Somewhat unique in Canadian social policy our national health care system represents the values of distributive justice and equity, meaning that need, not ability to pay determines eligibility for health care services. It is an affirmation that there are important forms of state/public social care that expand the social care individuals, if they are fortunate, receive in their interpersonal relations and through their families. British social welfare philosopher Richard Titmuss reminded us again and again that “policy is all about values.” In Commitment to Welfare (1968) Titmuss sets out persuasively the case for universal social services including health care maintaining that such a conception promotes social justice as social rights since there is no “humiliating loss of status, dignity or self respect.” People are not blamed for their personal circumstances nor are they deemed individual and social failures.

Gary Craig a professor of social justice argues that for the state to fully promote social justice, governments need to work for

• Achieving fairness, and equality of outcomes and treatment,
• Recognizing the dignity and equal worth and encouraging the self esteem of all members of society,
• Meeting basic needs, and maximizing the reduction of inequalities in wealth, income, and life chances,
• The participation of everyone, including the most disadvantaged.
• Certainly from this perspective it seems beyond contest that public medicare is central to our society’s claims to be one based on principles of social justice.

If we see the idea of citizenship as embodying social rights including the social right of universal health care, rights that are not market commodities, then the argument for privatization of health care is a basic denial of democratic citizenship. Universality as a guiding principle for social programs is seen by most in the social policy community as a way to foster relations between and among social groups, and as a force for enhancing social cohesion, a glue holding the country together in the same way the building of a transcontinental railway was seen in the 19th century and the creation of the CBC in the 1930s. University of Toronto philosopher Mark Kingwell suggests that the idea of citizenship, something that universal health care helps define, directs us to a number of things we share with one another: “that we are all vulnerable and fragile; that we all feel pain; that we all need to belong; that we all possess an imaginative capacity to feel concern, even love for others.” Building on these observations Kingwell contends that it is our imaginative capacities “that responds to the deep pull of justice.” What is important to acknowledge is we do have the wherewithal to feel and even be pained by the pain of others. “ The human community,” Kingwell writes, “is not so much a community of reason as it is, at a basic level, a community of feeling.” If we do not exercise and educate our imaginations we will not be open to the claims of justice by others. It is the verdict rendered many years ago by Canadian literary critic Northrop Frye in his acclaimed Massey Lectures, The Educated Imagination . Our imaginations give us access to the suffering of others as we see ourselves in them. Surely we can all see that allowing others to be sick - those living in poverty, those with untreated depression, struggling single mothers and their children - through lack of universal public health care is wrong. It at this juncture that we can give some thought to social caring and the idea of society being governed by an ethic of social care.

While it would be unusual to say that an ethic of care is not needed in our private lives, caring as an essential ingredient of public social policy is much less recognized. A care ethic and a social justice orientation are the sine qua non of humane state social policy. If we place a caring ethic at the centre of our social and health policies we will begin to see people in new ways, and have a greater appreciation for human suffering. There are a few hopeful signs that the state in Canada and elsewhere is giving some thought to a caring ethic. The 2003 federal budget mentioned the importance of working for a society that enhanced the well-being of all Canadians and that “puts people first.” Several studies in the past seven years provide evidence that the Canadian public want more generous and compassionate social and health policies. There is also considerable interest on a global level for an ethic of care; when the United Nations General Assembly on Governance Issues took place in 2000 a special commission preparing material for the meetings cited caring as a foundational value for global governance.

With the hegemony of neo-liberal regimes there has come to the fore a conception of citizenship that sees people as independent, self-sufficient, autonomous individuals pursuing their own private self interests. We have been lead to believe that each individual pursuing their own private interests will in aggregate be best for our overall society. The reality of people’s lives though is that we are often dependant and almost always interdependent and need a caring ethic in both our private and public lives. Joan Tronto in Moral Boundaries: A Political Argument for an Ethic of Care (1993) captures this when she writes, “since people are sometimes autonomous, sometimes dependent, sometimes providing care for those who are dependent, humans are best described as interdependent.” The political philosophy of liberalism in all its forms has not incorporated care as a way to think about citizenship and an ethic of care has not been part of the making of social policy.

Not bringing the idea and practice of caring into citizenship and social policy diminishes our conceptions of social justice and community. It is feminist theorists who have brought an ethic of care concern to the forefront of social thought and Carol Gilligan’s In a Different Voice: Psychological Theory and Women’s Development (1982) made the case that the ‘different voice’ is a voice of caring, and deep concern for others; and Joan Tronto again writes that care is now seen as “a species activity that includes everything that we do to maintain, continue and repair our ‘world’ so that we can live in it as well as possible. That world includes our bodies, our environments, all of which we seek to interweave in a complex, life-sustaining web.” Among four ethical elements that constitute care Tronto identifies attentiveness which means recognizing the needs of others; and responsiveness as “ a different way to understand the needs of others ; rather than putting ourselves into their position …it suggests that we consider the other’s position as that other expresses it.”

Neo-classical economics and liberal theory tend to have a one-dimensional and hence somewhat distorted idea of human nature. From this perspective, as feminist scholar Nancy Harstock astutely observes, “the paradigmatic connections between people are instrumental or extrinsic and conflictual, and in a world populated by these isolated individuals, relations of competition and dominance come to be substitutes for a more substantial and encompassing community.” Yet most people value human relationships and connections and the quality of life that we forge as perhaps even more important than economic considerations. We are not just consumers but also citizens and it is when we install a caring ethic into our social programs such as universal public health care that we move from consumer to citizen, citizens who do not want to privatize any aspects of medicare. Citizens are oriented to the community of others, their needs and a sense of security through public social programs that are central to any conception of the ‘good’ society.

Being attentive to the care related needs of others expands and enhances our moral horizons. Social justice and an ethic of care conclusively alert us to the fact that what we need and want is not the retrenchment and privatization of universal health care but instead a demonstration of how the state cares for its citizens through maintaining and enhancing public health care.

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