In my previous post on the healthcare debate I was reacting not to any proposed policy but rather the tone and tactics of the discussion. (How I wish it actually were a discussion.) I was very pleased in Obama's speech last night that he addressed that issue as well as specific policies. He named the lies for what they were. He accurately characterized some of the arguments as designed to kill reform to score a political "win" rather than seeking to improve a bill or offer alternative ideas. And he reiterated his conviction that it is still possible to have a reasonable discussion that doesn't descend into acrimony and name calling. (During the speech he was named-called on the House floor, "You lie!" so I'm less optimistic about this point but I hope it's true.)
But what about the policy itself?
Universal health care.
We have a moral obligation to care for the sick. This is not a situation where people must take personal responsibility or suffer the consequences. Few of us are willing to simply let the sick among us suffer because of lack of money or because of a bad decision they made some time earlier. Healthcare is a community responsibility. We have already adopted this principle through our policy of allowing the indigent to use emergency rooms. The reform movement only wants to build on this principle in a way that is more efficient and less expensive.
Portable, secure, healthcare
Healthcare should not be dependent on life circumstances that are transitory. Employment is transitory; no one should lose healthcare because they lose a job, or change jobs. Good health is transitory; no one should lose healthcare because they get sick. Place of residence is transitory; no one should lose healthcare because they move from one city to another or from one state to another. Family situations are transitory; no one should lose healthcare because they get divorced, or their spouse dies. Age is transitory; no one should lose healthcare because they age-out of a covered age bracket. All of this simply points back to the first principle: healthcare should be universal. We have a moral obligation to care for the sick. Anyone who is a citizen of the United States should be guaranteed healthcare by the US government.
Private insurance is incompatible with universal healthcare
The benefit of health insurance is that by buying into the system when I'm healthy, if I get sick I know I will receive the care I need regardless of my ability to pay. But if health care without regard to ability to pay is required by law (and moral obligation) than the insurance company no longer adds any benefit. Private insurance companies can only add an expensive drain on a universal health care system, adding costs of redundant staff and paperwork and advertising and so on. A single-payer system could provide the same administrative function much more efficiently and inexpensively.
rationed healthcare
Not to avoid the elephant in the room, healthcare is not an infinite resource. There are limited numbers of hospital beds, doctors, MRI machines, transplantable organs, and so on in every area of healthcare. A universal healthcare policy must have some means of guaranteeing a basic amount of coverage to all persons before it agrees to fund higher levels of care for some few people. People seeking care beyond the basic level would then have the option of paying out of pocket or entering into something like the current private healthcare insurance system.
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We have a moral obligation to care for the sick.
Who is the "We" here? Who enforces morality? Who pays for moral behavior?
I have all sorts of obligations in my life or varying sorts of moral orders, but who is supposed to enforce morality on me?
And what gives that enforcer the moral authority to do so?
Most people share a feeling that we cannot let the sick among us suffer without doing what we can to help. If you don't feel that obligation than feel free to do nothing. Moral obligations are only obligations to the people who feel them.
However, communities can decide to mandate moral behaviors by creating laws around them. Not killing or stealing begins as a moral obligation but murder and theft are also illegal. Even if you don't feel morally obliged as a citizen of the community you're still required to obey the law.
Caring for the sick is currently in an ambiguous, middle ground between voluntary morality and legally required. You personally can let sick neighbors suffer, but our hospital emergency rooms are required to care for everyone and your taxes make that care possible. If you pay insurance premiums your money goes to care for all people who share your insurance company, whether you feel morally obliged to care for them or not.
A universal healthcare system makes a legal obligation out of a moral one. All people will be required to participate in a system that cares for all people. Whether you feel a personal moral obligation will become irrelevant, but the fact that many people like myself do feel a moral obligation is a driving force in creating the new law.
And what gives the government (the enforcer) the moral authority to enforce our laws? We do. We elected them.
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