The Daily Clarity

The moral dimension of the healthcare debate

There are some issues that should transcend partisan lines, particularly in a relatively wealthy and developed country such as the United States. There are matters that require debate beyond economic rationalism and more as social ideals. Some things are above pure free-market considerations, and rather constitute obligations that a competent government is required to deliver to its populace. To demonstrate the point, there are no doubt cheaper options and functionally more efficient methods of government than democracy, but few would question its intrinsic value.

Some of the services a representative government should guarantee are unquestionable – potable water, personal safety, energy, road, transport, defense, and education to name but a few. What is included in this list in most advanced nations, and for some in the US this seems a surprisingly controversial issue, is adequate health services. A representative democracy has a moral obligation to ensure affordable access to high-quality health care service is an inalienable right for its people. However, it appears as if the healthcare debate in the US is missing the moral dimension to its analysis. The current argument, focused merely in terms of economics and free-enterprise’s supposed service delivery superiority, is an ethically fallacious and intellectually bankrupt method of understanding the issue

Whether the actual current Obama sponsored heath reform measures are the correct way forward is open to debate. However, there can be no question that healthcare reform is long overdue. US healthcare, viewed objectively and free of interest group color, is a failing system, lacking structured design, organically grown malformed, and astonishingly ineffective in outcomes. It is mostly misrepresented, slanted by a deliberate distortion of the facts, subject to massive lobbying agenda manipulation, and seemingly untouchable as a partisan scared cow. In contrast, for some reason – and it is a question of landed interest representation rather than accuracy – universal healthcare has been demonized as a vast socialist conspiracy. The debate on health reform as currently framed is a conjurer’s deceit, nothing more than a sleight of hand, of monumental proportions.

The misconceptions about the current American health system are abundant. It is often presented it as the best health system in the world, vastly superior to other nation’s ‘socialized’ systems. However in reality, it is nothing of the sort. It is factually inaccurate, by any standard of objective or scientific measurement to represent the US health system as an example of global best practice. In terms of all meaningful measures such as child mortality, life longevity, cost, efficiency, intervention rate, and successful outcome, it ranks poorly in comparison to systems in other developed countries. Overall, it ranked 37^th in the World Health Organization’s measurements of global medical systems; way behind many European countries misrepresented as calamitous socialized medical system, and where private override and top-up options, despite the rhetoric that government provision removes the capacity for free-market service coexistence,  are widely available. The US system is the most expensive in the world, a massive 16% of GDP being chewed up in medical expenditure, and yet highly ineffective in delivery and outcome. It is not best system in the world, in actuality, it ranks among one of the worst in empirical measures against its counterparts elsewhere.

This systemic ineffectiveness of the US system is subject to widespread denial. It is the Emperor’s Clothes of societal issues. Senator Mitch McConnell, in a glaring example of a ‘flat earth’ view, when confronted with such data of the current system’s failings, said in a recent interview ‘…these are just one set of measures. When you ask the American people they have no question about the quality of the system. They know they have the best healthcare in the world.’ If such a statement doesn’t give any astute observer pause for thought, then the American people are doomed to continue to accept such a fallacy, despite all the empirical evidence to the contrary.

Other such illogical justification of the US healthcare system also sully the debate – it is expensive because of the illegal immigrants, it performed badly on the WHO ranking as the UN is anti-American, reforming healthcare will be expensive (as if maintaining the current system will not be fiscally ruinous),  and on. Despite the desire to deny the truth, it is hard not to see that the US healthcare system is at best, heavily flawed, and in reality more likely broken in its current form. Bankruptcy from healthcare bills, rationing, systematic denial of claims, medical neglect of the less well of, needless litigations, health insurance profiteering, FDA inefficiency, and extraordinarily costs – all of these are issues infrequently observed in other developed nations, but rife in modern day America.

The Health Insurance companies are allegedly at present spending over $1M per week lobbying against Obama’s health care reforms. It is akin to the immoral denials of the facts by the Tobacco companies before the whistleblowers turned them in. The opposition to reforming the system is largely a result of professional lobbying, undue pressure on the representatives with threats to campaign funding, deliberate misrepresentation, and widespread public ignorance. The American people are being deliberately kept in the dark and misled on the facts by those who profit from denying free and unfettered access to the real information. It is a propaganda horror story.

There are others opposed to universal health care purely on a philosophical basis. They assume that no system run by government can ever deliver a service as effectively as a private enterprise option. This may be true, but in the basic requirements of a free society one should as carefully consider what should be guaranteed by government as opposed to what does not need to be. The US people would not allow the judicial system to be run by private enterprise, for example. There are certain things that are above and beyond the pure pursuit of profit, and healthcare is one of them. Healthcare is more than an economic concern; it is a requirement of an ordered and civil society.

The US is often a societal and cultural conundrum. It is an advanced society challenged by anachronisms of thinking. It clings to its right to bear arms in defiance of the norms of most civilized nations, and with a violent crime rate and jail population that reflects that. It remains heavily religious, even evangelically so, in direct contradiction to most social evolution processes that shows religious observance decreasing with levels of education. It remains challenged in many other developmental issues – racism, the dearth of analytical media, a predilection towards big-tent fundamentalists, vaudeville-like media commentators, and a sometime aversion towards intellectualism. The US is a contradiction, struggling with the societal maturity of a teenager, but the economic and military strength of a giant. It is therefore often a confused and self-contradictory society.

The US is now at a developmental crossroads. It has a true reformer as President. It is almost with missionary zeal that he is attempting to reshape and update America. There are those that oppose his attempts in all things, and those that support him regardless of his actions. However, one cannot judge all his policies by one standard. In terms of probability, it is highly unlikely he is all right or all wrong. One can agree with him on some issues, yet oppose him on others. It would be understandable to be highly critical of his Afghanistan and Pakistan policies. Some are, at least philosophically, more accepting of his attempts to create a more structured and regulated economy, perhaps saved from the brink of terminal freefall. Many are hopeful, but remain skeptical, about his environmental policies. There are other issues that he is so far untested on – education, judicial independence, security and more – though those who would rush to judge him harshly lump his positions as one, just as equally do his supporters.

However in relation to healthcare, one has to applaud his courage and support his objectives, if not necessarily agreeing with his current healthcare design iterations. Such reforms are not optional; they are a moral and civil imperative. The debate should be centered around how best to design and implement such reforms, not a blanket denial of their necessity. Reforms will happen whether under this regime or soon. A civilized country needs to undertake moral governance over its people so as to ensure long-term stability, security, and satisfaction. A sound, effective, and rational healthcare system is one of the pillars that a competent democratic government, predicated on the rights and interests of its people, needs to deliver. The debate at his stage of the country’s evolution should be on how to best to achieve this, not a discourse as to the need or validity. A rational, fair, and equitable health system is a moral imperative for a developed civil society, and such considerations in great nations are far more important than petty partisan politics or short-term economic considerations.