Wednesday, December 23, 2009

The ethics argument for health care reform

The health care debate is too much for any individual to understand completely. That’s why reading a bill on the Senate floor doesn’t contribute to the debate, other than to slow it down. There are persuasive arguments on all sides: doesn’t go far enough, goes too far, costs too much, gives too much to the insurance companies, is unfair to the insurance companies, and on and on.
I only know two things for sure about it, one ethical, one historical.
First, the ethical argument: What kind of society do we want to be a part of? Remember Lincoln asking if we wanted to be part of a nation that was half slave, half free? Remember John Kennedy asking if we wanted to be part of a wealthy nation with millions suffering from hunger. It’s time for Americans to ask ourselves whether we want to be a part of a society that provides its political leaders and most everybody else with health care, but leaves fifty million—one of every six Americans—uninsured, with additional millions worried sick that they’ll lose their insurance.
An ethical person must reject this status quo as unacceptable, a violation of the Golden Rule and of the principles of virtue ethics. So the system needs to be changed.
Now the thing I know about history: Theodore Roosevelt first proposed health care reform in 1912, then Franklin Roosevelt, Harry Truman, Lyndon Johnson, Richard Nixon, and Bill Clinton. All failed. If the current attempt fails we’ll likely go many years before reform is even attempted in the Congress.
So an ethical person must work to pass reform now—not necessarily the House bill, not necessarily the Senate bill, but SOME bill. The ethical person doesn’t want his country to take care of five-sixths and leave the rest to fickle fortune


Glenn Logan said...

This argument is an argument for incompetence.

I'm sorry, but it's just wrong to say, "Do something, even if it's wrong," which is essentially the argument you are making.

Nobody is denied health care in America. The problem is, some people don't get the right kind of health care -- they are forced to wait until they are actually ill to go to the emergency room and get treatment. But contrary to popular belief, people are not dying on the streets for lack of care.

Also unfortunate is the 50 million figure you cite, which is known to include such people as illegal aliens (approximately 10-15 million) and young, healthy people who do not want insurance, or wealthy people who do not need it. Furthermore, the CBO estimates that nearly half of that figure are people who are uninsured only temporarily, for four months or less.

Most credible estimates place the number of Americans who are uninsured due to an inability to afford health insurance at around 10 million, and every one of these people has access to health care, at least in emergency situations.

I assume, as a commenter on ethics, that you were unaware of these facts. But let me say that the biggest travesty of all is that we haven't even tried to define the problem, and yet we are calling for a bill to fix it -- a bill which doesn't fix it at all. But let's do something, even if it's wrong -- right?

What we should be doing is defining the problem, and trying to fix it. But we aren't. We are trying to make it go away by a huge, bureaucratic solution that is obviously flawed to the extent that it is likely unconstitutional. And this is the best we can do?

Americans should expect better.

Bob said...

Thanks, Glenn, for commenting. You certainly have a point that neither the Senate bill nor the House bill is ideal. I wouldn’t, however, call either incompetent—The result is likely the best our country can produce now.
You’re also right that nobody is “denied” health care. But c’mon—emergency room care? I have health care, in fact as a retired federal worker I have the same care that our members of Congress have. When my doctor examined me—non emergency—he prescribed a statin drug to lower my cholesterol, which had been seriously elevated. As a result my chances of a heart attack are significantly reduced. Had I depended on emergency room care I’d be a candidate for a fatal heart attack before I got to the ER.
Finally, after we argue about how many Americans are uninsured, let’s add in the number who live in fear of losing their coverage due to a layoff or to some newly discovered reason for the insurance company to cover them.
I don’t say that the bills to be reconciled are the best we can do, but they’re the best we can do in the foreseeable future. That’s why I say an ethical person should favor passage.

Glenn Logan said...


Fair points, all.

I grew up without heath care of any kind. When I was sick, I was taken to the doctor. My parents paid cash. When I got out of the Navy, I went to the doctor when I was sick. I paid cash. No health insurance, nothing.

This is actually still possible, but you would never know it. We have lost our way on health care. We are not asking the right questions, and as such, if the current legislation actually fixes anything, it will be by accident.

That's no way to govern. We can't make the perfect the enemy of the good, but no rational person could describe a near-3000 page bill, unread by anyone including its authors, as good. The refusal of the Senate to make the text available before voting on the thing is highly suspicious to even the most naive non-partisan, and should be.

All you have to do is look at the provision attempting to bind future Senate action to a supermajority as your ethical guide.

We can and should do better, and passing this monstrosity, in my judgment, is unethical and indefensible.

Jack Marshall said...

I'm with Glenn, Bob. The argument "anything is better than the status quo" a) is simply never true---things can always get worse; 2) is an invitation to sloppiness, which is what we got, and 3)depends on actually being able to afford whatever the "anything" is. Ethics separated from reality and consequences are meaningless. We should feed the hungry...heck, we should feed the world. But if doing so renders us impotent and lowers the quality of life for the nation in a decade or two, it is neither an ethical nor a practical course of action.

I also think reading a bill on the floor, when virtually no one voting for or against it has read it otherwise, is a terrific idea---indeed, an essential act. If a bill is too long to read, it is too long to pass.

Finally, I don't believe ethical results come out of corrupt processes. The supporters of the bill had the burden of proof to make a case for it, and they resorted to obfuscation, name-calling and lies (nobody, but nobody, in DC really believes that the bill will lower the deficit, for example.) So have the opponents, but until I know the honest-to-goodness facts about "anything," I'll stick with the status quo, as lousy as it may be. That's an ethical value too---it's called "prudence."