy the food needs of its whole population (through direct production, foreign trade, and food stocks). This involves both food availability and the ability to gain access to food (through entitlements).

A representative description of food security is offered by Shlomo Reutlinger in Malnutrition and Poverty: Magnitude and Policy Options:

Food security ... is defined here as access by all people at all times to enough food for an active, healthy life. Its essential elements are the availability of food and the ability to acquire it. Conversely, food insecurity is the lack of access to sufficient food and can be either chronic or transitory.  Chronic food insecurity is a continuously inadequate diet resulting from the lack of resources to produce or acquire food.  Transitory food insecurity, however, is a temporary decline in a household’s access to enough food.  It results from instability in food production and prices or in household incomes.  The worst form of transitory food insecurity is famine.

Here is how Sen formulates his "capabilities" understanding (developed, for example, in Hunger and Public Action):

The standard of adequacy is best understood functionally: a person, household, or population has food security if it has sufficient access to food to permit full, robust human development and realization of human capacities.

There is an obvious connection between the two definitions at the household and country levels; but from a human point of view it seems more useful to focus on household food security rather than national food security.  A country may in principle have more than sufficient resources to satisfy the food needs of its population, but fail to do so because of internal inequalities.  Thus achieving household food security in the less‑developed world requires both equity and growth.  Amartya Sen and Jean Dreze have made major contributions on hunger and famine in the developing world, and their work can almost always be linked back to the household level.  Here is a good source on their writings: The Amartya Sen and Jean Dreze Omnibus: (comprising) Poverty and Famines; Hunger and Public Action; India: Economic Development and Social Opportunity.

Michael Lipton has also been an important voice on this set of topics.  His central task in Poverty, Undernutrition, and Hunger is an attempt to provide criteria for distinguishing between the poor and the ultra-poor.  The ultra-poor have incomes and entitlements that are absolutely below that required to gain access to 80% of 1973 FAO/WHO caloric requirements.  Below this level is likely to lead to undernutrition (the failure of food security).  Lipton constructs a "food adequacy standard" as a way of measuring the incidence in a given country of absolute poverty.  Here is his statement of a food adequacy standard:

Income or outlay, just sufficient on this assumption to command the average caloric requirement for one’s age, sex and activity group (ASAG) in a given climatic and work environment, will be taken as meeting the poverty FAS; this is income or outlay on the borderline of poverty, indicating a risk of hunger. Income or outlay, just sufficient to command 80% of this average requirement, will be taken as meeting the ultra-poverty FAS; this is income or outlay at the borderline between poverty and ultra-poverty, indicating a risk of undernutrition and a severe risk of important anthropometric shortfalls. (Lipton 1983): 7.)

Food security can be put at risk in a variety of ways. Natural conditions can lead to a shortfall of grain production -- flood, drought, or other natural disasters can reduce or destroy the crop across a wide region, leading to a shortfall of supply. Population increase can gradually reduce the grain-to-population ratio to the point where nutrition falls below the minimum required by the population or household. And, perhaps most importantly, prices can shift rapidly in the market for staple foods, leaving poor families without the ability to purchase a sufficient supply to assure the nutritional minimum. It is this aspect of the system that Amartya Sen highlights in his study of famine (Poverty and Famines: An Essay on Entitlement and Deprivation). And it is the circumstance that is most urgent in developing countries today in face of the steep and rapid rise in grain prices over the past year.

The results of a failure of food security are dire. Chronic malnutrition, sustained over months and years, has drastic effects on the health status of a population. Infant and child mortality increases sharply. Often the gender differences in health and mortality statistics widen. And economic productivity falls, as working families lack the strength and energy needed to labor productively. Famine is a more acute circumstance that arises when food shortfalls begin to result in widespread deaths in a region. The Great Bengal famine, the Ethiopian famine, the Great Leap Forward famine, and the famines in North Korea offer vivid and terrible examples of hunger in the twentieth century.

So what is needed to maintain food security in a poor nation? Some developing countries have aimed at food self-sufficiency -- to enact policies in agriculture that assure that the country will produce enough staples to feed its population. Other countries have relied on a strategy of purchasing large amounts of staple foods on international markets. Here the strategy is to generate enough national income through exported manufactured goods to be able to purchase the internationally traded grain. This is the strategy recommended by neoliberal trade theory. If agriculture is a low value-added industry and the manufacture of electronic components is high value-added, neoliberals reason, then surely it makes sense for the country to generate the larger volume of income through the latter and purchase food with the proceeds.

This logic has given rise to several important problems, however. First is the vulnerability it creates for the nation in face of sharp price shocks. This is what we have seen in many countries over the past year. And the second is the reality of extensive income inequalities in most developing countries -- with the result that the "gains of trade" may not be sufficiently shared in the incomes of the poorest 40% to permit them to maintain household food security.

These considerations suggest the wisdom for developing countries to expend more resources on agricultural development (which often has an income-inequality narrowing effect) and a greater emphasis on national and regional food self-sufficiency.