tag:blogger.com,1999:blog-7476621888383604834.post4915044902998463057..comments2024-02-15T03:26:38.897-05:00Comments on Health Care Organizational Ethics: Rebellion Against the Individual Insurance MandateJim Sabinhttp://www.blogger.com/profile/03087828142188534542noreply@blogger.comBlogger6125tag:blogger.com,1999:blog-7476621888383604834.post-34048721922747246432009-10-24T20:53:04.781-04:002009-10-24T20:53:04.781-04:00Hi John -
Thank you for this very thoughtful comm...Hi John -<br /><br />Thank you for this very thoughtful comment and for the explication of Robert Audi's views.<br /><br />I think of health care more on the analogy to education than to free speech. As a body politic we have concluded that a socially responsible state owes the opportunity for basic education to its citizens. Without literacy and numeracy we can't exercise what the founding fathers thought of as our fundamental rights.<br /><br />In my view, health care is similar. Curing pneumonia or fixing a fracture isn't enhancement - it's sn intervention that gets us back to the starting block for exercising those same fundamental rights.<br /><br />I prefer to conceptualize health care as a societal obligation, not a right that individuals can claim. Any such "right" would have to be relative to the societal circumstances - especially its level of wealth and the competing demands on its resources. A right would be more independent of social circumstances.<br /><br />Best<br /><br />JimJim Sabinhttps://www.blogger.com/profile/03087828142188534542noreply@blogger.comtag:blogger.com,1999:blog-7476621888383604834.post-79698327649643495752009-10-23T11:34:38.273-04:002009-10-23T11:34:38.273-04:00In an earlier response to my comment, Jim asked f...In an earlier response to my comment, Jim asked for a clarification of Robert Audi’s position, to which I referred. <br /><br /><br />As I understand Audi, who could be taken as a good representative of the classical “liberalism as neutrality” position, government must be neutral relative to contending versions of the good. This means that no set of values, no ideology and no religious view should be seen as “trumping” any other perspective. All participants in deliberation deserve to be given reasons that they can understand and evaluate on terms that are not exclusive to, or comprehensible only within, a given life world or world view. This requires a public justification accessible to all. This is critically important when policy options involving coercion are being deliberated and when legislated policies entail coercion on individuals who do not agree with the values being promoted. See his Religious Commitment and Secular Reason<br /><br /><br />This view is often in conflict, of course, with the ideologically or religiously motivated view that truth ought to prevail and that those who hold the true are entitled to carry the day. In between is the view of open deliberation with all perspectives taken into account. Chris Eberle is a good example here. See his Religious Conviction in Liberal Politics<br /><br />In terms of your non-sectarian perspective, I think that this is a very tricky business. I recognize “equal opportunity” as an important value, as do you and Norman Daniels. Yet I wonder if we are on a slippery slope when we begin to equate a right to health, derived from the concept of equal opportunity, with a right of free speech. The latter is clearly and directly related to the ordinary operations of a democratic process in the sense that we cannot govern ourselves as a free people unless we can speak our minds in public. The founders, such as George Mason, clearly understood this and pushed for a bill of rights focused on those behaviors whose commission were essential for public participation as well as on those prohibitions of government action that would restrict that participation. <br /><br />I think that we need to be careful when we attempt to use inalienable rights in this context. My reading of American history suggests that the founders who used this rights language treated capabilities as givens rather than as variables to be enhanced. Unless we are candid on our expansion of the meaning of the concept for our modern day purposes of expanding capabilities, we run the risk of proposing policies that the those who gave us the core concept would not support. If we are expanding the applicability of the concept we need to be candid in our remarks.John Eleyhttps://www.blogger.com/profile/11803937993609981135noreply@blogger.comtag:blogger.com,1999:blog-7476621888383604834.post-8732451700038197522009-10-19T21:59:37.571-04:002009-10-19T21:59:37.571-04:00Hi John -
I'm afraid I don't know Robert ...Hi John -<br /><br />I'm afraid I don't know Robert Audi's work. I did a quick Google search and see that he's written quite a lot. What is the gist of his position?<br /><br />I see two central non-sectarian arguments for the societal obligation to provide access to health care for its members. (1) I agree with the way my colleague Norman Daniels grounds this obligation in the principle of equal opportunity. If all humans are created equal with inalienable rights to life, liberty, and the pursuit of happiness, health is a precondition for exercising those rights, just as free speech is. (2) For me the Kantian view of respect for persons as a primary moral stance entails a societal obligation for society to act as the Samaratan did. We can't claim to respect our fellow humans and at the same time allow them to suffer from major treatable impairments.<br /><br />The question of how much health care we owe to members of our society and the relative investments we will make in health care, education, national security, and other fundamental goods, requires a fair deliberative political process to answer. I don't think ethical principles will take us to that level of policy precision.<br /><br />But in my view ethical considerations forbid us from treating health care as a market commodity - you can get it if you have enough money and you can't if you don't.<br /><br />Thanks for posing this very fundamental question!<br /><br />Best<br /><br />JimJim Sabinhttps://www.blogger.com/profile/03087828142188534542noreply@blogger.comtag:blogger.com,1999:blog-7476621888383604834.post-85501099740766274322009-10-19T17:41:49.282-04:002009-10-19T17:41:49.282-04:00I would like an explanation of the origins of the ...I would like an explanation of the origins of the ethical or moral obligation to provide all with health care. Since all efforts to provide it will involve some form of coercion and the redistribution of wealth, I for one would like a reasoned position on the source, nature and limits of this obligation. I think that this must be a public reason not a sectarian one. In this respect I find Robert Audi's arguments compelling.John Eleyhttps://www.blogger.com/profile/11803937993609981135noreply@blogger.comtag:blogger.com,1999:blog-7476621888383604834.post-77593000556935166282009-10-01T10:59:52.039-04:002009-10-01T10:59:52.039-04:00Hi Roy -
I'm sure that for some "mandate...Hi Roy -<br /><br />I'm sure that for some "mandate resisters" their realistic fear is that the available insurance will be very expensive and will not provide good value for money. But I've always thought of the mandate mechanism as a back door way of avoiding the dreaded political action of raising taxes. <br /><br />In my view, our society has an ethical obligation to ensure access to health care. The most straightforward way for us to met that obligation would be via taxes. Since the tax system is graduated we would be using it to address the question of what a fair level of contribution is for each individual. As Zeke Emanuel's proposal in "Healthcare, Guaranteed" showed, assuring universal access on a tax supported basis doesn't require the other dreaded political action - a single payer system.<br /><br />A mandate requirement would definitely pose the Catch-22 you describe. Even for those at 500% (and higher) of the federal poverty level the available coverage is likely to be very expensive relative to income. Individuals may opt to pay the penalty for the "privilige" of being uninsured!<br /><br />Best<br /><br />JimJim Sabinhttps://www.blogger.com/profile/03087828142188534542noreply@blogger.comtag:blogger.com,1999:blog-7476621888383604834.post-60791671201381074872009-09-30T16:54:14.450-04:002009-09-30T16:54:14.450-04:00I wonder if some of the resistance to the mandates...I wonder if some of the resistance to the mandates comes from fear that whatever insurance reforms are enacted, they will not be sufficient to make individual coverage both accessible and affordable.<br /><br />In that case, if a mandate is enacted, it will pose a Catch-22: either you buy extremely expensive insurance (if you can find it), or you don't or can't, therefore have no insurance, but still have to pay a fine.Roy M. Poses MDhttps://www.blogger.com/profile/00497209843184497847noreply@blogger.com