Monday, March 29, 2010

Chad Goldberg explains the moral basis of health care reform

In the controversies over health care reform, it is often too easy to get caught up in the political struggles and technical details--which are certainly important, but not the whole story--and to lose sight of the moral heart of the matter, which has to do with fundamental imperatives of solidarity, mutual responsibility, and basic moral decency. Here is a cogent and compelling discussion of those central issues.

My friend and intellectual comrade Chad Goldberg, a political sociologist at the University of Wisconsin, had an e-mail exchange about health care reform with a relative who asked him:
I was just wondering if someone smokes, drinks, does drugs and does not work should get health care on my hard earned dollar?
I think Chad's response would be hard to improve upon, so I share it with his permission (below).

--Jeff Weintraub

From: Chad Alan Goldberg

Dear X,

Always nice to hear from you. So you want to have a discussion about the recently enacted health care reform legislation? OK.

You asked me if someone who smokes, drinks, does drugs and does not work should get health care on your hard-earned dollar. This is obviously a loaded question designed to compel me to admit that the reform is misguided and unfair. But if you really want to know my opinion, my answer would be yes for several reasons.

Yes, for the same reason that I contribute my hard-earned dollars to pay for your Medicare benefits without scrutinizing your health habits or personal behavior. Medicare is a massive government-run health care program that compels younger working Americans to transfer huge amounts of money to older retired Americans. And it does so for good reason: public health is not merely a private benefit but a public good, like public education, clean air & water, public roads, and other public services.

Yes, for the same reason that you pay premiums for private health insurance without scrutinizing the health habits or employment histories of the other policyholders. By pooling both your financial contributions and the risk of sickness, a large number of you can absorb losses more easily than any one of you on your own.

Yes, because by doing so you might save that person's life.

Yes, because if that person had routine access to preventive health care (smoking cessation programs, for instance, or treatment for addiction), it might help her to adopt healthier habits.

Yes, because if you want that person to work, then you want her to be healthy. People who are seriously ill can't work.

Yes, because you pay for that person anyway when she goes to the ER and those costs are passed on to you indirectly. (They get rolled into hospital overhead, which is paid by people like you who can pay.) And if she has routine access to preventive care and doesn't have to wait until her problems develop into full-blown emergencies before they get treated, at least it will cost you less.

Yes, because it's better than paying the hidden social costs of having millions of your fellow Americans without health insurance. For example, health care costs are linked to the majority of bankruptcies filed in this country. Those costs are absorbed by banks and passed on to you in one form or another.

Yes, because health care is a fundamental human right. It says so in the United Nations Universal Declaration of Human Rights, drafted by a commission chaired by Eleanor Roosevelt, which the United States voted to adopt in the UN General Assembly in 1948. Article 25 states in part: “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”
[JW: I know that UN documents make a lot of people yawn--and not always without some reason--but this notion that access to decent health care might be seen as a "fundamental human right" is not restricted to the Universal Declaration of Human Rights. For example, it also happens to be the official position of the US Conference of Catholic Bishops:

For the Catholic Church, health care is a basic human right and providing health care is an essential ministry. We pick up the pieces of this failing system in our emergency rooms, clinics, parishes and communities. This is why we strongly support Congressional action on health care reform which protects human life and dignity and serves the poor and vulnerable as a moral imperative and an urgent national priority.

Which brings us to Chad's next point ... ]
Yes, because you're a good Christian, and therefore you remember what Scripture teaches us: “Take care lest you … say to yourselves, ‘My own power and the might of my own hand have won this wealth for me.’ Remember that it is the Lord your God who gives you the power to get wealth” (Deuteronomy 8:17). And it is the Lord who commands us: “open your hand to the poor and needy kinsman in your land” (Deuteronomy 15:11).

Finally, I doubt that you personally will be paying more taxes under the health care reform legislation unless your income is much higher than I think. (The law requires families with an annual income above $250,000 to pay a little more in taxes on their investment income and contribute a little more to Medicare from their payroll taxes.) In fact, you might well receive new benefits from the legislation in the form of changes to the Medicare prescription drug program. That program’s unpopular “doughnut hole”—the big gap in coverage left by President Bush and the previous Republican Congress—will now be eliminated by 2020. In the meantime, millions of Medicare recipients who are affected by it will immediately begin receiving rebates and in 2011 a 50% discount on brand name drugs. I’m in favor of that too.

Hope you have a happy Easter and are enjoying the spring weather.

Yours truly,

P.S. I have great faith in this country and its future. America has surmounted worse problems in the past, and I am sure we will get through the ones we face today if, listening to "the better angels of our nature" (as Lincoln said), we trust and look out for each other.


It is necessary that we never lose sight of what is the aim of public education. It is not a matter of training workers for the factory or accountants for the warehouse, but citizens for society. --Emile Durkheim