If we accept for the moment the ideological premise that free markets and dramatically limited government are the ideal economic basis for freedom, liberty, and the pursuit of happiness, how do we then reconcile the very real human effects of those theories? This question is best exemplified by the current struggle in the US over healthcare.
Wide-open free market competition for health has been the norm (kinda sorta) in America since its inception. Health in the modern American world has ceased to be the biologically simple matter of freedom from disease and physical handicap that it is elsewhere, and has become instead the struggle for basic access to the technology all humans depend on to extend and repair life.
In that struggle there is absolutely no denying that there are some 10, 20, or 50 millions (pick your favourite statistician) who certainly do have the option of purchasing from the market place the health technology they need to reach the standards of contemporary health. On this, the small government ideologues are correct - they do have the option. The issue becomes then not the availability of acceptable healthcare, but one of the penalties individuals and society pay when 10, 20, or 50 million human beings make economic and social tradeoffs when they must balance that option for good health against others in a free market system.
In a society such as this, proper health is a commodity like everything else. It is - according to the "freedom, liberty, and the pursuit of happiness" crowd - not a right a human being should enjoy, but rather just another economic option available in the marketplace. Health - your happy, shiny consumer choice. As a consumer good, health competes with all other consumer options, including food, clothing, shelter, transportation, and a host of others.
For people living at the very bottom of the economic spectrum - tens and tens of millions - this free market choice is perverted somewhat in as much as low levels of income exclude more consumer goods than they include. For poor folks it is not a case of which commodity to choose, but rather one of which commodities are available after cost excludes the rest. Food comes first, then shelter, then clothes, and then for many, many millions - the "options" of the grand free market disappear. Tens of millions are not free at all to choose them, are not at any kind of liberty while their income dictates their health and well being, and are in no way in the pursuit of any kind of happiness, but rather brutal survival. That's just the way the free market and limited government has turned out. A permanent and growing social "underclass" that obeys all the rules of economics as they are currently designed.
If you absolutely believe human life is not a right, and insist that the profit inflated cost of private health care is only a commodity that must be paid for in a free marketplace - a commodity whose cost pits it against the substantial costs of the other basics of survival - then you must by extension accept this permanent and exponentially growing underclass of millions and millions. Free markets and small government have proven - in real time - to include a vast chunk of humanity that cannot participate in the society they defend.
Pretending this swarm of unhealthy, frustrated, angry, and downtrodden human beings does not exist is not acceptable. They must be accounted for whether the ideology or theory recognizes their existence or not. The challenge for small government defenders is to account for this slowly boiling multitude, and somehow fit its existence into the argument; the argument that God, the founders, the constitution and Adam Smith meant it to be this way.
Social conservatives and liberal economists in the US need not defend their ideology as much as they have to account for the teeming masses that their ideology manufactures. So far, they have simply pretended they don't exist, or blamed it on the sloth and stupidity of individuals whose numbers exceed that of the entire Roman Empire. Clearly, there is a disconnect between their philosophy and its practice. It is high time in this discussion that the defenders of the status quo make some comment or accounting for an angry nation of people that have somehow slipped unnoticed by them through their theory and philosophy.
If liberal economists and social conservatives can accomplish that, it will go a long way towards resolving the intractable insanity that is the health care debate in the US, and solve at the same time, finally, the vision of America they are prepared to live with - in reality and not ideology. It is squarely on the shoulders of this ideological group to come to terms with the human effects of their system, and prove that society is better off with a seething mass of discontented poor that may in time compel that ideology onto the dustbin of history.
This is the challenge that has to be met by ideology, that in the real world where living breathing, coughing, hacking, aching, sad, lonely, hopeless and despairing human beings must live cheek to jowl amongst the few that have so much, how does one craft a just society that founders and God and worn old declarations would be content with? How - against the service of all history - does one create a vibrant, wealthy, optimistic nation that should expect to lead and dominate for centuries to come? How to fashion a heroic civilization where tens of millions live precariously on the merciless edge of charity?
Perhaps social conservatives and liberal economists may be more willing to bend their wooden theory if they came to grips with the millions of excluded that clearly exist and continue to grow. They may find that by accepting life and health into their narrow spectrum of basic human dignities, their ideology may soften enough to recreate a single America from the hardening clay of two. However, one thing remains certain; that the existence of the poor and disenfranchised products of the free market system must be recognized and explained in one fashion or another.
Their options are clear. Speak directly to the forgotten now, or have the forgotten speak to them at a not so pleasant, distant future.