Society’s Moral Obligation?

I have a question for anybody who stops by and I really want to hear what people have to say. So I’m putting myself out there. I’ll be embarrassed if there is a big “No comments” following this post. Here’s the question:

Is it society’s moral obligation to provide a minimal level of health care to all its people or does that border on excessive welfare handouts?

Okay, I lied. A follow-up question:

What does society owe to its people? Clean water, shelter, an education, nothing?

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14 responses to “Society’s Moral Obligation?

  1. I do believe that it is society’s moral obligation to provide health care to every individual, especially in a nation where most medical advancements are made. There is no excuse for so many people go uncared for.

    And that goes for your other question as well. I believe that, especially, in a country with the amazing resources available here, there is no excuse for people to be hungry or homeless, or left with no education or skills. There should be no question as to whether or not every person should be provided with the basic necessities of life.

  2. Phew, I avoided the shutout!

  3. I’m having a hard time understanding what you mean by “society.” I know, I know. Maybe I’m being too difficult here but defining that term might help me a bit. Is “society” the government, the people (if so, then the second question kinda confuses me), the inherit soul of nature, God even? I mean, I think I know what you’re getting at so I’ll give it a go:

    Yes, health care should be provided for all people no matter social/economic standing. I’m not even sure how someone could argue otherwise.

    As for what is owed people, structures should be set up so that all people – again, no matter their social/economic standing – have access to the basic necessities of life.

  4. Joe,

    You have to be difficult. I’ll leave “society” as a non-specific term. For some it will mean government, for some it will be a community, religious or not, for some it will be an even more general term, the “people,” but I want this to be as open ended as possible.

    I would say that many people say that health care should not be provided to all. It is often argued that only those that contribute to society (another vague term, how do you define that?) should receive benefits from society – health care, social security, welfare, etc. So to ask the question again. What do we owe to the citizens or the persons that define our society? If we owe anything what are the conditions, if anything? What would you say are the basic things that we owe?

    What are those basic necessities of life?

  5. To say that the obligation is a moral one is taking a large step, assuming that a moral compass is what drives our actions. For you and I, it may be a moral or “faith-based” obligation, but for others it is not. The obligation to provide is more of a belief in human rights and equality. Less about morality, I think.

    Regarding your second question, I don’t think society owes anyone anything. The word owe implies “you do something for me, I owe you sometining in return.” It is not about owing. It is about distributive justice.

  6. I had the same thought as Joe (sorry…) but what my mind translated “society” into was, “we.” So that your question becomes “what do we owe each other?” Of course “we” just sidesteps the definition problem but so did you, so we’re even. But you could consider “we” both globally and locally–and I think both are called for.

    So what do we human beings owe each other? The basic stuff for human flourishing–and that includes but also goes beyond the physical necessities. My off-the-cuff list: adequate physical care (food and water, home and clothing, health care), adequate stimulation and freedom of expression (education and play), adequately stable, sustainable community (where one has a way to contribute and be fulfilled thereby). I suppose what I am trying to envision is not a society where some particular entity has the assigned responsibility for providing these things directly, but a society which is structured so that the resources to fill any need are available for anyone who needs them. Oh, there’s a word for that, right? Utopia. Yeah, I’d like to live there.

  7. Now, I want to be more specific. What should the government provide to its citizens? Each country has created a social contract with its people and established a list of things that come with being a citizen (or just a resident). What are the basics? The bare minimum? Should a government provide clean water, sanitation, housing, defense, income security, certain freedoms, justice, or healthcare? Should these things come from the free market, social groups, philanthropy, churches? How do we decide wat is a Right and who should provide it? Any thoughts?

  8. Public services (those provided by and/or paid for by some level of government) come in four flavors: 1) those paid for by the recipients (e.g., water, sewage treatment, thrash collection), 2) those for which no member of society can reasonably be excluded (e.g., national defense; economists call these “pure public goods”), 3) those paid for by society for which society receives at least an indirect benefit (e.g., education; economists call these “quasi-public goods”) and 4) those paid for by society, irrespective of any direct or indirect benefit to society (most congressional earmarks fall into this category, i.e,, pure wealth distribution).

    There’s obviously a case to be made for public funding of health care, Contagious diseases can be contained more effectively if the entire population is immunized. But where’s the public benefit derived from prolonging the life of a smoker’s lung cancer? How do we benefit from paying to treat a diabetic who has eaten his way to a diseased state? Compassion drives many to argue for public money to treat these “avoidable” conditions. But they’re really asking for confiscatory wealth distribution. Charities collect voluntary donations for assisting the indigent. But when government demands that people be treated and that the payment for such treatments be passed along to others (either in taxes or higher fees for their own services), this represents wealth distribution.

    So your question is: Should the government be involved in wealth distribution? Well, we already are to a great degree. And at the extreme (e.g., communism), it’s highly inefficient. In general, I don’t support it. It’s hard to make an argument for the fairness of such practices. And, as a practical matter, it sends a message to our citizens that you’ll still be taken care of, regardless of your risky behavior, your lake of self-discipline and your unwillingness to manage your health. Such a practice can (and does) decrease the public’s motivation to take control of their health, causing health care costs to rise still further.

  9. It is a dangerous game to play when we begin to blame people for their illnesses. Would you say the government should provide treatment for someone who get lung cancer due to second hand smoke? Or someone who develops diabetes simply due to genetic reasons? There are very few people on this planet who are qualified to decide who is worthy to treatment under this paradigm of medicine. Punishing people for what some people term “recklessness” by denying them live saving treatment is patently irresponsible.

  10. Casey, I wouldn’t presume to deny ANYONE life-saving treatment. I just don’t want to pay the bill when the need for the treatment came from that person’s irresponsible lifestyle. That sounds cruel, doesn’t it? But when people don’t experience negative consequences for irresponsible behavior, they continue to act irresponsibly. Some might say that it’s cruel to put a thief in jail; but the threat of jail keeps many people from becoming thieves. So maybe it’s more cruel NOT to put thieves in jail.

    So given that it’s impossible to precisely determine which diseases are the result of irresponsible lifestyles, how do we separate the worthy from the unworthy? Well, some companies are already taking a macro-approach where they offer rewards for those that appear to be maintaining a healthy lifestyle. There are BMI targets (including improvements) and several other parameters that are used and those that fall within acceptable ranges get the rewards. The results have been astounding and all but a handful of employees have strongly endorsed the policy. Opposition, as expected, comes from those who feel that it’s coercive and from those who are denied the rewards because the refuse to change their lifestyles. Such a system doesn’t guarantee fairness. Some are punished because of genetic pre-dispositions or other limitations inherent to their being. But systems can be made to accommodate exceptions and the notion of universal health care without some accountability guarantees unfairness to those who have to pay for the irresponsible members of society.

  11. Mr. Parrish,

    I have a problem speaking about all of this theoretically. You say that you would not presume to deny anyone life-saving treatment. But is it ethical to charge a person over $2000 a month for insurance because they are in the process of battling cancer, or to deny them affordable treatment because they have made choices that you deem irresponsible that are directly related to their illnesses? While that is not technically denying them treatment, they are being categorically denied said treatment because of their financial limitations.

    I do agree with you that it is beneficial to provide incentives to people for making better life choices and for changing unhealthy habits. But there are many, more fundamental changes that must be made before these incentive programs are even thought of for the nations’ poor. There are direct correlations between living in poverty and the incidence of diabetes, high blood pressure, heart disease, asthma, and many other ailments. You cannot buy enough healthy food to feed a family of 4 on such little income, and most times even with government assistance. But processed foods, low quality meats, foods high in sugar, fat and preservatives, are affordable. Children living in poverty, be it in public housing or simply in poor neighborhoods are far more likely have asthma due to environmental pollutants, and mold and dust from dilapidated buildings. Unless these things begin to be addressed, there is no way for the poor to begin of their own volition to live healthier lives.

    This is not simply an issue of health care, but of meeting the needs of the poor on many levels. The people the media show who are receiving Medicaid, and Food Stamps, and who live in public housing, and who choose to continue living this life because it is easy, represent very few of the people who are actually receiving government aid. But we are shown those people, because they are easier to blame for their station in life, and easier to penalize with cut-backs and punitive stipulations, and thus it is easier to leave these systems as they are.

  12. Casey, in order to address the problems of those whom we both might agree are truly victims, we have two basic choices. We can A) provide assistance to all comers, irrespective of the degree to which their illness was due to their own irresponsible actions, or we can B) limit assistance to those we deem to be worthy of our assistance, i.e., those who became ill despite their best efforts to maintain a healthy lifestyle.

    Both options have their share of problems. Option A will necessarily cost substantially more than option B and affordability of any solution will necessarily be a major issue in gaining acceptance of any plan. Not only will you have to cover substantially more people, but you’ll be sending a message that people needn’t bother maintaining their health because “the other guys” will pick up the tab if you get sick. Bot these factors will add to the ultimate cost and, it can be argued, the latter actually causes more people to become ill.

    Option A requires that someone must determine whether an illness is due to the patient’s irresponsibility or is simply bad luck, genes or some other factor beyond his/her control This could be done on an individual basis, such that special circumstances could be considered. Or it could by done through systematic rules of eligibility. The former would be more expensive and open to charges of arbitrariness. The latter would inevitable result in some denials of service that were unreasonable. A hybrid approach would likely be best, something that had defined standards but allowed for appeals, similar to the approach used for certain HMO procedures.

    But to address your concern about my dispassionate analysis, which fails to consider the challenges of the real people involved, let me relate a story from my experience. My ex-wife’s second husband (of four) received TWO heart transplants, paid for either by Medicaid or the hospital (not sure which). They were made necessary by his cocaine habit (oops, another illness in the minds of many, deserving of free treatment). Somehow he was able to shelter enough of his assets that my step-children were able to walk away with $60K while the state or other patients at his hospital had to eat the $200K cost of his transplants. That bothers me, especially when I think of the true victims whom you describe and whom I would classify as significantly more deserving.

    So what do we do with a cocaine addict having a life-threatening illness and unable to pay for treatment? I’d draw the line at paying for his funeral. And I could sleep at night knowing that a slew of innocent children would be receiving affordable health care as a result of his sacrifice.

    I think you raise some important points about the difficulty in determining responsibility. However, I think it’s equally important to give it a shot, rather than take the easier, compassionate-but-not-fair approach of simply doling out care to all comers. When you give care to all comers, I (the guy who’s footing the bill) am making sacrifices for some irresponsible dude who’s unwilling to make sacrifices himself. That’s inherently unfair.

    I’m off ’til next week but would be happy to continue this discussion when I return.

  13. In reviewing my post (above), I thought I might clarify a point and also correct out one of my many typos (“Option A” in the third paragraph should be Option B).

    In an earlier post, I stated, “I wouldn’t presume to deny ANYONE life-saving treatment.” and in this most recent post suggested that I’d only be willing to pay for the cocaine user’s funeral (and that only for public health reasons). I’m not in favor of allowing cocaine users access to medical care, providing they can pay for it themselves or solicit donations from those who think that responsible behavior is asking too much of people. Absent funds to pay for care, it wouldn’t bother me if they died in the street; I’d just drive around them. In other words, I don’t support a system that will require me to subsidize irresponsible behavior. I felt that way when our welfare program used to allow people to retire at age 22 at my expense, requiring that I delay my retirement to pay for it. And I feel the same way about our health care system. I’m already having to pay higher insurance premiums because our system requires providing free care for people having no legal right to be in this country. It’s compassion run amok.

    If, as you maintain, “it’s society’s moral obligation to provide health care to every individual”, then I think you and any other similarly willing citizen should be allowed to pay for it. But when you ascribe a moral obligation to society, why isn’t it equally appropriate to expect some moral obligations from individual citizens? You’re endorsing an entitlement mentality that the self-indulgent, irresponsible and lazy elements of society will happily accept. And you’re simultaneously saddling the hard-working, self-sacrificing folks with the bill. It doesn’t take a close reading of B. F. Skinner’s work to predict how this will influence behavior.

  14. Oops, one more typo: I should have said, “I’m not AGAINST allowing cocaine users access to medical care…”

    I knew I shouldn’t have written these posts after the cocktail hour…

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