Government Healthcare Reform: Paradoxes and Quandaries
Government Healthcare Reform: Paradoxes and Quandaries
Suppose a medical treatment costs $500 a year and will save a patient’s life with 100% certainty. (That’s more or less the case with HIV infection; if issues of drug royalties are put aside, it should cost no more than $500 a year to manufacture and administer a cocktail of antiviral medicines which are nearly 100% effective in suppressing the viral infection that leads to AIDS.) If an American can’t pay for this hypothetical treatment, should society provide it for free?
For this specific example, I say yes. Whether this is a right or not is another question. Perhaps it’s better seen it as an issue of social justice, not a right per se. A person doesn’t technically have a right to receive free healthcare, because that amounts to saying that another person can be forced to pay for it. With greater confidence we can say that there is a social obligation to provide for the health needs of the poor. People are required by conscience, duty, and justice to do this.
Consider now a second example: a medical treatment that costs $10 million per patient, and has only a 1% chance of success. If there were no other treatment, a billionaire, someone with plenty of money and nothing to risk, might choose this treatment. Does a poorer person, someone without $10 million, have a right to receive the treatment at the public expense? Common sense says no.
Between these two extremes are many actual disorders and treatments. For example, there are many very expensive treatments for late-stage cancer, often with limited chance of success, perhaps at best extending life at a low quality for a few months. Does justice require that society pay for these treatments for the poor?
These considerations illustrate how issues of social justice and ethics, some potentially involving intensely personal religious and spiritual values, must play a role in determining appropriate allocation of healthcare and associated financial resources. In a traditional society these issues would be sorted out with attentive deliberation, kindness, fairness, and wisdom. None of these are virtues which anyone suggests modern governments enjoy a superabundance of.
Does one have a social responsibility to contribute to the healthcare costs of the poor?
Does society have a right to fine a person who does not?
Does government have a right to require one to be employed in order to pay for healthcare of other people?
If jobs with good working conditions are scarce, does government have a right to require one to work for inconsiderate or exploitative employers? Is one required to work under conditions that may involve unreasonable stress and stress-related illness?
May government require us to work ourselves sick in order to pay for public healthcare?
Could a hypothetical evil society exist wherein corporations and governments cooperate to exploit the workers — the government forcing people under threat of fines and imprisonment to be employed? The element of choice being removed from the worker, would employers be tempted to neglect workers’ needs and welfare?
Would it be ironic if, under the name of socialist principles of justice and egalitarianism, a more capitalist (in the negative sense) system of worker exploitation is created?
There is no cure for the common cold. Therefore it cannot be that said anyone has a right to receive treatment for the common cold. If an effective cold treatment were invented tomorrow, would that create a right that did not exist before?
If a treatment exists which nobody can afford, does anyone have a right to that treatment? As soon as one person can afford it, does that immediately produce a right of everyone in society to receive the treatment?
Consider the issue of efficiency. Under the Obama healthcare plan, citizens would be required to buy insurance policies that are, compared to a few years ago, exorbitantly expensive. Many, if not most health economists would claim that healthcare costs today are unrealistically inflated. In theory we could design more efficient, alternative healthcare and healthcare financing systems that cut the costs by 1/2 or 2/3. Or said another say, many believe that government intrusion into healthcare financing (e.g., Medicare), has radically increased healthcare costs and inefficiency. If justice demands that poor people receive healthcare, does that also mean it demands their access to insanely overpriced healthcare? Or does justice only demand that richer citizens contribute towards the medical expenses of the poor at a level commensurate with reasonable and realistic prices?
When Robin Hood meets the rich man in the forest, well may he say, “Stand and deliver! I take from the rich and give to the poor!” The rich man, if he has a conscience, can little complain. Robin does him a favor, for all applaud justice truly served. Let him toss his bag of gold, have a jolly good laugh, and be on his way.
But what if Mr. Hood says, “Stand and deliver. Yield thee up three bags of gold. One for the poor man, one for my own services, and one for the extra fees I levy on the poor. For I run the clinics, which, though mean and miserable, are most expensive. They are staffed with my lazy friends, and we buy overpriced supplies from crooked merchants who bribe us. But none of this is your concern. Three bags of gold, I say, or else.”
Do people have a right to healthcare?
Do people have a right not to starve in a land of plenty? Does government policy officially prevent starvation?
It is commonly said that the three necessities of life are food, shelter, and clothing. There are people in America without food and shelter. Why is the government more interested in healthcare than in these more fundamental necessities? Could it be that the government is unduly influenced by special interest groups — pharmaceutical companies and insurance corporations?
Is the government’s interest more in justice, or power?
Suppose we allow there is a right not to starve. And suppose it should cost $5 per day to feed someone. What if the government created an extremely inefficient program that cost $20 per day to feed a poor person. And then the government said that all food distribution to the needy must occur within this program. Do the poor ehen have a right to demand that the rich pay $20 per day for their food? Or would justice require only that the rich pay $5 per day?
If the rich pay $5 per day towards the food of each poor person, and the government cannot spend this money efficiently, would it not be the government which is unjust? If the government is unjust, is it the duty of the rich to compensate for this? Would there be a stronger moral obligation to change the government?