Why Not a Moral Case for Health Care Reform?

Author’s note: Yes, I am aware that Ezra Klein wrote a post called “What Happened to the Moral Case for Health Care Reform?” here.  This post was half-done by the time that appeared and I never consider it to be bad to be on the same frequency as Ezra Klein.

The past several weeks have seen an almost-unprecedented level of attention  given to President Obama’s (and Congress’) attempts to reform the American health care system.  As observed by the editors at The New Republic here, a useful but sometimes unfortunate amount of attention has gone to the admittedly wonkish details of reforming the system (the taxes, the precise structure of “health insurance exchanges,” will there be a public option?, etc.), to the detriment of the “moral case for health care reform.”  Among the strongest proponents and supporters of comprehensive health care reform (among whom I count myself), the moral case is the most compelling and often the original reason we were drawn to this particular cause above or beyond any others.  Why the disconnect?

Before going any further, it might be important to recognize that any time President Obama or Congressional leaders mention “47 million uninsured Americans,” the moral case is being made implicitly.  But why not just put it out there? 

First, the moral case that has been made by other countries in their own pursuit of health care reform (specifically moving towards universal coverage) may not work so well on Americans.  In general, Americans are less enthusiastic and more suspicious of government involvement in economy and providing forms of “welfare” to its citizens.  Americans tend to be more individually focused than European countries, which have a more communitarian ethos.  This has its positives (better welfare in Europe) and negatives (less individual rights in favor of group rights in Europe).  But for appeals to “justice”, “fairness” and “equity/equality”, there will always be a higher threshold to cross on this side of the Atlantic.

Second, at this particular point in their history, Americans are (and with good reason) narrowly focused on the cost of additional government programs and growing budget deficits.  While some of us are not as concerned as certain GOP  politicians claim to be, it does not pay to be flippant about endless deficits and the growing U.S. debt (neither of which I believe is a necessary or certain outcome of health care reform).  In that sense, talking about the details of cost, tax incidence, and “bending the curve” is inescapable.

Third and finally (and most perjoratively I might add), many of the persons at whom such arguments are aimed, namely, those who are not already convinced that health care reform must pass, don’t really give a damn about “the other”– those who don’t have insurance, or who are losing their insurance, their livelihood, their savings, or their health because of a lack of coverage or inadequate benefits.  These are the people Andrew Sullivan is describing (even if not consciously) when he says:

I believe in capitalism in as much as history has yet to show a more efficient or democratic way of allocating resources and rewarding effort. But to believe only in capitalism, to see this money-making machine as an end-in-itself, is spiritual death. And if capitalism is to survive, a citizenry capable of retaining spiritual perspective is critical.



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