HEALTH CARE AS JUSTICE

September 17, 2009

The most moving part of Barack Obama's speech to Congress and the country on health care last week was his tribute to Ted Kennedy. He quoted from a letter the ailing senator had written in May, to be delivered after his death. "What we face," Kennedy wrote, "is above all a moral issue; at stake are not just the details of policy, but fundamental principles of social justice and the character of our country."
Obama went on to say that "part of the American character" is "a recognition that we are all in this together; that when fate turns against one of us, others are there to lend a helping hand," and that "sometimes government has to step in to deliver on that promise."
A major disappointment in Obama's approach to health care is that he has never framed the debate specifically in terms of moral principle and collective responsibility. He has used morality as a rhetorical device, as he did in this speech, but has never made a compelling philosophical argument that medical care is a basic human and civil right that demands a unified national commitment and the sacrifice of individual interest for the common good. Doing so would have changed the very nature of the debate, calling on legislators and the public to account for their various positions in ethical terms.
The fundamental moral question is: Is care for those who are sick part of the Constitution's pledge that "we the people of the United States" will "promote the general welfare," right along with ensuring domestic tranquility, providing for the common defense, and securing the blessings of liberty? Common sense would surely say so. When the country is threatened by swine flu, doesn't the federal government have the obligation to muster all of its resources, financial and technical, to combat and prevent it? Virtually no one would argue otherwise. Are not infant mortality, whose rate in this country is among the highest of all developed nations, and the thousands of needless deaths for lack of care to the uninsured and denial of care by insurance companies just a slower, institution-caused pandemic?
Is making money off the sick morally wrong? Aren't doctors and hospitals care-givers rather than businesses? Shouldn't insurance companies be simply risk-sharers, not profit centers? Denial of coverage for a woman with breast cancer, Obama lamented in his speech, "is heart-breaking, it is wrong, and no one should be treated that way in the United States of America." And yet, he said, "insurance executives don't do this because they are bad people. They do it because it's profitable" — strangely implying that profit is a good in every case. A law compelling all insurance companies to return to their roots as non-profit collectives would be an important step towards health-care justice.
Is health care a privilege reserved only to American citizens? "There are also those who claim that our reform efforts will insure illegal immigrants," Obama stated. "This too is false — the reforms I'm proposing would not apply to those who are here illegally." The "You lie!" blurt by Representative Joe Wilson of South Carolina only called attention to a moral contradiction. Health care is a universal human need. Denying coverage to illegals is not only morally inconsistent, it undermines the nation's collective health. Doesn't the good health of every person living in this country enhance the good health of all? The president himself noted that emergency-room care, mandated as a social obligation to the uninsured and to the illegal, adds "a hidden and growing tax" of $1,000 per insured person per year. Would it not simply be better, both morally and practically, to provide equal care to all human beings living in this country without scrutinizing their papers?
In his 1933 inaugural address on the economic crisis, Franklin Roosevelt saw the solution in "our interdependence on each other; that we can not merely take but we must give as well; that if we are to go forward, we must move as a trained and loyal army willing to sacrifice for the good of a common discipline." The situation is similar with health care today.
"I am not the first president to take up this cause," Obama stated at the beginning of his speech, "but I am determined to be the last."
As long as the fundamental principles of social justice, rather than the details of policy, are not addressed, his solution will only be an interim one.
With audacity, I hope he won't be the last.