The Moral Case for Health Care Reform?

As the health care bills currently before Congress move tantalizingly close to passage, those who favor government management of health care markets increasingly assert "the moral case" to advance that cause.  These influential opinions attempt to close off debate, as if to say, "All that the Lord has spoken, we will do."  Precisely for that reason, citizens must consider if the arguments are moral imperatives in search of a political will, or merely the other way around.

Our nation was established upon this shared moral code: individual citizens are endowed with certain moral rights, and among these are life, liberty and the pursuit of happiness.  Since we possess these fundamental rights with or without the formation of government, the government of the United States was established not to create these rights, but to secure our free exercise of them.  A right to life implies a governmental duty, not to give life, but to secure an individual's freedom to live.  A right to liberty implies a governmental duty, not to grant liberty, but to secure individual autonomy.  A right to the pursuit of happiness implies a governmental duty, not to award happiness, but to secure the free application of that pursuit.  This is the shared moral code that can frame a thoughtful debate on health care policy.

Most coherent attempts to present the moral case for health care reform are similarly bounded by the claim of an absolute right on one side and a resulting governmental duty on the other.  Rights advocates cite some variation of the twenty-fifth article of the UN Declaration of Human Rights:

Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

Despite the considerable clout derived from the assertion of a basic human right, such contentions are nothing more than highly contestable social ambitions.  In fact, alleging the "right to medical care" and protection from circumstances beyond one's control is nonsensical, similar to this argument in Monty Python's Life of Brian:

Stan:          I want to have babies.

Reg:           You want to have babies?!

Stan:          It's every man's right to have babies if he wants them.

Reg:           But you can't have babies.

Stan:          Don't you oppress me.

Reg:           I'm not oppressing you, Stan - you haven't got a womb.  Where's the fetus going to gestate?  You going to keep it in a box?

Judith:        Here!  I've got an idea.  Suppose you agree that he can't actually have babies, not having a womb, which is nobody's fault, not even the Romans', but that he can have the right to have babies.

Francis:      Good idea, Judith.  We shall fight the oppressors for your right to have babies, brother.

Reg:           What's the point?

Francis:      What?

Reg:           What's the point of fighting for his right to have babies, when he can't have babies?

Francis:      It is symbolic of our struggle against oppression.

Reg:           It's symbolic of his struggle against reality.

The health care debate has become exactly this: a symbol of our struggle against reality.  Heath care is presented by advocates as a technological panacea, a supernatural wonder that ends suffering and delivers us from death. As Max Frisch wrote, "Technology is a way of organizing the universe so that man doesn't have to experience it."  It is mere fantasy to assert a fundamental human right to avoid reality, and without a rational basis to assert an entitlement to health care, there is no corresponding government duty. 

Even if one firmly believes in the existence of an individual's right to health care, such a right neither implies nor justifies a requirement that other citizens supply it, only that we do not stand in the way of that pursuit.  It would seem that if the right existed, the corresponding government duty mandated by our society's moral code is to secure the right to access by eliminating restrictive interference, not to provide a system of regulation dependent upon taxation, rationing, and other limitations of personal liberty.

So set aside the notion of rights and consider obligations.  Many have argued that, "there is a moral obligation to care for people who are sick."  The worthwhile discussion is not if such an obligation exists, but rather:  "Is one primarily bound to fulfill this responsibility individually as determined by personal conscience, or must citizens fulfill this obligation collectively as determined by the whole?  Likewise, is a personal obligation to help those who are sick satisfied when society acts on the individual's behalf?"  Health care reform advocates insinuate that "caring for those who are sick" is widely accepted as a collective obligation, but it is a far stronger case to state that Americans view this strictly as an individual obligation. 

As a nation, we believe passionately in personal moral agency, as is seen in our historical aversion to "legislating morality", our unwillingness to assume personal responsibility for others' behavior, and our reluctance to assign praise or blame to groups.  It follows that when others act (or "care") on our behalf -- especially when the means for this care (that is to say, taxation) limits or even prevents our own activity -- they preclude us from doing what we are morally obligated to do on our own.  The government usurpation of an individual's moral obligation to care for others is itself a moral wrong because it violates one's absolute right to moral autonomy when carrying out individual obligations of conscience.

There are two additional moral arguments put forward in favor of health care reform, and both are variations of the utilitarian principle claiming that what is moral is "the greatest good for the greatest number." 

First, the supporters' argument goes, "in the course of extending health care to all, it is acceptable to limit some individual freedoms if the greater whole is served."  With very few exceptions, individual liberties in this country are morally restricted only when one's exercise of a freedom directly violates the rights of another citizen.  That is not the case here.  The argument for universal health care (that individual liberties can be restricted to favor the good of the whole) is the same argument in favor of slavery: "Some people do have their freedoms limited under the law, but taken as a whole, our society is better off as a result."  When human liberties are restricted for "the good of the whole," watch out for moral harm.

Second, supporters of health care reform have said that some citizens have a right to medical care for which others pay because the United States is one of the wealthiest nations, and as such has a moral obligation to spread our affluence.  It is not clear what prosperity has to do with this argument.  Perhaps it is meant that there exists a collective right to take the wealth of some citizens based on a communal need - a highly debatable moral premise - but it would seem that this right exists or doesn't exist without regard for the nation's relative wealth.  Those who argue that the U.S. should have universal access to health care because of our wealth sound much like Willie Sutton revealing that he robbed banks because "that's where the money is."  Robbing banks -- or individuals with abundant resources -- is not moral, no matter how much money is to be had, nor the good such money may do.

Thankfully, Americans do not need a government to suggest that caring for the sick is the right thing to do.  We are a moral, generous, caring people who -- given the freedom and opportunity -- are already inclined to care for the sick in our families and communities.  The government oversteps its moral boundaries -- our shared moral code -- by creating a health care system based on taxation, rationing and restrictions, even if it's done in the name of equality for all.  Government has a moral obligation to remove barriers (regulations and other legal limitations) to health care, not establish new ones.

John W. Truslow, III is the Associate Director of the Center for Ethics and Corporate Responsibility at The J. Mack Robinson College of Business, Georgia State University.
If you experience technical problems, please write to