On Healthcare: Morality, Ethics, Religion, and Such

Posted: April 8, 2012 in Uncategorized

To start, this will be all over the place and brusque. And it certainly won’t be considerate of your medical history. Such is the scenario with American health care. The following perspectives should be public knowledge – though I doubt seriously the extent to which the majority of Americans have thought deeply about them. So to offset what may upset I will say, Happy Easter to Christians and Chag Sameach to those of Jewish faith (as of sundown, this past Friday)!

And why not begin an ethics of public health with these undertones? It’s clouding the news these days: the Constitutionality of the individual mandate to purchase health insurance, as proposed by the President Obama Administration and passed under the 111th US Congress, then signed into law by the former. “Obamacare.” First thing’s first, to sum it up at its surface level, “Obamacare” is an array of political interests that coalesced into a law with several provisions – only one of which is a mandate that all individuals have some form of health insurance by a certain date (whether private, public, or quasi-public, as provided by a not-for-profit contractor). That is to say, the individual mandate is not analogous to Obamacare; it is one of the many intricacies within Obamacare.

Now that that’s cleared up, this essay will focus on that very provision. At root in the mandate’s purpose is the desire to facilitate and propagate the benefit of improved overall public health. Societal health, that is. What that surely amounts to is American individuals’ sacrifice at some level, big or small – be it being forced to buy insurance for oneself, forced into an insurance coverage exchange, forced to pay taxes for others’ insurance, or remaining absolutely unaffected, beyond paying the taxes one already pays. The extent to which these are stratified in effect needs no further analysis herein. But for all intensive purposes, let’s agree: it will be beneficial for some, suck for others, or really not significantly impact most – beyond the fact that they agree or disagree with the “mandate,” and are already paying taxes for others’ insurance by law (Medicare, Medicaid, Disability, Social Security, the like).

Let’s pause there and look no further into its specifics. Instead let’s start, as appropriate on Easter Sunday, by clouding the political dynamic with the religious undertones I began with. Why not? After all, this is something that the right of the aisle has become politically adept at doing. First, on Christianity and the parables of ‘helping thy neighbor,’ perhaps at one’s own shortfall materially, consider the tale of the Good Samaritan.

Dude, you weigh too much for me to keep holding you up looking all grief-stricken and what not. I will honestly pay for you to hobble your heavy ass to the hospital.

The moral of Jesus’ parable is – by one of many round-about Biblical means – “Do unto others as you would have them do unto you.” Help people, be nice, do what’s right. Because that’s what you would want for yourself if you were banged up and bleeding on the side of the road. Whether or not it’s at one’s own expense to help a person bleeding – their time, cost of travel to the hospital, etc., they’re likely to do it because it’s the right thing to do. The most impassioned believer might even pay a penniless person’s medical bill. One of good faith would ardently support these values at their core. Man oh man, lest these ethics translate unto public health. A Democratic talking point to use henceforth might be, “For those who love God, know that helping others at your own expense will not go unnoticed by God”. Would that assuage the debate? It seems not. Now, sure, there are multiple contradictory factors to compare regarding the political Right’s ardent hatred of “health care reform” and ardent love of the religious values of helping others’ no matter ones’ own expense, but I’ll leave it there for your own consideration.

And what of this mandate’s economics? Here we can blast the Left. Short of ‘socializing’ health (something appalling to the American Right and politically unfeasible in the U.S.), it’d seem the standard middle-ground would be to settle upon something that involves choice, not government mandate, right? Right?

Apparently not. The Obama Administration, realizing a political avenue to get health reform passed, went the route of mandating the individual purchase of insurance (whether or not the Supreme Court holds the law up). This eliminated individual choice, proper, to an extent, which does two things un-liberal. First, while working to improve overall public health, this law, in a round-about way, does in fact target the more working-classes of the American wealth divide. It forces them into some means of paying more to ensure their own health. For others who can’t afford even that, it perhaps increases taxes across-the-board to cover their costs, and thus the law impacts the middle-classes further. Again, not getting into whether I think this is right or wrong for this specific law, I’ll leave it there for your consideration. Besides, as I’ll later point out, I believe this individual mandate to be the lesser of another option in effectiveness anyway. Pun intended.

But secondly on the un-liberal doings of this individual mandate law, it also blatantly shoves guv’ment in the face of the Right rather than trying to caress it into the political mold. On its face, you’d of thought this naïve political play unmovable via legislative process. But it passed. Why? Because Democrats missed a major political opportunity and insurers won a major victory. This law passed – at the end of the day – because big insurance in America lined the pockets of its supporters and brought to table big ticket lobbyists who wooed the Left into settling with the “mandate” over the to-be-discussed “public option.” At least with a mandate insurance providers still make money. And profit-motive can indeed woo some of the Right side. And so it goes, those hired on K Street found the mandate at least less deplorable than the concept of government competing with their clients’ – insurance companies’ – dollars. Of course, the Left then met this sacrifice in the middle by not calling out insurance companies as the very frickin’ problem with our health care system, and instead just said, “Screw it; we’ll just force people to buy insurance to cover the health care dilemma,” rather than forcing the following argument. Again, I leave it there for consideration rather than examining the political worth of this move.

And so why did the Dems choose this route? Because it’s the only way health reform would’ve passed, correct? I really, truly, find that hard to believe. Because I, like any other reasonable Economics 101 student, political middle-grounder in Intro. to Politics, or flat out Home-Ec. student who cuts through all the b.s. and sees what should’ve been done on the surface level, see a much more reasonable, and effective, middle-ground for both sides: passage of the “public option.”

The public option defined, simplistically, is the option that government-backed insurance can be ‘bought’ by consumers. It would be an option available in the market, among the other types of private insurance. Essentially, the government insurance program would enter the insurance provider market as a competitor to insurance companies, set a lower price for the cost of its insurance (without blocking those with pre-existing conditions from participating), and thus it would compete against private oligopoly or tendencies toward colluded prices – in theory forcing them to internally regulate their costs and overhead and, then, lower their own prices. Hence, individuals would no longer lack access to health insurance because they could either get it from the government, buy it privately at market-forced lower cost, or choose not to (even though it could be attained).

It’s called the Econ. 101 regulation of a market failure, a libertarian value, even: government interference when a market has gotten out of control or has failed in disallowing certain types of people from entry.

“Damn cuz, that’s some oligopoly-driven dead weight loss right there. I buy my insurance straight cash.” – Tron

There are different shades of oligopoly, asymmetric information, moral hazards and transaction costs associated with the insurance market that require some kind of government interjection – the question is whether it should be offered as an option…or mandated upon people. Again, I’ll leave it there for your own considerations.

And so we’ve summarized two sides of a dilemma: the Right fully agrees, in its backbone of American values, that we should help people (but not by mandate, by choice or out of charity); the Left fully agrees that healthcare is an individual right and should available to all (but has forced government mandate to buy it to achieve its goals). Somewhere in between morality and the law, we should’ve settled on the common-sense solution.

And yet we’re staring down a decision that’s not even debating that of common sense. Instead the Supreme Court decision to be had on the individual mandate will outline our health care system for the rest of my lifetime, in all likelihood. I want nothing more than for health care to be available to all. It is a human right, in my mind. Any person with a soul should agree – regardless of their political affiliation (and we know where I lie). Granted, there might be disagreement about how you get there, but a human right it is, indeed.

So, having never said which side of the coin I hope the Supreme Court lands on with its individual mandate ruling, I will say on the record that this Left-side agenda to play out the individual mandate was a foolish undertaking from the start. And I mean that. And if it is overruled in a majority Right-leaning Supreme Court, the potential subsequent debate on the possibility of a “public option” will be doomed from the start. In that scenario, as much as I’d hope the Right would understand history and allow the public option to move forward, given the defeat and hoop-la of the mandate, I’d sincerely doubt that plausibility.

But that fairytale-land scenario only offers a hypothetical chastising of the Right, which isn’t true to my form. So here goes a real one: regardless of what happens, how politically-motivated, disrespectful and crass of national GOP leadership to have labeled the entire debate around the word, “Obamacare,” rather than making the basic more common sense argument about the mandate that I’ve outlined above! Shame! I say this is because one has to know the law would be called the same were it the “public option” in play. It’s for another blog entry to analyze the cultural talking-down-to and disrespectful undertones of this effective political labeling. But I will say racial, cultural and, certainly, under-informed propaganda are rife in the labeling of a President of the United States’ last name in a derogatory fashion to describe a law trying to help societal health at-large. Never in history has another President’s efforts been so unabashedly culturally charged in debate. It’s fair to say that the debate’s actual facts have been skewed to reflect a general disdain for the President rather than what the law entails, in full.

Where’s my proof? Backtracking to my initial point of this essay, “Obamacare,” for starters, isn’t the analogue of the “individual mandate” – it’s the mandate’s parent decree; the mandate is subsidiary to it. Consider that changes to the overall Affordable Care and Patient Protection Act (aka, the Affordable Care Act (ACA) or “Obamacare”) were made in Congress before it passed. Many changes. It is absurd to think that any proposal these days has made its way from the President’s budget, to many different policy tables, through Committees on both sides of Congress, before Congress itself, and back on the President’s table to be signed into law without undergoing some extreme transformation. Yet the ACA is not labeled Pelosi-ObamaCare. Or just BaucusCare. That labeling of Obama is just so much more juicily polarizing.

Likewise, no one blames the insurance lobby for making this law what it is. Indeed, let us remember that the “public option” debate highlighted above actually pre-dated that of the individual mandate in going before Congress a few years ago. It didn’t require any individual mandates, it improved societal health, and it lowered public costs – but it was disallowed by a Republican-controlled Congress. Hmm. Actual reasoning was surely the driver of this decision. Nope, it was insurance dollars and GOP pro-business delusion. Might we consider GreedyCare as well? Again, nope, somehow this has come into fruition as being solely driven by our current President, rather than being a concession made by Democrats (against their normal party platform to drive/create a government entity; this actually mandates poor people to buy something and forces them to buy it from private insurers without any created government provision – making insurers more money in the long run, gasp! Did you read that right!?). Hmm, one might consider calling it “Insurance Dollars Tricked the Hell Out of Americans into Believing This was Solely Driven by the Black President-Care.”

I’d like to see a survey of 500 random Republicans that demonstrates the majority understand the basics of US health care and why this law is necessarily “bad” to them. Call it a hunch, but I doubt it’d be a majority. For that same matter, let’s see that survey of Democrats and why they think it’s “good” for them. Let’s see Democrats who think this is better than the public option or a single-payer (gasp, socialized) system. All in all, I’d bet neither side really ‘gets’ it. Oh wait, this polling has already been done!

“Tell the guv’ment to lay their hands off my insurance and not to touch my Medicaid!”

Regardless of who I’m mad at (and I am always mad at someone), I doubt now that the “public option” ever has a place in our society if this health care law is even overturned to begin with. And it certainly doesn’t stand a chance if the individual mandate is upheld – as that will be the final law.

So, too, am I starting to doubt the capability of our government to achieve actual, successful governance as our population swells and our body politic becomes increasingly stratified, under-informed, willing to be a sheep in following their political mold, and well, flat out naive on the issues. As has been the trend herein, though, I leave it there for your own consideration.


  1. MGM says:

    Good insight and clarity. Ultimately a moderate and reasonable opinion that represents what could happen with gov’t efficiency.

  2. BGWsolutions says:

    Recent interaction re: this post via social media copy/pasted below to prompt further discussion:

    You have some good points in here. I think, in order to achieve a comprehensive analyzation that represents the current stratification in politics, I would have liked to read your thoughts on A) how the idea of the single payer system originated (the republicans) and how the ACA differs, and how to combine the two in an attempt at reconciling the two ideologies and B) a look into the Ryan plan and how at it’s roots, is quite similar to the ACA and how it inherently relies on government more (read – inefficient, ironically, the very thing republicans fight against most). Then ask these questions,if you really wanted to dive into constitutional law; what is the difference between taxing people to pay for their health care while simultaneously giving them tax breaks for purchasing health insurance and bypassing the taxes and simply imposing an individual mandate?
    12 hours ago · Like

    Another question I had about the economics of health care in your essay, about mid-way, where you wrote this law burdens the middle class. I think this is more a political/social question. Is it fair to expect people to pay for their own health care? In our hybrid version of socialism/capitalism, will the higher tax brackets always contribute more than what they get back out and vice versa with lower tax bracket earners? With the single payer system; how fine is the line between an attempt at requiring lower income consumers of health care to pay their own way and an attempt at making health care affordable for the very same same demographic?
    12 hours ago · Like

    Benton Wislinski:
    Awesome! Thanks for the post and questions, literal and rhetoric. I’m confused a bit by a couple of them, so I’ll clarify, if only for myself. To be clear, there are three real options. 1) An individual mandate to buy insurance (what ‘Obamacare’ does). 2) A single-payer, thus government operated (otherwise it’d be a monopoly, if private), health care provision system – as we see in many European countries. 3) A “public option,” which is a government insurance provider that merely ‘enters the market’ and as such competes for consumers. The result of the middle-ground latter of the options is both assuaging ‘don’t mandate me’ and ‘don’t socialize healthcare’ GOP concerns. It’s merly a market competitor that can more confidantly set its price so as to offset the volatility and abuse of the private insurers’ pricing. It’s not a mandate; it’s not required. But it damn sure will force market insurers to lower their price and compete. As a result, ‘choice’ is still the consumers.

    Not sure on where you were going with the Ryan plan. But suffice it to say I think his budget proposal is utterly moronic. Much like I espoused that the individual mandate – however you try to draw comparisons (though I’m not sure they really exist) – is also a silly way to go about it. It’s politicized, reactionary, and shortsighted. Much like our healthcare system’s operation as is.

    As to your latter post. All Americans – check that all Americans – would be responsible (under the current tax code that’s constantly at issue and debate) for some burden of paying for new player’s into a market that cannot afford mandated insurance. As a Dem, I’m not necessarily against taxing people. (And this doesn’t even consider the impact, then, on already in place ‘socialized’ systems, such as Medicare and Meidcaid). BUT, I also admit that this ‘individual mandate’ is, again, not the best option. Hence, my essay. BW.
    11 hours ago · Like

    Benton Wislinski:
    Not sure I made it quite clear: the ‘public option’ is not analgous to a single-payer system. They’re very different. It’s a government provision of insurance, but it’s not the only insurer. It’s a competitor against other insurers in the market competing for customers. Thus lowering costs for consumers.
    11 hours ago · Like

    Unfortunately, I have not mastered the FB post as a literary masterpiece. I would have done myself better to talk more the idea of the single payer system and why it works better economically and to give me time to the underpinnings of the individual mandate and their effect on the marketplace.

    The three options you have listed do not account for the individual who carries no insurance by choice who racks up a large medical bill then says; “sorry I cannot pay for this’. The hospital is required, by reasonable efforts defined by current law, to treat these patients, regardless of their ability to pay. In this circumstance, it does not matter how affordable or otherwise the government insurance option is, this individual is not a consumer of it, and doesn’t have to be because of ‘choice’. The hospital then writes that expense off and, to cover the incurred cost, charges more to people who have insurance, this argument assumes rational people with means will purchase health insurance, to cover, not only the cost incurred by the patient but part of the cost of uninsured patients. By this logic, insurance companies already pay for the vast majority of health care in this country. The individual mandate requires most people to be part of this pool so market can accurately gauge supply and demand and take corrective action all in the name of competition and efficiency. Will it work? This remains to be seen.
    10 hours ago · Like

    As for the tie between the gov option and the single payer system, I (incorrectly in haste) tied the two together because the gov option was created to spur competition in a single system to give the consumer better pricing and baseline quality. In ACA, there is a subsidy for lower incomes households that is tied to the second least expensive insurance plan that meets the government specifications. This, I believe, will cause the insurance companies to lower their final cost to the consumer to compete for these consumers. I think this accomplishes the same ends as the gov option or better because, although not impossible, we have yet to see a government program that can reach the same levels of efficiency and utility as the equivalent private industry. From an Econ perspective, we should reserve gov programs for markets where social utility is paramount to efficiency and the market cannot accurately provide social utility (read – prisons, schools, the army etc.)

    The tie between the Ryan plan and the individual mandate is a little hazy but this is the idea. Health care for seniors is a government plan right now – we pay taxes, seniors get health care. The Ryan plan will remove people for Medicare if they buy their own insurance and give them the tax credit of approx the money they would receive indirectly through the government to pay for private insurance. Eventually, this method would apply for all seniors and the government would take a step back and rely on the private sector to handle this. The reason I compared the two is this; if the cost of your health care is built into your taxes but you don’t receive health care benefits from it, is offering a tax credit to you to purchase health care an option? If the marginal cost to receive an essential good is zero, rational customers will consume it without condition. It is still one’s choice to carry health insurance or not unlike the mandate but the decision to not have it is irrational.
    10 hours ago · Like

    This last argument is NOT a justification of the ryan plan, it simply looks more into the single payer system. I think to achieve progress in the idea of the ‘individual mandate’, a dialogue not suitable for FB will be required. The idea behind the individual mandate is that, with health care being an in elastic good, those with insurance are already paying for those without. Also, if all the healthy people decided not to have insurance and the insurance companies were required to provide insurance unconditionally, there would be a market failure and the cost of insurance for healthy individuals would not be appropriate. This dynamic causes inefficiencies which the mandate attempts to address.
    10 hours ago · Like

    • BGWsolutions says:

      To be clear on these prompts/responses, I’m in FULL agreement that the single-payer option is the best option economically and socially. Unfortunately, given my inclinations toward faith in the American people to make sound decisions (as highlighted above), I’ve all but given up hope that that may one day play out. All in all: the public option is ‘American’ culturally to the extent that it facilitates regulated market interactions and solutions toward the health care dilemma, thus undoing any reasonable right-wing complains on government interference. As such, if politically crafted smartly, it could be pushed as the ‘right-er’ version of what the individual mandate was trying to accomplish.

      I only hope we haven’t lost that opportunity. And I definitely would love to see nationalized health care, as a moral and human right and solutions. But, you have more faith than I in American governing capabilities, my friend.

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