Healthcare is a moral issue first

On May 4 the House of Representatives passed a poorly understood healthcare bill.

The more people learn about it, the less they seem to like it. Maybe that’s why it was so shrouded in secrecy before passage, with barely any analysis of its likely effects or opportunity for public discourse.

{mosads}Oddly, despite the secrecy, the bill might be getting closer to the true, honest positions of some politicians (and their constituents) than prior bills.

The reason is that healthcare is not only a policy matter: Many Americans and a majority of citizens in other industrialized nations consider access to affordable healthcare a moral issue, too. But this moral issue implies policy stances that not many people are taking.

There are some very simple policy consequences of this position. One is that government must intervene in healthcare because the free market will not satisfy this obligation. The obligation to provide affordable coverage to those with pre-existing conditions perfectly illustrates this.

Consider the unlucky person with the most costly pre-existing condition in a world without government intervention in healthcare. Pooling risk with this person would always add to your cost of insurance. So, absent charity, you wouldn’t do it. Since charity is not guaranteed, some of these people would end up at the whim of an insurance market unbound by government controls. Which means some of them will not be able to afford their insurance.

But this violates our moral position, so government has to intervene. And once government is involved, it has a moral and an ethical obligation to use its power in the most fair and efficient manner possible. Thus, if you believe accessible healthcare is a moral obligation, all debates should be about how the government should help to provide it.

The deciding factor in these debates should be cost and coverage, independent of partisanship. This means studying the issues at play, analyzing the costs of competing plans, and so on.

Now let’s say you do not believe that accessible healthcare is a moral obligation. There are some very simple policy consequences of this position as well. One is that government must not intervene in healthcare. Government, after all, is about obligation, so if you don’t believe healthcare is an obligation, government should not be involved.

There’s more to government’s non-involvement than merely repealing the Affordable Care Act, though. Under this position, Medicaid should go. And Medicare should be privatized. State-run schools should not provide assistance to children with special needs. Hospitals should be under no obligation to treat the sick who lack an ability to pay. That quite literally means a public hospital should allow people to die.

If this does not sound harsh to you, then congratulations, you are consistent in your beliefs. I encourage you to be honest about them so we can have a productive debate. Deliberative democracy is the best way we know to figure out whose moral values society should adopt.

If this does sound harsh to you, though, then it is likely you do indeed believe that healthcare is a moral obligation. You simply question how it should be implemented. In other words, at some level you believe we have a moral obligation to provide care. You just don’t like the way we’re doing it.

You may very well be right. Your moral obligation then is to find a better way. Offer plans, assess their potential benefit and negotiate compromises with all those who share your moral position. Gather information and query experiences from everyone from academics to people working triple shifts in the trenches. This is a slow and often frustrating process, with mistakes and wrong turns, but it’s all we have. And it moves generally in the right direction over time.

This is not what the politicians who voted Thursday did. You can tell by the absence of information, studies, and CBO reports that should have been referenced to convince us of the merits of their legislation.

Instead we observed secrecy and a rushed bill. That tells us the origin of the desire in Congress to repeal does not arise from implementation concerns. Instead, it comes from a difference in moral values.

If you share these moral values, of course you should support the push to repeal. You have absolutely every right to do so. But if you do not share these moral values and are considering supporting a repeal anyway, perhaps it’s worth thinking about how you might better align your policy stances with your moral values.

David A Siegel is an associate professor of political science at Duke University.

The views of contributors are their own and are not the views of The Hill.