Moral Reflections on the Merits of Universalized Health Care

E. Christian Brugger
Senior Fellow

     The question of the merits of a nationalized healthcare system in the U.S. is generating enormous interest in the media and blogs, and rightly so.  I add a few thoughts for anyone interested. 

BOHC     Healthcare is a pressing issue in the U.S. chiefly because of the problem of the uninsured.  Most agree that the status quo in the U.S. tolerates unacceptable harms towards those who cannot, despite the good stewardship of their resources, afford decent and ongoing health care.  (Some consider emergency room care to be a morally adequate solution for meeting their needs.  In a nation as prosperous as ours, I do not.)

     The Catholic Church teaches that there is a right to have one’s basic health care needs fulfilled; call it a right to some minimum standard of decent, humane and accessible care[1].  This of course does not imply that a nationalized health care system is a right.  But it does imply that Catholics should work for some kind of improvement in the current system on behalf of those who cannot afford adequate care.    

     The numbers of those who cannot afford care in the U.S. are fewer than many think.  Those who are factually indigent actually have access to a relatively high quality of healthcare through Medicaid.  Many other Americans who can afford health insurance choose not to purchase it for reasons unrelated to factual need.  It turns out to be lower middle class families and individuals (e.g., including perhaps but not limited to blue collar workers, day laborers, immigrants, single income families, single parents, former prison inmates, and minimum wage workers), who cannot afford health insurance.  I do not know the numbers but I suspect that these are still relatively high.  It is on their behalf that I think something should be done.

     So what should be done?  One solution is universalized care.  But before such a radical social solution is adopted it needs (among other things) to be morally scrutinized.  It would be a bitter irony indeed if the very solution implemented to rectify injustices turned out (intentionally or unintentionally) to cause greater injustices. 

     Pertinent ethical questions can be asked of the health care proposals circulating around congress.  Do they or will they mandate federal funding for the wrongful destruction of human life (e.g., abortion, infanticide, euthanasia, and reproductive services that involve the destruction of human embryos)?  Do they in any other way abet the commission of wrongful acts (e.g., require end of life counseling encouraging the removal of food and water for patients for whom such care is necessary and effective for sustaining life)?  Because these questions concern intrinsically evil acts, they have the highest priority.  Other questions include the long term social and economic consequences of implementing and running a universal health system in a country as large as ours.  England has 60 million people and the inefficiency and economic drain of the U.K.’s National Health Services is a constant concern.  The U.S. has over 300 million people.

     Perhaps the most proximate question is whether a nationalized system is necessary.  We know from experience that government bureaucracies, once created, are self perpetuating.  The more complex they are the more dependencies they establish making their dissolution highly unlikely.  Practically speaking, once health care is nationalized, there’s no going back.  Is there then another way to provide for those in genuine need without committing ourselves to such a socially costly solution?  Could Medicaid be expanded to include those who cannot afford health insurance while leaving the present system, with its strengths and weaknesses, otherwise intact?  Is leaving the present system structurally intact desirable?  Since the rise of managed care in the past 25 years, health care has changed considerably, especially the experience of the doctor-patient relationship.  Is there any reason to believe that nationalizing our health care system will improve this?  My family and I lived in England for three years in the 90s and received some excellent care from the “sisters” and doctors of the NHS.  But the experience of visiting our neighborhood health clinic was not unlike visiting a department of motor vehicles agency in the U.S.  After all, it was a government office.  Is the further de-personalization of American health care an acceptable harm to tolerate for sake of the good of rectifying harms to those without insurance?

     Rationing too will take place under any nationalized system.  This does not bother me in principle since at the end of the month given my modest teacher’s salary I myself am forced to ration food to my family: “don’t eat that now or we’ll have nothing for dinner tomorrow!”  Rationing becomes problematic when resources are limited based upon unethical criteria such as “quality of life” calculations.  Given the ideological commitments of the majority party, is there good reason to believe that such calculations will find their way into the administrative apparatus of a nationalized system?  Rationing could also be unfair to accept if government inefficiency is the cause of the limiting of resources to the needy.  Will a top-down bureaucratic Leviathan run from Washington facilitate the efficient distribution of health care goods and services?  I have my doubts.

     Yet something has to be done.  So what’s the solution?  This is a weighty question indeed.  Although I do not have a certain answer, I know this perfectly: now’s the time for reasonable citizens to roll up their sleeve and get into the ring with their public officials for whom the question of health care reform is often little more than a game of re-election politics.  Demand answers to your questions: do we need to nationalize?  Is there a less socially costly solution?  Will protection of innocent human life be assured in any plan adopted?  Will the values of Christians be assaulted by family planning and sexual education ideologues with power? Will the quality of health care increase or decrease?  How will the diagnostic and therapeutic integrity of the doctor-patient relationship be maintained?  Will the next generation of qualified candidates for the medical arts be deterred from adopting the profession because of the imposition of onerous regulations?  How will transparency in such a huge bureaucracy be guaranteed?  Can we afford it!?  How will the increase in debt affect the long-term economy? 
Now’s the time to throw timidity to the wind.  Speak up.

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[1] See Benedict XVI, Encyclical Letter Caritas in Veritate (2009), no. 43, John XXIII, Encyclical Letter, Pacem in Terris (1963), no. 11; cf. John Paul II, Encyclical Letter Sollicitudo Rei Socialis (1987), no. 42, par. 3, Pius XI, Encyclical Letter Quadragesimo Anno (1931), no. 28.