Does Justice Demand Health Care?
A few years ago when my wife and I lived in an apartment complex, our next door neighbor, a retired elderly lady, weakly knocked on our door.
We opened it to find that she was gagging on fluids and barely able to breathe. Her medicines had not gone down properly as she had taken too many at a time, and she seemed in danger of choking.
Against her irrational protestations, I called the paramedics. They arrived quickly and were able to facilitate her swallowing and breathing. I was glad we were home.
I was reminded of this incident while in a conversation recently with someone arguing that health care is not a right, but rather a privilege. My interlocutor thought that my neighbor should not have expected my assistance, but that I was right to help her out of compassion. Honestly, I cannot make sense of this. My neighbor didn’t knock on my door so she could borrow my Playstation 2; she needed immediate aid. My aid!
I’d have been a moral monster to stand there and do nothing or to say, politely, “I’m sorry, but I’m a tad busy to privilege you with my time, and frankly I’m bothered that you interrupted my day, expecting my assistance. Take your sense of entitlement elsewhere.”
In that moment, I felt morally obligated to do everything I could for her. Not being trained at the time in CPR, the most I could do was call 911. Alex Knapp recently asked whether or not rights can be discovered; I wouldn’t say that in this situation I discovered my neighbor’s right to health care, but I did discern it as readily evident. Her inability to breathe spoke to me. Perhaps I could hear the call only because I have something of a developed conscience, but heard it I did.
My neighbor’s adult son was grateful, but, as I see it, he would have been perfectly right to be indignant had I refused help. His mother was entitled to my assistance and the care of the paramedics. A refusal to offer this minimal health care in my power would have been a grievous wrong.
This is why I say that health care is a matter of justice. The health care needs of those who require our help and whom we have the power to help obligate us to do what we can for them. My neighbor needed immediate and temporary care from me, and I was able to provide it, but of course people’s health care needs extend beyond the immediate and the temporary. Consequently, the voice of justice also calls us into the future, to institute means of providing long term and permanent care to all those in need whose assistance we have the power to provide.
Yes, when instituting these means, considerations of political feasibility and economic achievability must be made, but, nonetheless, heath care is first and foremost a matter of justice–of giving our due to our neighbor.
At least, that’s how I see it.
If you were not home (perhaps visiting relatives), would you have failed your obligations to your neighbor?
Nope. Had I not been home, I would have had no knowledge of the need and no power to offer any help. My neighbor’s need alone does not obligate me; I also have to know of the need and have the power to respond in some way to it.
Now, had I made promises to my neighbor to be available on that day in case she needed help, and then I was away, then it may be the case that I would have failed my obligations.
I’m going back to a particular sentence and re-reading it: “My interlocutor thought that my neighbor should not have expected my assistance, but that I was right to help her out of compassion.”
While I’m sure we can both agree that your interlocutor was saying something monumentally unpleasant, I don’t know that, when you get down to it, that your interlocutor was *WRONG*.
As you say, had you not been home…
If by “expected my assistance” you mean “expected me to be home and help her,” then you’d have a point, but I’m pretty sure my interlocutor didn’t mean it that way. The context of the statement indicated that my neighbor should not have expected my assistance out of some sense of a right on her part to be helped by someone able to help her.
And if you were a Job Creator, out there Creating Jobs, you’d have been doing far more good for more people than by being home helping an individual little old lady. In fact, the only reason you’d be home is that excessive taxation had made you go Galt.
And not helping her would take a helluva lot of Galt.
Who is Max Galt?
Sorry I think you are confusing justice with morals or some other concept. So your argument is that being in need of something gives you a right to it? I have a need for money but that hardly gives me a right to it, justice or no justice.
Depends on what kind of need we’re talking about. If the cord to my Playstation breaks and I need another one, I have a need, but this need isn’t the kind to constitute a right. If I need medical attention due to an illness or something life threatening, then I have a need of a different sort, one that constitutes a right to be helped by those able to help me, a right that established a moral obligation.
I think your interlocutor is wrong in saying that the instance you cite is not a case in which justice required that you provide assistance to your neighbor. Because you were available to provide assistance (and, indeed, there was no other party readily able to provide assistance) and your neighbor would suffer a significant harm if you failed to act (while you would suffer no great harm from acting) it seems pretty clear that justice required the action that you took.
This is fairly similar in rationale to our current (though often derided) laws that require emergency rooms to provide care to anyone who comes in, regardless of ability to pay. The theory is that since it’s an emergency room, they need to provide assistance regardless, while an ordinary doctor’s office is not so required (in theory because the harm of them not providing service to people who may not be able to pay is not necessarily immanent, and so it’s reasonable for them to insist that someone show some ability to pay eventually before rendering service.)
The urgency seems like a clear factor here, because if your neighbor knocked on your door and said, “Hey, I’ve really been worrying that one of these days I’m going to have some medical expenses I can’t afford, and that my income isn’t sufficient to save for those expenses. Can your family start contributing $100/mo to a savings account which I’ll use for my medical expenses when they come up?” I think it would be far less clear that you’d be required by justice to agree. Your neighbor in that case would not suffer an immediate harm due to your refusal, and should you refuse there are other resources (including her own) that your neighbor could turn to in order to prepare for the eventuality that she was concerned about.
This sounds about right, Darwin. I wouldn’t have any moral obligation to contribute to my neighbor’s health savings account simply because she asked me. When my neighbor came to me, urgently needing help, I could have done only one thing, and I was obligated to do that one thing.
I do happen to think that health care is an obligation shared both by individuals and by society, but there are multiple avenues to seeing this done. Giving my neighbor a monthly check isn’t the only way I can fulfill my social obligations to her, and my doing so may not be the best way of responding to the specific obligation. On the other hand, “the best way” may not be the morally obligatory way. If society institutes a means of providing health care coverage for my neighbors in need, but I can envision a better institutional (or other kind of) means, I may still have an obligation to participate in the social institution, especially if this institution, despite its faults, is the means currently available to help provide care to the members of society (now and in the future).
If you are, say, an Ayn Randian Objectivist, then your neighbor’s need makes no necessary demands upon you at all. If, however, you call yourself a Christian, then your neighbor’s need places you under the obligation to meet that need, to the best of your ability, and even if meeting that need entails sacrifice on your part.
Are you suggesting that obligation is relative to one’s beliefs or ideology?
Proximity?
Yes. Duties are imposed by society. Obligations arise from one’s personal values, if at all.
But you were asking about “justice.” I don’t think that “justice” can be defined. Justice is whatever the prevailing power structure says–or allows–it to be, at any given time. That’s why God is “just” no matter what God does. And if God does the opposite on another occasion, God is still “just.”
I define justice as giving our due to our neighbor.
And on what basis do you determine what is due your neighbor in any given circumstance?
Darwin — What you describe is exactly how insurance of any kind works: a defined group of people each agree to pay X-dollars per month to guarantee that if they need medical care, or their house rebuilt, or their car repaired, the money to cover it will be there, drawn from the general fund to which all in the insured group contributed. Obviously, this will not work on a one-to-one basis; it must be a group arrangement. That is why the individual mandate is not, imo, an infringement of anybody’s rights. Unless by refusing to pay to be covered the individual also agrees not to ever seek medical care for which he cannot pay out-of-pocket, up front, then he should be required to pay, so that you and I don’t end up paying for his INEVITABLE need for medical services. It is precisely potential need that must be addressed, and nobody is exempt from that potential.
Kyle,
I think your formulation here is about right. In that situation, you probably did have a moral obligation to do what you did. Sometimes I balk at acknowledging that the choking woman had a moral right to expect the same, but to follow through on the train of thought below, I’ll concede that she did. The question then might be asked, should this moral right/duty relationship translate into a legal right/duty? In my understanding, legal rights/duties are, at their core, based on moral rights/duties anyway. So I don’t think that there’s conceptually any problem arguing that “there should be a law” requiring you to do what you did, rather than leaving the choking neighbor’s fate up to your enlightened sense of conscience, etc.
In my view, the problem with such “Good Samaritan laws” is not that we don’t have a moral obligation to be Good Samaritans. We do. The problem is that there simply are too many considerations in play to enforce such laws. One was already touched on above: Did you have an obligation to be home? Perhaps not, if you had no idea she might have choked that day and required your assistance. But what about now that you know she’s choked in the past? Are you “on notice” that she might require similar assistance again? Worse, what if she begins choking on a regular basis? Do you have an obligation to stay at home except when absolutely necessary? Does this obligation depend on how much free time you have? Should you refrain from working longer hours than necessary, even if that means sacrificing career advancement and potential providing a nicer life for your family? Do you have an obligation to work out a schedule with her, to check in and out with her? What if you were a doctor? Do your duties increase along with your knowledge and ability? Do these duties to the neighbor reduce the time and energy you have to fulfill pre-existing moral commitments to your family? How do you reconcile these conflicts?
And then what about the neighbor’s moral duties? Does she now have a duty to refrain from engaging in the behavior that caused her to choke, and which thereby impose these new moral duty on you? Do you have a moral right to compel certain preventative measures on her part?
These questions go on and on.
It is because the law does not want to engage in these kinds of questions that it generally refrains from passing Good Samaritan laws that require active support of our neighbors. That is, if your neighbor urgently needed some medicine in your house but you weren’t home, the law might allow for a moral right to break in to get it. (There are several factors at play here, too, but nowhere as complex as those above.) But requiring your active assistance? That’s a laundry list of factors and balancing tests that cannot be effectively considered in the legal system.
But again, I agree with your basic moral claim.
Here is my concern, however. We’ve established (or at least stipulated to) the personal moral relationship at play. Let’s assume that I’m right that it is impracticable to enforce the terms of that personal moral relationship in the law. It might seem intuitive, then, that we should instead try to enforce those terms by recasting the moral relationship in terms of society’sduties/rights to provide health care to the individual. However practicable or impracticable that might be politically or economically, I wonder if you’d agree, Kyle, that this is fundamentally different from the personal moral relationship you’ve described between you and your choking neighbor. And thus, if there’s a moral argument to be made for government-provided health care, we need a different moral paradigm than the one you’ve alluded to in the OP.
Great comment, Tim. For the reasons you mention, I am opposed to passing Good Samaritan laws that require active support of our neighbors.
Regarding the concern you raise in their final paragraph, I agree that we can distinguish between personal or individual responsibility and social responsibility, although the two are closely related. They require different moral considerations, but both are, of course, moral considerations.
Government functions by force, and this mode of operation brings major ethical problems to the table. My argument in this post, if sound, has not reached a basis on which I can say that government involvement in providing coverage or care is a moral obligation. I’ve laid some groundwork–notably the notion that we’re obligated in part to the extent that we have power to act–but it would be fallacious of me to conclude, on what I have written, that society has a moral obligation to enact Obamacare or Single Payer or some other State means. I think a case can be made, but I didn’t make it here.
Well, I did make it here. We do have a choice. We can follow Ayn Rand, or we can follow Jesus Christ. The former says “Pay as you go.” The latter says, “What you do for the least of your brothers, you do for Me.” It is clear that most of those commenting on this thread are not considering the issue in Christian terms–so their arguments are intellectually consistent, within an amoral value system. I see no way to reconcile institutionalized selfishness with a moral point of view.
Rodak — Again, it cannot be taken for granted that Christ’s injunction is satisfied by paying taxes.
If the taxes are earmarked for helping the poor, due to the political action of persons working to make that happen, then Christ’s injunction is satisfied, at least in part. Moreover, when one willingly pays taxes, and votes to have oneself taxed, with the INTENTION of those taxes being used to help the poor, then one has done what one can do–as a citizen–to fulfill Christ’s injunction.
I disagree that politicians are doing the work of Christ when they “earmark” funds taken from citizens’ by force. I also have trouble seeing how one’s “intention” concerning where tax dollars go makes any difference in the matter. That money is being taken from you regardless of your intentions. Thus, there is no sacrifice in the transaction. The funds are then spent by government agents far removed from the Christian’s interaction with the IRS and without any imprimatur of Christian charity—just the opposite, in fact: it is a government hand-out, a concession, an entitlement.
I also wonder, in a context where one is doing Christ’s work when paying taxes, how deductions and credits and the like are to be understood.
I do think that fulfilling one’s civic duty is part of the full Christian life, but the notion that the Christian’s duty to the poor can be fulfilled in any meaningful way by paying taxes is fraught with problems.
Tim —
With regard to the woman in Kyle’s scenario, what she had was not a *right* but a rather a *need*. I don’t find addressing the provision of health care to the needy in terms of rights to be very helpful. The poor are with us always. We all, therefore, have an obligation to provide for their needs as best we can. Jesus did not means test the individuals he healed, nor did he read their hearts to determine if they were morally worthy of being helped. If they are hungry, we have an obligation to feed them. If they are in jail, we have an obligation to visit them. If they are infirm, we have an obligation to heal them. The most efficient way to do this is as a society. As a society we train professional healers and provide them with the facilities they need to do their work and their research. We all contribute, and we all benefit. And, if our immediate neighbor knocks on our door, we do what we can to help on an individual basis. And if we don’t want to wait for that opportunity, we can do volunteer work. We can write a check and help over and above what we contribute in taxes. It should never be a case of either taxes or charity; it should always be both taxes and charity. I don’t see how this is so very hard to understand in the American context. Contrary to what Republican politicians would have us believe, yes — we DO WANT a western European model of health care delivery.
Rodak: Missing from your analysis is the nexus between the individual moral obligation and society’s moral obligation. I’m currently re-exploring the government’s role in providing health care, but I still don’t see that role as moral in nature. I see it more along the lines of the government’s role in establishing and regulating the currency, establishing and regulating the legal existence of banks and corporations, constructing and maintaining public roads and other infrastructure, etc. I think health care may flow from this sort of role as well.
Also, I did express some misgivings about labeling the woman’s need for care a “right,” but if we’re going to say that Kyle had was a moral duty, then I’ll concede that she had a moral right. I’m of the view that rights and duties are inseparable.
Tim —
I also make a distinction between a “duty” and an “obligation.” I think that an obligation is a more personal thing. A duty is derived from social/ethical expectations. I don’t think any duty was imposed by society on Kyle in that circumstance. I do think that an obligation was imposed upon him by the teachings of his God.
It is true that our society qua society has no God-given obligations imposed on it. If, however, enough individual citizens feel that they have such obligations imposed on them and can unite politically to enact their personal values politically, God may triumph in the process.
Rodak — Not to be rude, but I still don’t see the nexus.
Many are called, but few are chosen. 🙂
Tim —
Your tax dollars are not taken from you by force. They are taken from you according to legislation passed by your elected representatives. If you really feel that you are being robbed, you should refuse to pay them and take the consequences.
A better plan, however, might be to work to try to influence those representatives to allocate those funds in ways you approve of. If neither of those alternatives appeal to you, simply sit on your ass and listen to Rush Limbaugh, decide on his say-so that “the government” is your enemy (rather than your servant) and bitch and moan about how you are being persecuted. Then you’ll be right where the Lords of the Universe, the 1%-ers, want you: in the fold with the rest of the bleating merinos, waiting for the next fleecing, hoping it’s not the butcher instead.
Tim –
I also make a distinction between a “duty” and an “obligation.” I think that an obligation is a more personal thing. A duty is derived from social/ethical expectations. I don’t think any duty was imposed by society on Kyle in that circumstance. I do think that an obligation was imposed upon him by the teachings of his God.
It is true that our society qua society has no God-given obligations imposed on it. If, however, enough individual citizens feel that they have such obligations imposed on them and can unite politically to enact their personal values politically, God may triumph in the process.
Kyle,
You’ve already decided “health care” is a right and that “society” must provide it.
In an earlier post on another thread, I addressed the rhetorical trick of using the term “health care,” and I’ll bring it up again here:
When we think of health, we think of soundness of body and a normal state of affairs for most people. We have the rights of life and liberty, but it’s hard to enjoy those rights if we are not healthy. So the term “health” has a lot of moral oomph to it. It’s pretty easy to believe that we have a right to be healthy. Each of us can work towards ensuring that right by taking responsibility by eating right, exercising and not smoking.
When we talk about doctors, nurses, hospitals, drugs and devices, we are no longer talking about health care. We are now talking about medical care. This is an economic good that we can buy with our money just like we buy living spaces and the furnishings, food, vacations, education, etc. It’s subject to the same realities that all other economic goods are: If you have enough money, you can buy it. If you don’t, you can’t. So people have to use their best judgement as to how they budget for medical care with the money they earn.
I think you argument fails in a couple of ways. First is the use of the term “health care” when you mean medical care, because you aren’t talking about helping your neighbor eat right and exercise more- you are talking about rendering medical aid, and no one ever thinks of first aid as “health care.” Second is because you are describing an emergency situation that needs immediate attention and extrapolating from that to a claim that “society” (whatever the heck that is) has an obligation to provide ongoing medical assistance to anyone in need.
It’s kind of strange that someone who is claiming to make a moral argument would use two shady rhetorical tricks to support that argument. I suggest you go back and look at what it is you really wan the rest of us to believe and change your argument to honestly convince us that your idea is correct.
Here is what I believe right now:
There is so much government price protection of the medical care industry, including the medical insurance industry, that people with lower incomes are priced out of the market. I believe there is a clear moral argument to be made for giving poor people cash to spend on medical care and no longer requiring employers to subsidize medical insurance. This will bring the power of freedom of choice back into the medical care market and bring down prices so more people can afford care.
When we talk about doctors, nurses, hospitals, drugs and devices, we are no longer talking about health care. We are now talking about medical care.
Maybe this is how you talk, but in common parlance, “health” can refer both to 1) soundness of mind and body and 2) being free from illness and injury. “Health care,” as most people use the term, includes “medical care.”
no one ever thinks of first aid as “health care.”
No one? Really? You should tell that to Google, then. I suppose you think that when most people talk about health care reform, they are not ever talking about improving the quality and access to medical care?
Second is because you are describing an emergency situation that needs immediate attention and extrapolating from that to a claim that “society” (whatever the heck that is) has an obligation to provide ongoing medical assistance to anyone in need.
I did? Where? I didn’t mention society until the comments, and then I was careful to note that individual responsibility does not automatically entail social responsibility, i.e., the responsibility of society.
It’s kind of strange that someone who is claiming to make a moral argument would use two shady rhetorical tricks to support that argument. I suggest you go back and look at what it is you really wan the rest of us to believe and change your argument to honestly convince us that your idea is correct.
Maybe I like being a shady trickster.
Kyle,
Do you really need me to show how you transitioned from your personal experience in the first few paragraphs to the general case with your own words?:
“My neighbor needed immediate and temporary care from me, and I was able to provide it, but of course people’s health care needs extend beyond the immediate and the temporary. Consequently, the voice of justice also calls us into the future, to institute means of providing long term and permanent care to all those in need whose assistance we have the power to provide.”
Your logic and writing is pretty lax in this post. I pointed it out.
“Maybe I like being a shady trickster.”
If you do, then why do you pretend to the moral high ground? What’s the point in asking for justice when you don’t care about integrity?
Ah, well, I confess to moving from a particular to a universal, by way my perceiving an objective right to health care or medical care, but the quoted statement doesn’t quite reach the level of society’s responsibility for health care/medical care. It’s moving in that direction, but it doesn’t establish any imperative that we have, say, some form of government intervention. Were I to conclude such simply from what I wrote, then, yes, my logic would be lax, but I haven’t quite gotten there.
Michael — You raise some very good points here. I don’t know why you derail them by accusing Kyle of bad faith. Other than that, I think they deserve consideration. In particular, I’m shocked that I never distinguished “health” care from “medical” care myself. I think it’s a worthy distinction, on the order of the misuse of the notion of health “insurance.”
Also, I also am a big fan of the narrative that medical care (I’m going to road test your distinction) is so expensive and inscrutable at least as much because of government intervention as market forces. While I’m open to the notion that government has an important role to play in medical care (and health care too, perhaps), I am no fan of the idea of adding more layers of government intervention to correct problems created by earlier layers of government intervention. If your glasses failed to correct your vision, you wouldn’t wear a second pair of glasses on top of them, would you?
No, but my sister has to wear glasses to correct her Lazik! 🙂
I’ll take the criticism regarding my apparent accusation of bad faith against Kyle. The way I wrote my
hmm, it posted before I was finished.
As I was saying,
The way I wrote my post does have that tone, now that I read it differently. I apologize to Kyle for that.
I do still think, in general, that the term “health care” is used for it’s moral weight. Also, using an example of a personal, emergent incident as a proof for a more general claim is a common logical fallacy. Very common.
Thanks.
No worries. A couple remarks:
1. I can’t speak for others, but I do not use “health care” in place of “medical care” because the former has more moral weight. In my view, there’s a right to both, as you use the terms.
2. Moving immediately from a particular to a universal would be a logical fallacy, but you can arrive at a universal from a particular by way of a detour, e.g., if the particular case discloses a universal truth.