06/04/2013 05:26 pm ET Updated Aug 04, 2013

The Missing Moral Dimension in the Health Care Debate

A recent report suggests that spending for Medicare will not go up as much as originally projectioned. As Paul Krugman points out in his recent piece in the New York Times, "the long-term upward trend in health care costs -- a trend that has affected private insurance as well as Medicare -- seems to have flattened out significantly over the past few years."

This is good news for those concerned about the costs of providing all Americans with access to quality health care. But it also obscures an element that has been sadly and surprisingly missing from recent health care debates, especially among those vehemently opposed to the Affordable Care Act (Obamacare). That missing element is the moral basis for health care. The political debate has become focused almost entirely on costs rather than on the services those costs help to pay for. By concentrating on costs to the virtual exclusion of everything else, the opponents of providing universal health care want us to believe that health care is an optional consumer commodity, one that consumers can freely choose to obtain or not to obtain depending on their preferences. Among people committed to the libertarian principle that all choices are essentially economic and are to be made by individuals pursuing their own self-interests, it is almost inevitable that everything with a cost attached to it is a commodity, to be chosen or not chosen as one sees fit.

But to treat health care as an optional commodity, which should compete in the market place alongside the option of choosing a large flat-screen TV, fundamentally misunderstands what health care is and why its provision is a moral imperative in a society that claims, however confusingly, to be a moral society. In a family, the health of the members is not normally treated as a commodity whose purchase is optional and whose importance is to be weighed alongside the purchase of a new car or a club membership. When a child is dying of a disease that can be treated, the family does not seriously ask whether it should seek the treatment and forgo the vacation. It places the health of the sick child above everything else. In a family context most people know that the health of those they love is an essential moral necessity not to be compared with truly discretionary options. (As a nation we used to think of national defense in the same way: It was a moral necessity and should be funded by taxes at whatever level was necessary to make it reliable.)

Now this is not to say that the costs of medical care are irrelevant: Under our present health care system, taking care of the ill is often a matter of how much one can afford to pay for it, whether out of pocket or through insurance. And there are legitimate questions about how to make the provision of health care as cost-effective as possible. The U.S. spends far more of its health dollars on overly expensive treatments as compared with the rest of the developed world and often with far less successful treatment outcomes. There are enormous savings that can be found not only by subjecting our treatment regimens to rigorous analysis and best-practices comparison. There would be significant economies in moving to a universal single-payer system which would eliminate the dubious contributions of numerous private health insurers who must of necessity treat health care as a consumer product the sale of which can make a profit for them. But even with all the savings that can be obtained by making the system more effective and efficient we are still left with the moral dimension: Health care is not a commodity to be purchased or abstained from on the basis of individual preference. Health care for all is good for the individual as well as for the society as a whole.

Addressing health needs is a moral obligation because health is essential to the well-being and flourishing of all persons. And it is more than a personal good; it is a social good. The best health care possible should be provided to all members of any society that claims to be looking after the common good or the general welfare of the people. That is why its partial provision through a society-based program, Medicare, is called an entitlement. An entitlement, despite the bad odor the conservatives believe emanates from that word, is a moral term derived from a socially accepted moral obligation. As such, it ought not to be treated as a "discretionary" economic expenditure. It is shocking that a political party that has clothed itself in the mantle of morality has failed utterly to articulate the moral basis of health care or to offer any moral justification for overturning Obamacare or any alternative moral vision for what would replace it. Leaving millions uninsured, as the state of Texas continues to do, is a moral scandal. A political party that cannot address the provision of health care in moral terms has forfeited its right to speak for moral values in America. Once our moral obligation to provide health care to all has been accepted the way will be clear to figuring out as realistically as possible how to provide it efficiently and effectively. But if the moral dimension of the debate is ignored, health care will be treated as having no more moral claim on our resources than does the demand that social taxes pay for my desire for a month's vacation in the Alps.