Today the President of the United States announced yet another version of his vision for the nationalization of the healthcare industry in this country. He and his loyal supporters have long been enamored with a European model of socialized medicine. Why intelligent people from this country would embrace a program that systematically destroys the best healthcare system in the world is beyond understanding. I have thought about this particular public policy matter from a number of angles, but the one I hear discussed the least is from an ethical perspective.
In business school, we offer students several templates within which individuals might find direction in making ethical decisions. Those templates are aligned with the Categorical Imperative or Universal Law, Utilitarianism and a Social Justice template most often associated with the philosopher John Rawls.
The legislations being offered by Congress and the President may be evaluated by using these three templates. First, do the programs offered in the legislation apply to all. Right now, even with full implementation, tens of millions of residents in this country will still be without health coverage. Similarly, the mechanisms of the legislation will eventually lead to those with good, satisfactory private insurance coverage having to go to a public option. Private insurance companies, based on the soundest of economic influences, will opt out of most insurance markets leaving on the single payer system left. Of course, a single payer system then is shaped around a one size fits all approach and will necessarily lead to rationing at every level of care. Rationing is typically done based on price, then first come first served then lottery. Only government can coerce behaviors that either deny service or force service on individuals. Thus the universal law template does not apply.
The utilitarian argument fails at the outset. By forcing individuals to have insurance and then forcing those with insurance to move to a less satisfactory position cannot possible be considered doing the most good for the most number. If 260million people are already happy with their insurance, making those same people unhappy to cover another five percent of the population seems hardly a good decision.
Finally, the best ethical argument can be made for reform based on a social justice model. In this case, we follow Rawls suggestion that we seek equal outcomes for equal circumstances. After we peel away the numbers associated with those that have coverage, refuse coverage and are covered by some form of government insurance, we have around 10-12 million people that truly could use support. Covering these people Cadillac programs could hardly cost the taxpayers of the country the 4-6 trillion dollars this current monstrosity will cost over the next 10 years.
Why, then, is the administration and this Congress attempting to nationalize the healthcare industry? There are strong ethical arguments that stand up so there must be some political reason for this pursuit. Perhaps the real reason is that by controling the healthcare industry, the progressive elites might continue their quest of the perfection of man and some sick, twisted notion that egalitarianism leads to a better way of life. Of course, both of those notions are false, mostly because any action taken by the government that infringes on individual liberty is dangerous and should be fought at every turn. The tyranny of the imprudent magistrates is a danger to all.