Several years ago my dad suffered a traumatic brain injury. To put it as plainly as I can: He is alive today because he had major brain surgery followed by a three-week long nap in the ICU that cost someone several hundred thousand dollars. Following that, he stayed in a rehabilitative hospital for six months and continued therapy there for six more months as an outpatient. This was all enormously expensive care.

My parents also received a great deal of help from friends. They did not pay for the labor required to build a wheelchair ramp or to remodel the downstairs bathroom to make it handicap accessible. My mom also is a full-time caregiver for my dad, which allows him to live at home.

One way of talking about my dad’s story, then, is as a vindication of local bonds of friendship, affection, and fidelity. The little platoons of society—church, neighbors, family—came together to serve my parents at many points and the bond of marriage in particular has been essential to everything about my dad’s care since his injury nearly four years ago.

But there’s another way of talking about it as well: Dad’s highly expensive medical care—three weeks in an ICU, six months in a rehab hospital, six more months of outpatient care—was mostly paid for by a far-off insurance company and with the aid of people my parents have never met. (To be clear, the company threw several fits over having to fulfill their contractual obligations but they did mostly fulfill them. I’m not here to defend insurance companies.) There’s a real sense in which many of the people who have contributed in significant ways to my parents’ lives are bureaucrats sitting behind computers, people sometimes derisively referred to as paper pushers, and people who my parents have never met face-to-face.

This brings me to one of my main questions after reading the latest post at Post-Liberal Thought from Andrew Willard Jones, Marc Barnes, and Jacob Fareed Imam. There is much to like about the piece. Their treatment of libertarianism is sharp, for example. Moreover, extolling the virtues of the little platoons is always useful and I think I’m even in broad agreement with the roided up version of localism that the piece proposes in this paragraph:

It is the national state that would like to isolate individuals from the burden of coercion, hoarding all such political power for itself and applying it anonymously. In contrast, when politics get local, coercion gets personal. Men should face the coercive reality of politics head on, and not cower behind a statist hegemon. We should use coercion as personally as possible and answer for it as universally as possible. Law is particular. Justice is universal.

But in its attacks on the administrative state I’m not sure the piece adequately reckons with the reason the state came to exist in this form in the first place.

Some portion of it is explainable in the terms used in the essay. States really do sometimes attempt unjust power grabs through the invention of laws and procedures that insert the magistrate into places it does not belong. But is that the only explanation for the expansion of government in the modern era? I don’t think it is.

The genius of modernism, to the extent that it has a genius at all, is its technical ability. This is also routinely its downfall as modernism has no mechanism within itself to distinguish between technical problems and non-technical problems, which is where so many of the evils brought about my modernity have come from.

But there really are such things as technical problems and modernity handles them quite well. The problem of providing highly expensive medical care to people who lack the money to pay for it is a technical problem that requires a technical solution of some kind. Similarly, the problem of providing for the material needs of a rapidly growing population (caused by improved medical care) has also been addressed to some degree by modern technique.

Such techniques, however, are enormously complex to carry out. Take the problem of healthcare, for example. Modern medical care is extremely expensive due to the cost of machines, drugs, training for the doctors and nurses, and so on. To make it accessible to a large group requires assembling an enormous pool of people who all pay into a shared fund and then receive payments out of that fund when they need care. This pool could (and often does) number in the millions.

Moreover, managing the money and care associated with a pool of people that large will in itself require a large number of paper pushers. There are more and less efficient ways of structuring the work, of course, but there’s no way of making such a task simple. Even in a highly efficient system you will require more administrators than were necessary to manage a doctor’s work in, say, 18th century New England.

Most of the genuine goods that modernity secures seem to have a similar quality. Supplying clean drinking water to a large city is a highly complex problem that is solved by a group of people who are basically invisible to most of the people who benefit from their work.

I’m the last person who needs to be reminded of the dark side of many of these modern innovations. It is not at all clear to me, for example, that we should desire to preserve the factory farm system, even granting that it has proven to be one method for feeding the world’s people. If anything, the factory farm system seems like a good analog for much of modernity—a technical solution that solves a problem through an unsustainable technique that most people accept because they won’t be the ones affected by the technique’s failings.

So, certainly, we should be leery of abuses of technique, needlessly large systems, and any explanation for our current social order that is insufficiently imaginative about alternative ways of securing desired social goods.

Even so, some problems really are tremendously complex and require large, administrative structures to solve. I rather suspect medical care is one such example. And it is not clear to me that the vision of post-liberal society offered by Jones, Barnes, and Imam has an answer to this problem. So: The reality of local political authority? Si. The de facto abolition of the administrative state? No.

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Posted by Jake Meador

Jake Meador is the editor-in-chief of Mere Orthodoxy. He is a 2010 graduate of the University of Nebraska-Lincoln where he studied English and History. He lives in Lincoln, NE with his wife Joie, their daughter Davy Joy, and sons Wendell, Austin, and Ambrose. Jake's writing has appeared in Commonweal, Christianity Today, Fare Forward, the University Bookman, Books & Culture, First Things, National Review, Front Porch Republic, and The Run of Play and he has written or contributed to several books, including "In Search of the Common Good," "What Are Christians For?" (both with InterVarsity Press), "A Protestant Christendom?" (with Davenant Press), and "Telling the Stories Right" (with the Front Porch Republic Press).