Monday, October 19, 2009

Is Ethics Relevant for Health Reform?

As I sat down to prepare a talk on health reform and ethics I'll be giving soon, a Tina Turner song started to play in my head - but with "ethics" substituted for "love":
"What's ethics got to do, got to do with it?
What's ethics but a second hand emotion?"
Given the mind-numbing daily stories about twists and turns in Washington and the daft Republican rhetoric about "socialized medicine" and "death panels," an observer might conclude - "health reform is only about politics and special interests - ethics is an irrelevant second hand emotion!"

I've had that thought myself. But I think it's wrong.

There's no doubt that partisan politics and special interests are leading players in the reform process. (As an example, see here 'for an audio of Senator Jim DeMint's excitement about "breaking" President Obama and creating his "Waterloo" by defeating health reform.) But in addition to the impact of PAC money bribes and armies of lobbyists, politicians and special interests try to get their way by playing on the public's strongly held but unexamined values. From the political perspective this is "stealth ethics." From the philosophical perspective we might call it "pseudo ethics."

President Obama reported receiving a letter saying (see here for a videoclip of the President telling the story):

"I don't want government-run health care. I don't want socialized medicine. And don't touch my Medicare."

This story got a big laugh from the President's AARP audience. But it makes a deeper point about ethics and health reform. Ethical reflection isn't just a matter of asserting values. It requires bringing our values to bear on the world of facts, and, reciprocally, modifying our values as the facts may require. The joke here is that the anti-government, libertarian letter writer made the facts fit the values. Since she (it was a woman) liked Medicare, Medicare couldn't possibly be a government program!

Muddled "pseudo ethics" are stirring the reform pot in several ways. Here are two examples:

  • Health insurers are "villains." There's lots to criticize in the conduct of insurance companies and in the way we've structured our health "system" around competing insurers. But even if Mother Theresa were in charge of U.S. health care we'd need an insurance function to oversee the way we spend our funds and to seek value for money. The global condemnation of insurers abets the public fantasy that if we get rid of the villains we'll be in a paradise that requires no difficult choices.

  • From a moral perspective the aphorism "life is priceless" conveys what Albert Schweizer called "reverence for life." But as a piece of economic guidance the aphorism is psychotic. It implies that any limit that threatens life is evil. In actuality we constantly make choices that involve weighing life against other values - how much to spend on auto safety, whether to put defibrillators on every street corner, or whether the convenience of texting while driving is worth the risk to mortality (ours and others) it poses. By not distinguishing between the metaphoric meaning of "priceless" as applied to whether life should be revered and the need to use funds wisely, we again invite the body politic to remain ignorant about our ethical obligation to set limits in health care.
So ethics does have something "to do with it" - it's not just "a second hand emotion." But what's required is not shouting about values - that's easy, and accomplishes nothing. What's really needed is the much more difficult task of shuttling between values and facts - looking at the facts in light of our values, modifying those values as needed, as when the anti-government libertarian contemplates the fact that Medicare is a 44 year old government program, and developing options that serve important values to the greatest extent possible.

If the democratic process works as the founding fathers hoped it would, this is what the legislative process should strive to do with the bills that have been developed in the House and the Senate.


Tom Degan said...

A friendly reminder to my fellow Catholics:

When Jesus healed the sick he did not make exceptions for any "preexisting conditions". Just a thought.

I don't know what kind of health care reform will come out of this session, but I strongly suspect it won't be much. There is, however a silver lining behind this very dark cloud. I am reminded of the Civil Rights Act of 1957. Don't be embarrassed if you've never heard of it, there really isn't a hell of a lot to remember about it; a mere pittance, really - a scrap of leftovers tossed out to "American Negros" (in the parlance of the age) in order to appease them. But it made the passing of the Civil Rights Act of 1964 - the one we remember - all-the-more easier seven years later.

We'll live to fight another day.

Tom Degan
Goshen, NY

Jim Sabin said...

Hi Tom -

Thanks for the valuable comment. Even though I'm not a fellow Catholic I like to invoke the saints in my thinking and writing, as I did with Mother Theresa in this post.

I really appreciate your reference to the Civil Rights Act of 1957, which I'd completely forgotten. When I looked it up in Wikipedia it brought back memory of Senator Strom Thurmond's 24 hour filibuster - I'd read about it in the papers at the time.

I've been thinking about whatever bill (I assume there will be one) that comes out of this year's health reform process in the same way as you. I don't expect much either. But my optimistic self predicts that the legislature will be "empowered" by the process and by actually accomplishing a piece of legislation we'll be readier to do more and better when the health "system" s - - t continues to hit the fan.

I enjoyed reading Tom Degan's Daily Rant!



bobrien said...


My name is Barbara O’ Brien and my blogging at The Mahablog, Crooks and Liars, AlterNet, and elsewhere on the progressive political and health blogophere has earned me the notoriety of being a panelist at the Yearly Kos Convention and a featured guest blogger at the Take Back America Conference in Washington, DC.

I’m contacting you because I found your site in a health reform blog search and want to tell you about my newest blogging platform —the public concern of health care and its reform. Our shared concerns include health reform, tort reform, public health, safe workplaces, and asbestos contamination.

To increase awareness on these important issues, my goal is to get a resource link on your site or even allow me to provide a guest posting. Please contact me back, I hope to hear from you soon. Drop by our site in the meantime.


Barbara O’ Brien

Ghocheng said...

Great post and read it twice. Keep posting good post my friend

Jim Sabin said...

Hello Barbard and Gho Cheng -

Gho Cheng - thank you for the kind words! I do plan to continue blogging. I see that you have recently started a blog. Good luck!

Barbara - I'll send you an email separately after I'm back from a forthcoming three day trip to Los Angeles, where I'll be speaking at an ethics committee's retreat. I see that the site you mention is about asbestos-induced illness and mesothelioma. Industrial hazards and environmental toxins are central concerns for social and organizational ethics.