Jesuit bioethicists take a stand on universal health care.
The Moral Case for Insuring the Uninsured
As health care ethicists, we believe providing universal access to health
care is the right thing to do, and now is the right time to do it. Much like
our commitment to providing universal access to K-12 education, the
reasons for doing so are both pragmatic and moral. And these reasons are
so compelling that they require us to do what it takes to overcome
obstacles.
Each year, according to a report of the prestigious Institute of Medicine,
approximately 18,000 Americans die prematurely because they lack health
insurance. Persons who lack insurance typically do not seek medical care
until their illnesses have progressed to the point when they can no longer
be ignored. Then the illness is far more difficult (and expensive) to treat.
This simple fact of the death toll from lack of insurance should provide the
moral will to treat this situation as we treat any national emergency that
threatens large numbers of Americans whether that emergency is from an
aggressor such as terrorists, a natural disaster such as Katrina, or a
communicable disease such as swine flu. In national emergencies, we
require our representatives to determine what needs to be done to alleviate
the threat and to appropriate the resources to do it. In such situations we
would be very surprised to hear our representatives or members of the
media talking about whether this was the right time for action, arguing to
slow down the momentum toward action, or debating whether we can
afford to act.
But, of course, people dying prematurely in hospital from lack of timely
and proper management does not capture the moral imagination of the
public the way a terrorist attack or hurricane might. Such suffering is
easily out of sight and mind. Moreover, because most Americans have
health insurance, it is easy to assume the uninsured must somehow be
different from ourselves or to blame for their predicament. However,
while there are some in our society who willfully fail to purchase health
insurance that they could afford, lack of health insurance is usually caused
by unfair or profoundly unfortunate circumstances. Most of the uninsured
live in households in which the head of the household works full time
often for a small business. Not only is it difficult for a small firm to
finance health insurance, but such firms are typically charged much higher
prices for their coverage. Similarly, many persons lose their insurance
when they involuntarily lose their job for a period of time.
Of course, we are never ethically obliged to do the impossible and it is
natural to ask whether we can afford to expand health coverage--
particularly during economic hard times. Nevertheless, the total amount
required to achieve this goal is approximately 3 – 5% of the total spending
on health care in the United States. In other words, the increase required is
significantly less than the rate of one year’s medical inflation. Many
credible policy analysts believe we need to control health care costs in the
long run in our nation. However, it is clear that insuring the uninsured is
not a major part of that issue. In other words, insuring the uninsured is not
a significant part of the problem of rising health care costs in the United
States.
We believe that thinking about our values—values of justice, solidarity,
and compassion—changes our perspective on health care reform.
Currently, support among the public is wavering because of concerns
about cost, funding mechanisms, and what is in it for the person who
currently has private health insurance. From the point of view of our
common values, the final concern is the most relevant. A just and
compassionate society is obligated to try to meet the basic needs of all
members of the community—not every imaginable desire, but our most
basic needs such as food, a foundational education, and basic health care.
Political leadership, if it is to be true moral leadership, must have the
courage and will to push forward legislation that may not please everyone,
but will give all persons access to an acceptable level of health care
services. We become better people when we respond to the arbitrary and
capricious threats to life and the pursuit of happiness that afflict our
neighbor. And, of course, when we guarantee justice for our neighbor, we
do so for ourselves and our families as well should disaster befall us.
The Consortium of Jesuit Bioethics Programs:
James J. Walter, PhD, Loyola Marymount University
Carol Taylor, PhD, MSN, RN, Georgetown University
Mark G. Kuczewski, PhD, Loyola University Chicago
Amy M. Haddad, PhD, RN, Creighton University
James M. DuBois, PhD, DSc, St. Louis University
Peter Clark, SJ, PhD, St. Joseph’s University
Debra Bennett-Woods, EdD, Regis University
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