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The Moral Basis for Healthcare Reform in the United States

Published online by Cambridge University Press:  11 January 2011

GRIFFIN TROTTER
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Extract

In speculating on the motives for government, English philosopher Thomas Hobbes identified the pervasive role of fear and the danger of violent death, holding famously that where no government prevails to secure physical safety and property, there can also be no enduring knowledge, art, or civilization—leaving human lives “solitary, poore [sic], nasty, brutish and short.”

Type
Special Section: Open Forum
Information
Cambridge Quarterly of Healthcare Ethics , Volume 20 , Issue 1 , January 2011 , pp. 102 - 107
Copyright
Copyright © Cambridge University Press 2011

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References

1. Hobbes, T. Leviathan. Tuck, R, editor. Cambridge, UK: Cambridge University Press; 1996 [1651]:89Google Scholar.

2. For over a decade, Gallup pollsters have used the following two questions to divide Americans into four ideological groups (with 10%–15% of Americans in their polls typically ending up classified as “undesignated” because of equivocal responses): (1) “Some people think the government is trying to do too many things that should be left to individuals and businesses. Others think that government should do more to solve our country’s problems. Which comes closer to your own view?” and (2) “Some people think the government should promote traditional values in our society. Others think the government should not favor any particular set of values. Which comes closer to your own view?” Gallup classifies as “liberals” those who deny that government is trying to do too many things and deny that government should promote traditional values. “Populist” is their classification for those who deny that government is trying to do too many things and affirm that government should promote traditional values. “Libertarian” denotes persons who affirm that government is trying to do too many things and deny that government should promote traditional values. “Conservative” denotes persons who affirm that government is trying to do too many things and affirm that government should promote traditional values. On this scheme, about 20% of respondents in recent years have fallen into each of the four ideological groups, though the percentage is slightly higher for conservatives. Throughout most of the 1990s, liberals lagged behind populists and libertarians, who in turn lagged behind conservatives (who reached 35% in January of 1996). The Cato Institute, a libertarian think tank, has adopted a stricter definition of “libertarian” that requires the two aforementioned responses to the first two questions plus a “too much power” response to the following question: “Do you think the federal government today has too much power, has about the right amount of power, or has too little power?” With this more restrictive qualification, Cato finds that only about 10%–13% of U.S. citizens qualify as libertarians. This seems to correlate with citizens’ self-reporting. When U.S. citizens were asked by Gallup in 2006 to designate for themselves which of six possible categories described their political orientation, 54% said they were “conservative” and an overlapping 53% indicated they were “moderate.” “Liberal,” “progressive,” “libertarian,” and “populist” were selected by 34%, 28%, 10%, and 7%, respectively (also with overlap). See Gallup News Service. Many Americans use multiple labels to describe their ideology. 2006 Dec 6; available at http://www.gallup.com/poll/25771/Many-Americans-Use-Multiple-Labels-Describe-Their-Ideology.aspx (last accessed 31 May 2010). For a summary of the Gallup polls and the Cato modifications, see Boaz D, Kirby D. The libertarian vote. Policy Analysis No. 580. Washington, DC: Cato Institute; 2006:7–12; available at http://www.cato.org/pubs/pas/pa580.pdf (last accessed 31 May 2010). For early development and application of the four-ideology scheme, see Lilie SA, Maddox WS. An alternative analysis of mass belief systems. Policy Analysis No. 3. Washington, DC: Cato Institute; 1981.

3. In a survey conducted in the late 1970s, the following question elicited a positive response in 21% of Americans surveyed: “If we really gave every person an equal chance, almost all of them would turn out to be equally worthwhile.” Meanwhile 70% indicated: “No matter how we treat everyone, some people will turn out to be better than others.” McClosky, H, Zaller, J. The American Ethos. Cambridge, MA: Harvard University Press; 1984:71CrossRefGoogle Scholar. Despite ambiguities in the question (e.g., regarding the meaning of “better”), responses seem to exhibit a fundamental dividing line between Americans, with liberals tending toward the minority opinion.

4. Rawls, J. A Theory of Justice. Cambridge, MA: Harvard University Press; 1971:103–4Google Scholar.

5. Disadvantages proceeding from disparities in the natural and social lotteries are, in my opinion, probably not regarded by most U.S. citizens as “unfair” in the sense of indicating a social injustice (for instance, in the failure to remediate them), but rather more commonly as reflecting a more or less cosmic inequity for which social and/or political remediation, if indicated, hinges on duties of charity or benevolence rather than requirements of social justice. However, I am not aware of any empirical findings that clarify this issue. H. Tristram Engelhardt, Jr., claims that genetic and social disadvantages should be regarded from the standpoint of secular morality as “unfortunate” rather than “unfair.” This is sound advice if “fairness” is indelibly linked to “justice,” as some liberal egalitarians seem to hold. But I do not think that it is or that it should be. See Engelhardt, HT Jr. The unfair and the unfortunate: Some brief critical reflections on secular moral claim rights for the disabled. In: Ralston, DC, Ho, J, eds. Philosophical Reflections on Disability. New York: Springer; 2010:229–37Google Scholar.

6. See note 3, McClosky, Zaller 1984:18.

7. Pew Research Center. Pew global attitudes project 44—nation major survey. 2002. Final Topline, p. T-42; available at http://pewglobal.org/files/pdf/185topline.pdf (last accessed 31 May 2010).

8. Though it is true that “scarcity” pertains with respect to virtually all goods and services in any economic system, this economic sense of “scarcity” is not equivalent to the zero-sum notions of scarcity that are often employed by those who obsess over total spending on healthcare. Rather, it denotes the fact that, at any given time, the supply of any particular good or service will be finite. For many goods and services, including most healthcare goods and services, supply is flexible and dynamic and will increase with increasing demand. Except in cases where the healthcare “market” is excessively regulated (e.g., in granting a state-sponsored monopoly over certain services to physicians and then allowing them to arbitrarily limit entry into their profession), healthcare goods and services are not typically “scarce” in the sense that if one person purchases a particular good or service, another is automatically deprived.