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August 22, 2009

The Moral Obligation to Provide Health Care

Dave Schuler poses an interesting question:

As I’ve said before, I don’t believe that there’s a right to healthcare nor have I seen a coherent argument made that it is, merely a claim. However, bear with me.

Is is possible to make a coherent argument that government-provided healthcare is a moral obligation but that our obligation doesn’t extend to people in Zambia? I don’t think it is but I’m willing to listen to the arguments.

A few observations. The most obvious thing that comes to mind here is that if Barack Obama thinks moral obligations are so important that the federal government should impose them by force, does that mean he thinks the federal government should force him to take care of his siblings? After all, that's arguably a pretty basic moral obligation. It's pretty unfair that he was raised by white grandparents and given the opportunity to attend an elite private school in Hawaii.

If equality of income and opportunity are the moral imperatives of the 21st Century in America, why didn't he put his money where his mouth is and extend a helping hand to his own family?

In his defense, Obama is hardly alone in wanting the government to step in and shoulder his moral obligations:

Arthur Brooks, the author of "Who Really Cares," says that "when you look at the data, it turns out the conservatives give about 30 percent more." He adds, "And incidentally, conservative-headed families make slightly less money."

And he says the differences in giving goes beyond money, pointing out that conservatives are 18 percent more likely to donate blood. He says this difference is not about politics, but about the different way conservatives and liberals view government.

"You find that people who believe it's the government's job to make incomes more equal, are far less likely to give their money away," Brooks says. In fact, people who disagree with the statement, "The government has a basic responsibility to take care of the people who can't take care of themselves," are 27 percent more likely to give to charity.

But more importantly, precisely what is the moral obligation to provide universal health care?

Interestingly, Obama never got around to that part.

He has a habit of making grand, sweeping statements that conveniently manage to avoid the kind of pesky details that might subject his imperial pronouncements to critical review. It would be interesting to hear Obama spell out the precise nature of the moral obligation to provide health care: where does it begin? How far does it extend? If we all share a moral obligation to make sure every American has equal benefits, why should some people pay more for that benefit than others? On what moral basis do we (as Obama has assured us) exclude illegal immigrants from this benefit?

Like Dave, I'm willing to entertain the argument for a shared moral obligation to provide universal health care. I'm just not sure it exists. But if it does, surely the President of the United States ought to be able to make that case, shouldn't he?

Posted by Cassandra at August 22, 2009 01:50 PM

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I just posted an excessively long comment about this over at Reclusive Leftist and now I'm going to have to think about it again?

Over at RL I said I agreed that providing everyone in society with access to health care was a moral imperative. I don't think that's the same as a right. I'm struggling here but it seems to me like the difference between charity and welfare. Charity is a moral imperative; welfare is a government program which has enshrined a right.

I believe that if a society is wealthy enough to do so then that society has a moral obligation to provide all its citizens with the basics (pretty much in this order): food, shelter, health care. But society does that because it can and because it believes it's generous - not because the recipients have the right to demand those things from others. (I'd have to think about children; they might have what I would consider a "right" which is a big part of the welfare dilemma.) We can choose to enshrine that generosity in legislation but that still doesn't establish that the recipients have a right to it - any more than ADM has a "right" to get agricultural subsidies.

we all share a moral obligation to make sure every American has equal benefits

Some benefits, yes, but not necessarily equal benefits. That applies to food and shelter also.

As for citizens in other countries, I believe we have a moral obligation to help them, also, but less of a one than we do to citizens here. And they certainly have no right to demand our help.

This question gets even more interesting once you talk about *how* we live up to that moral obligation. Obamacare wants all of us who are pretty happy with our health care to give up a lot to help the less fortunate; I'm simply not willing to do that any more than I'm willing to give up my home so the less fortunate can have shelter. I am, however, willing to consider other plans that would get health care to the uninsured. That is, I'm willing to chip in some money to provide a helping hand but I'm not willing to risk my own health to help someone else.

Posted by: Elise at August 22, 2009 03:09 PM

I think there are two basic questions here, and the failure to address them is at the center of the moral confusion:

1. Even if you agree that ensuring that everyone has health care, I think you have to stop for a second and say, "OK -- WHOSE obligation is it?"

A theoretical moral obligation is one thing. Most people would agree that if you witness someone hurt or dying in the middle of the road, you have a moral obligation to stop and help.

But is that the same as saying you think failing to stop and help should be punishable by law? Because once the government mandates any action, the question of enforcement arises. And most enforcement takes the form of coercion.

I think what Elise may feel is an individual moral obligation to help the less fortunate. We had a discussion a while back about prostitution in which many people pretty much agreed prostitution was bad for society but no one wanted the government to force their morals on individuals who disagreed.

2. This is the mother of all slippery slopes.

Because once you agree society has a moral obligation to give people health insurance, where does that stop?

Some people don't have jobs either.

Many people have less of many goods than their fellow citizens do. If we are wealthy enough, do we have a moral obligation to erase income inequality? Many liberals think so.

Where does it stop? I think the basic premise is flawed.

Posted by: Cassandra at August 22, 2009 03:27 PM

The question really is, how do conservatives and liberals differ in how they handle moral obligations. For instance, I happen to be at Lake Whatever, and I see someone fall into the water when their canoe tips over. There they are, out there flapping their arms around, and quite obviously making a failing attempt at swimming. Equally obvious is the fact that if the person who fell into the water is not helped, they will drown!

Now, anybody who happens to have an ounce of humanity in them will see that the morally correct thing to do is that of helping the drowning person. By nature, the conservative, if they know how to swim, at all, will jump in the water and do their best to help the drowning person, because that is the morally correct thing to do. On the other hand, the liberal, who also sees this as a moral obligation will yell to the first person they see to get help for the drowning person. Once that has been done, they will get back into their Volvo so they can meet their friends at Starbucks, and tell them what a wonderful thing they have just done.

My income is nowhere near that of Albert Gore's, but he feels obligated to tell me how I should live. We should all sacrifice. I do, I give to charity. In fact, I give more to charity than does Gore. But, to those with a Gore mentality, individual donations mean little. To their way of thinking, and to ease their tax haven mentalities, the nation as a whole must give. In other words, they are good because they think and we are less so because we actually do.

Really, how often have you heard the media bragging about how generous the American people are? More generous than any other nation on this planet, by the way. What the media will say, though, is that, on a per capita basis, the U.S. government is not the most generous in the world.

For those who truly cannot pay for health insurance (by the way, when Hawaii went that route, they found that 85% of those get free health care, could afford it and had dropped their policies to get the freebee version), I doubt if any of us would say, no.

If you can fix something with a fly swatter, why use an artillery piece?

Posted by: RIslander at August 22, 2009 03:28 PM

And they certainly have no right to demand our help.

Doesn't passing a law that forces others to pay for your health care create an enforceable right?

Posted by: Cassandra at August 22, 2009 03:29 PM

Let's say that all but 40 million Americans -- out of 330 million people living here -- are buying Multivitamin "A."

Of those 40 million, 20 million are receiving Government-subsidized Multivitamin "B" and another 10 million could afford to buy "A" but chose not to do so, leaving 10 million who cannot reasonably afford Multivitamins and who are ineligible to receive Government-subsidized vitamins.

Does the government therefore have the moral obligation to provide Multivitamin "Z" to *everyone*, after first insisting that 290 million Americans stop buying Multivitamin "A" -- and bankrupting the economy merely to provide 10 million Americans with vitamin supplements when, for a small fraction of the cost, the 10 million who can't afford vitamins could be simply given the eligibility to receive Government-subsidized vitamins?

*And* the Government then reserves the right to "review" your status if you become ill, and decide to withhold the vitamins from you?

If you believe that's okay, you would have loved the USSR. Under *Stalin*...

Posted by: BillT at August 22, 2009 03:31 PM

All I can say with any kind of certainty is that if a national health plan is passed into law, George Soros will somehow make a bundle out of it.

Posted by: RIslander at August 22, 2009 03:34 PM

Doesn't passing a law that forces others to pay for your health care create an enforceable right?

I get your point and that's why I say I'm struggling with this. We've passed laws that give money to a lot of things: agricultural subsidies; food stamps; the military; Medicare. The military is both a moral obligation and a practical necessity; food stamps and Medicare are moral obligations; agricultural subsidies are neither. I don't think any of those do - or at least should - create an enforceable right because we should always be able to change the law. And we can change it because we've decided we're not obligated; because we've decided we can't afford it; because we've decided there's a better way to do it; or just because we don't want to do it anymore.

To try it another way, food stamps, Medicare, and foreign aid are all society deciding to impose a tax burden on itself in order to be generous. I think that's the moral thing to do if we can afford it (leaving aside the issue of unintended consequences for the moment). But I don't think it creates a right on the part of recipient.

If Obama wants to tell me that helping the poor get health care is the moral thing to do, I'll agree. If he wants to tell me that the poor have a right to health care, I'll disagree. The existence of a right on the part of the recipient takes away choice on the part of the provider.

I feel like I'm using a lot of words and not getting any clearer. Shutting up now.

Posted by: Elise at August 22, 2009 03:58 PM

we all share a moral obligation to make sure every American has equal benefits

No. We don't. As a parent, I am not under an obligation to treat my children equally. They are not the same. One is a boy. One is a girl. One is almost 8 and one is 5. One is arty-fartsy and one will probably grow up to be some kind of an engineer. One is bossy and one is more submissive.

When disciplining my children, I cannot and WILL NOT impose the same consequences on both children (unless the situation warrants it). They each respond to different consequences. They are not equal, aside from the fact that they are both my children and they are both human beings.

In this country we are under no obligation to provide EQUAL benefits to all citizens. Equal access...yes. But access does not mean that the benefits themselves will be equal.

From an ethical and moral standpoint, society is well-served when it's populace is healthy. So ensuring access to quality health CARE is one of society's basic goals. But access to health CARE does not equal health insurance. They are not the same thing.

This is one point where the entire premise fails.

Posted by: Sly's Wardrobe Mistress at August 22, 2009 04:55 PM

During the Great Depression, Franklin Roosevelt got all kinds of laws passed and enacted all kinds of acts. Fortunately for the country, a goodly number of them were overturned by the Supreme Court. Should the Democrats loose the majority in both houses, or, should enough of them lose their seats and the Blue Dogs worry about losing theirs, health care, if passed, will be repealed within a couple of years by Congress, itself. The only thing stronger than their "beliefs" seems to be their innate fear of losing their positions.

Posted by: RIslander at August 22, 2009 05:04 PM

Good for you, SWM.

I used to tell my boys, "The world isn't fair and I wasn't put on this earth to make it so."

access to health CARE does not equal health insurance.

That's why I loved that quote from Ben Franklin on the other thread:

The Constitution only gives people the right to pursue happiness. You have to catch it yourself.

Posted by: Cassandra at August 22, 2009 05:12 PM

We already have equal access FOR EVERYONE in this country. Anyone, everyone, from illegal alien to Xerxes I WON! can walk into any hospital ER and be seen for any ailment, be it a cold, string bean up the nose, heart attack, etc. -- whether they are capable of paying for it or not -- and the hospital must provide treatment. How much more *equal access* do we need?? Better yet, how much more *equal access* is possible?
That is, if we're really talking about equal......

Posted by: DL Sly at August 22, 2009 07:49 PM

Assuming the moral imperative exists for our govt. to provide healthcare, it doesn't mean that there's one for a one size fits all imperative. I'll compare a military example. In most (not all) areas, married military can choose to forfeit a housing payment and receive govt. quarters. Govt. quarters vary in how well they meet individual family needs, however, if one takes the payment, it can be used to purchase or rent a dwelling. It could be a small apartment to a large house, with a short or long commute depending on how much the family is willing to spend. Singles, especially in combat zones or on ships, often don't get ritzy choices though. Where there's no choice, the options tend to be basic at best. Likewise, a moral imperative for the govt. to provide healthcare can be something as simple as a credit to be used for purchasing healthcare or insurance. How much a person wants to supplement very basic coverage should be a matter of individual choice. Again, this presumes there is in fact a moral imperative.

Personally, I think that a country as wealthy as ours should help the weak and defenseless. But, the best way to help, is by having the govt. get out of the way of and support agencies, absolutely including religious ones, and individuals, at as local a level as possible. When there is face to face help, it tends to be much more effective, including cost effective, and appropriately tailored.

Posted by: HChambers at August 22, 2009 08:12 PM

"Anyone, everyone, from illegal alien to Xerxes I WON! can walk into any hospital ER and be seen for any ailment, be it a cold, string bean up the nose, heart attack, etc. -- whether they are capable of paying for it or not -- and the hospital must provide treatment. "
Unless that hospital happens to be a certain hospital that just happened to have a certain first lady as its vice-president.

Whoops! Looks like UCMC administered the wrong oath. That being the hypocritical oath. Ah, but Michelle's in good company, Dr. Zeke Emanuel thinks that the Hippocratic Oath represents a minority view. At least at the time of its inception, which somehow invalidates its utility.

Posted by: bthun at August 22, 2009 08:57 PM

Linked you. Bunk. Boot to the head.

Posted by: smitty at August 22, 2009 10:02 PM