moral analysis of healthcare in the us

Is healthcare moral? Let’s analyze the morality of the American Healthcare system.

My existence growing up was an odd one, having lived on three continents by the age of 12. I think that being from the hardline conservative state of Idaho, as well as spending time at a young age in an International School whilst living in the UK, gave me a strong appreciation for both sides of the political coin. Many people have the views they do because of:

  1. Idealism about how things are better elsewhere or
  2. Sticking to what they know because they have never experienced anything different.

Being exposed to many different cultures early on gave me an open mind toward new ideas and tolerance for things unfamiliar, while my parents’ conservative politics put a lot of emphasis on individual responsibility. I still value both of these things.

Something I was too young to think about was the cost of healthcare differing between the two main places I’d lived – Boise, ID, and Surrey, England. When I got to high school (back in the US), I heard the debates by friends and family on the conservative side of the coin talking about how universal healthcare is impractical. I didn’t realize the difference living in the UK between this and private insurance. So naturally, I bought it without really thinking about it. I trusted the people I’d grown up with. Also, our family’s insurance was really good, so healthcare problems didn’t affect me directly the way they would a family with less income or worse insurance (the two are often intertwined, as I’ll mention below).

My freshman year of college I read The Conscience of a Liberal by Paul Krugman for a class on political theory. It was then that my thoughts started to change on the matter. I had assumed this book would be a hotheaded secularist bashing on conservatives and bragging about how open minded and tolerant he was, but for the most part it was about socialist economic and healthcare systems.

I’m still not completely sold on socialism. Nobody but my mother would call me a “bleeding heart.” However, I have come to a point where I personally see the need for a more socialist healthcare in this dear country of mine. The United States is considered to have one of the worst healthcare systems in the western world. You would think for how many resources we have our people would be better off. Right now our system is on the verge of changing rapidly, shifting back toward conservative and more capitalist based systems while we were beginning to venture away from such things. I want to ask you to consider if this is practical and/or ethical. Many of these questions are things I had to ask myself before some of my views changed. I don’t have all the answers to how to make it better, but I’ll try to explain my problems with it and why I think going in the direction we are is a bad thing.


Is there a Place for Money?

This is not a question of “wouldn’t it be nice?” This is a question of ethics. Is healthcare a right or a privilege?

The fourteenth amendment promises that the State should not deprive any person of life, liberty, or property without due process of law. It’s also responsible to protect these things for people. From that standpoint – which I reckon most people agree with – healthcare in its most simple and necessary form should be a right granted and protected by the State. This would imply that money – rather, basic consumerism – should not be a player in people’s right to healthcare.

People disagree with this all across the board. In a 2009 episode of Philosophy Talk, it was argued that healthcare isn’t a constitutionally guaranteed right, but also that, given the richness of our nation, people ought to have free basic healthcare on some level. While it’s argued that more riches should be able to buy more luxury goods, healthcare seems much different than a luxury good. For the purpose of this article, I’m going to assume we all agree that life is a right, not a privilege, and conclude that healthcare should also be a right, regardless of class or income.

Is there a Need For Money?

Money, for better or worse, makes our world go around. Doctors don’t typically get free housing or food. Neither do the manufacturers of medical equipment and medicine. People need money to eat and therefore need to get paid somehow.

Miles Zaremski, in a speech he gave in 2012 as part of a UNESCO Conference on Bioethics, stated that “certain items in our lives must be a result of shared sacrifice of a society.” This is true but it doesn’t solve the need for money on a survival basis in our society. Conservatives in my life have argued to me that without economic incentive, healthcare quality will diminish. My mother remembers someone saying to us in the UK “well you have Private insurance, so you’ll be fine” indicating serious flaws in the British Government’s Healthcare system.

I actually agree with the economic incentive argument; the amount of work that the medical field requires (everything from manufacturing to research to hospital staffs) is too much for anyone to do on a volunteer basis.

So yes, money is needed. The good ol’ USA relies on people to provide that money. Other countries operate differently though.


How Does the United States Compare and Contrast with Other Westernized Countries?

In Commonwealth Fund’s 2014 international comparison reports, the United States was ranked 11 out of 11 (meaning last) overall in relation to effective healthcare systems. Specifically, we ranked last in quality care, cost-related problems, efficiency, equity, and healthy lives. We also, as of 2011, spent more than any other country on healthcare. Primarily, our healthcare system is run differently, and that comes down to a capitalist system.

Now, I’m not saying that this study is perfect or agreeable across the board. This same study ranked the UK first. A lot of people, including the author I mentioned earlier, Paul Krugman, think that the UK has a very flawed healthcare system, but many people also agree that the United States’ system is nowhere near the best. According to a 2012 analysis of the US in comparison to Canada and Germany, the United States has the highest percentage of dissatisfaction with the current system. I don’t believe nationalized medicine is the only way out, as Germany had low approval ratings as well, but I believe it is a step in the right direction.


How Will Things Change under the leadership of Donald Trump and the GOP?

There is no doubt that the Affordable Care Act (ACA), A.K.A. Obamacare, had some major flaws. Even people who benefitted from it could recognize that. We can be sure that more people are now insured because of it, but I think that one reason for the flaws is that it was the closest step that could be taken at the time toward universal healthcare inside of a capitalistic healthcare system. The former seeks to help people, while the latter seeks to profit.

President Donald Trump is seeking to fix the problems with the ACA. People are dubbing his new plan “Trumpcare,” but bi-partisan politics aside, there are many aspects of the ACA Trump is doing away with. For starters, the required mandate set in place by the ACA that individuals pay when they don’t have coverage has been done away with. Many of the taxes that were placed on those making higher incomes have disappeared as well. You can read more about it here.

There are a lot of critiques of the new GOP health care system, of course, as Donald Trump is basically the most hated man in the United States (and the world). These critiques cross all political parties and barriers.

In an interview with Salon, health policy expert Maura Calsyn from the Center of American Progress responded to the repeal of the ACA mandate. “Having [an individual mandate] allows the ACA to include such strong consumer protections… without a mandate people could just buy insurance when they get sick, which raises costs for everyone.” She added “The current bill instead includes a ‘continuous coverage’ provision… if you lose your insurance for more than three months, the insurer can then charge you more.”

It seems that both Obamacare and Trumpcare hurt the poor in different ways. One, by forcing them to pay for healthcare, and two, by increasing the penalties for not being able to afford it.


Future Predictions 

New operating models are always being tried in the healthcare industry so that costs may go down and quality stays the same or improves. These operating models are going to need to change with this healthcare plan, and I’m not sure it will get easy enough to do so with.

I would guess that more and more people, however, are going to be uninsured. If that was the biggest benefit of the ACA, then repealing the ACA could take that benefit away. Neither plan, however, is capable of doing a stellar job when it comes to incentivizing people to buy healthcare.


What to do?

This is the one question I promised not to answer. I think that taxing the rich is actually the answer to this on some level and putting that money toward healthcare. I recognize that our country is in debt, and I recognize that people have a right to property. Yes, a right, not a privilege. But when someone’s excess property is the only way to help keep someone else’s only life, it may be time for that societal sacrifice Zaremski talked about above.

However, I’m not sure. And it’s fine if you disagree. Blast me about this on Twitter @robolitious if you feel so inclined. Honest conversation and open minds is the starting point to figuring this whole thing out.

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