The Political Morals of Healthcare Reform

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President Barack Obama’s attempt to reform healthcare has generated unexpected controversy amidst overwhelming consensus among those who have opposed it in the past, such as hospitals, physicians, insurance and pharmaceutical companies, and among republican and democratic elected officials. The slogans, being shouted at very high decibels, reveal opposing concerns among large sectors of the population. There have been illustrations depicting racism, Nazism, and Marxist socialism and communism along with charges of euthanasia, coverage of abortions, inclusion of illegal immigrants, loss of benefits, and decline in the quality of care itself.

It appears from the attacks and vitriolic denunciations that those opposing healthcare reform are either badly misinformed about the objectives and the means to implement reform; or that they are all too well informed, which is why they are so critical; or that being correctly informed is secondary to their attempt to derail the process. My intuition tells me that all of the above characterize the attitude of citizens and institutions. There is a certain level of ignorance because of the complexity of the legislation. This ignorance justifiably generates fear and concern, although a portion of it is unfounded as it appears to be caused by willfully planned confusion. There is also politics at play, meaning that there are special economic interests along with legitimate ideological convictions seeking to stall or derail reforms.

While a short presentation does not lend itself to a comprehensive discussion on the morals of healthcare reform, we might gain at least some perspective on one fundamental aspect. For example, we could start with the proposition advanced by Whole Foods CEO John Mackey in an op-ed article in The Wall Street Journal. Mackey asserts the following:

Many promoters of health care reform believe that people have an intrinsic ethical right to health care-to universal and equal access to doctors, medicines, and hospitals.  While all of us can empathize with those who are sick, how can we say that all people have any more of an intrinsic right to health care…? A careful reading of both The Declaration of Independence and the Constitution will not reveal any intrinsic right to health care … because there isn’t any. This “right” has never existed in America. (Emphasis added)

Mackey provides, perhaps inadvertently, a crucial political question: Is there anything in the Declaration of Independence and the Constitution that sheds light on whether or not healthcare is an intrinsic right, meaning that all citizens are entitled to it?

Should we arrive to a resolute Yes, the issue would be solved immediately, at least in principle, since it would be up to us citizens then to abide by our devotion to our country, its institutions, and its values. If the answer were No, the issue of healthcare reform would be left to politics; our traditional process of debating, protesting and demonstrating somehow will provide us with some type of answer.

Fortunately, we do not have to read much into both documents to extract a rather compelling answer. Nor does the reading have to be all that careful; the answer is actually quite explicit. We must pay close attention, nonetheless, to a key word, “intrinsic,” for its definition could cloud the explanation.

Merriam-Webster defines the term “intrinsic” as “originating or due to causes … and included … within a body, organ, or part.” A synonym of the term would be “inherent,” something that is constitutive of or found within the inclusive body, organ, or part; in our case, the Declaration of Independence and the Constitution. The term does not signify that whatever is intrinsic, in this case healthcare, has to be explicitly spelled out in the documents. It simply means that following a careful reading of both documents it will become self-evident that healthcare is or is not an intrinsic right.

In the second sentence of the Declaration of Independence—the document that more than any other American text serves as the basis of our moral DNA—we read the following: “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable rights, that among these are life, liberty and the pursuit of happiness.”

The term “unalienable,” actually is a powerful word; again, according to Merriam-Webster, it signifies that whatever is unalienable—life, liberty, and the pursuit of happiness–is so vital that it cannot be surrendered or transferred.

What then is the relationship between the concepts of life, liberty, and the pursuit of happiness and healthcare? May we suggest that the most significant human condition that makes possible life, liberty, and the pursuit of happiness is good health? Let us think about this. Can we truly enjoy life when we are sick? And, how can we possibly enjoy our freedom when sickness afflicts us? As to our own pursuit of whatever it is that makes us happy, do we not have to be of sound mind and body to enjoy it? Even masochists have to be healthy to be able to feel the joy of pain and suffering!

Since good health is not entirely possible among humans without adequate healthcare, given that all men are created equal (when it comes to basic rights) and endowed by their Creator with certain unalienable rights such as life, liberty, and the pursuit of happiness, healthcare becomes an absolutely indispensable right, thus, intrinsic, for without it we would not be able to enjoy our most cherished principles noted in the Declaration of Independence. No matter how we juggle the words, our right to life, liberty, and the pursuit of happiness loses its true meaning without good health, which is largely made possible by adequate healthcare. I would add that eating wholesome foods is part of leading a healthy life, and Whole Foods provides plenty of it (unpaid advertising).

We turn next to our beloved Constitution, our most fundamental source of law and order in the nation. Its preamble, a short, one sentence paragraph states: “We the people of the United States, in order to form a more perfect union, establish justice, insure domestic tranquility, provide for the common defense, promote the general welfare, and secure the blessings of liberty to ourselves and our posterity, do ordain and establish this Constitution for the United States of America.”

First, we notice that the constitution addresses, thus incorporates, the people of the United States, likely meaning all citizens and legal residents. Next, the document identifies the objectives it seeks to attain or the reasons for which a constitution is established. These are:

1) to create, to develop a much better society than the one preceding it, which was a loose confederation of states.
2) to establish justice, traditionally defined as creating conditions of equal fairness and equality before the law for all.
3) to insure peace, law, and order throughout the land.
4) to defend the entire population against any foreign threat but presumably including domestic hazards as well.
5) to promote the general welfare of its citizens, the term “general welfare” being understood as those activities and policies that safeguard the well-being of the population.
6) to make a reality for all, including those to come, the gifts or bounties that liberty provides or makes possible.

A careful and honest reading of the preamble should tell us that enjoying good health, which is possible mainly through adequate healthcare, directly relates to reasons Five and Six, in the same manner as healthcare becomes an intrinsic right in the Declaration of Independence. Further, healthcare relates to reason One, as it is reasonably derived from the aim of developing a better society, since inequality of access to healthcare would result in a less than a “perfect union.” It relates to reason Two as well, since fairness and justice for all would seem to require a need that is fundamental to all human beings. Healthcare is also related to reason Three if we accept the proposition that peace and order stem in part from a system of government that is fair and socially responsive toward its citizens when in need. Lastly, the significance of the fourth reason becomes obvious, as any foreign or domestic threat to the nation could attempt against peoples’ lives.

One would have expected that no Declaration or Constitution would be necessary to assert what seems to be self-evident, that good health is a prerequisite of living a good life and that all human beings are called to enjoy good health. It would be preposterous to think otherwise without providing sensible reasons why some should enjoy good health and not others.

That enjoying good health is both a universal need and a desire—for which healthcare is required–unfortunately does not translate into all human beings on earth having that need and that desire met. Human-created inequalities abound within and among all nations making it difficult for many to have access to adequate healthcare. That does not mean that the universal right to healthcare is not humanly intrinsic to life, liberty and the pursuit of happiness. It seems to be. But it means, too, that governments and their citizens have a moral obligation to provide a level of healthcare to its entire people commensurate with their corresponding national wealth and individual needs. In our case, being the richest nation in the world, there does not seem to be any plausible reason why not all citizens should enjoy a level of healthcare corresponding to our technology and national wealth.

While we may assert that healthcare is ethically mandated as an intrinsic right, healthcare does not translate into an entitlement without a cost. This cost entails a dual responsibility with personal limitations on all participants. On the one hand, it means that all citizens should be entitled to have access to adequate preventive healthcare as well as to treatment during sickness, particularly when their medical or financial conditions go beyond their means to cover them. Along with this principle, there is the issue of individual responsibility: to become health conscious, mindful that his and her right to healthcare should be accompanied by his and her duty to lead a healthy style of living to the best of their possibilities.

While some only take into account the aspect of individual responsibility for his or her health, there is a parallel duty that often is callously forgotten. The concept of dual responsibility requires a great deal of social and political sensitivity to the fact that individual emotional and psychological dysfunctions do exist in real life as well as economic and financial crises–some triggered by individual dysfunctions and others by external forces—that negatively affect individuals’ lifestyles and their incomes, thus their ability to retain health insurance. Furthermore, as a society we cannot hold individuals responsible for their lifestyles without demanding, too, that greed–the craving on the part of hospitals, doctors, lawyers, and insurance and pharmaceutical companies to gain exorbitant profits–be considerably tamed.

While the Declaration of Independence and the Constitution substantiate the fundamental principle of adequate access to healthcare as an intrinsic right, other aspects of the legislation deserve scrutiny. Among these are questions of cost, as well as those concerns that were identified at the beginning, such as euthanasia, a limited public option, mandated coverage versus individual freedom, coverage of abortion, inclusion of illegal immigrants, loss of benefits, or the potential decline in the quality of care itself. One would hope, however, that notions related to racism, Nazism, and Marxist socialism and communism would be eliminated from the debate, if only because idiocy does not lend itself well to rational argumentation.

Note: As a matter of full disclosure, I must state that I have close relatives who are in the legal, medical, and medical insurance businesses.

To contact the author copy and paste my e-mail address and send via your e-mail provider. RicardoPlanas@reasonandpolitics.com