Obama Care and Ethics

The big news, or the lack of it, last week was the Health Care Summit. The big news because it was discussed ad infinitum in every news or opinion venue. The lack of big news because it seems that, despite our tentative hopes, no miracles emerged from the summit. I began thinking about the ethical issues related to health care, why this has become such a big issue, why it is and promises to affect so many people. Here are my thoughts.

First of all, we are promised the freedom to “life, liberty, and the pursuit of happiness,” and clearly we consider these rights to be equivalent to ethical mandates. Health, and therefore, health care, is clearly related to all three of these mandates. And I don’t think any of us would argue that we have an ethical responsibility to ensure that people’s health is attended to. After all, our higher moral sentiments are clearly aroused when we see pictures of starving or ill children from less advantaged countries. We hardly want our children or parents or other family members to be writhing in pain from some treatable problem or disease merely because they have no health insurance or are unable to pay for the health care they need. We hardly want anyone we know to die of a stroke for the “lack of a $6 prescription to high blood pressure medication,” to quote a doctor speaking during the Clinton health care debates.

Second, some people are very clearly disadvantaged when it comes to access to health care, and, as a result, find their health and happiness, and even their ability to work, at risk. Some may be unemployed and not have money to pay for health insurance or health care. If they have access to a government supplemented plan (Medicaid), they may not have access to the best that health care has to offer. If they do not have a car, accessing this health care may be difficult. Other people may be self-employed; and again, insurance and/or health care may be beyond their reach financially. Still others may work for small businesses, that may have difficulty providing health coverage for their employees. And finally, anyone may be denied health care because of their inability to pay for it, or denied health insurance coverage if they have preexisting conditions that threaten the profitability of the insurance company. If we believe that health care is a moral obligation, then we have to find some answers to these problems. We don’t worry about the wealthy because they can pay for whatever they can find. We worry about the middle class and lower income folks who can’t. And our worries are called humanity. They are about caring. They are about sensitivity to need. And, of course, given that most of the country is middle or lower class, these worries may also be about our self-interest.

Third, in a free market economy – which most argue is best for our citizens – we believe that people have the right to make a living (part of those freedoms above), and this clearly includes doctors and hospitals and those who run insurance companies and medical/pharmaceutical research companies. If these medically-associated businesses can’t make a living or a profit, if they can’t pay their employees, sooner or later, they will have to stop providing care or go out of business. They suffer, and we lose out on their services or what they might produce or create.

Relatedly, emergencies or crises create a greater sense of need than ongoing health maintenance or prevention, and so, marketing and profits being what they are, it is sometimes difficult to persuade the general public to take care of their health or to pay for prevention. And so the medical culture in our country has become overly focused on problems and medication, and under-focused on self-care, prevention, and health promotion. The crises and emergencies also bring in more money for health care providers and cost more for insurers. The ethical question becomes, how much profit do they have the right to make? On the backs of whom? What is fair? How much disparity in benefits and income will we tolerate between the heads of these companies and the disadvantaged who are in need of services before a revolution breaks out? History points to revolutions that broke out in the face of vast disparity.

Fourth, much of government exists to take care of “externalities,” that is, those services that benefit us and are often times needed for society to function well, but are not profitable for businesses to invest in (ie., roads, bridges, the military). And we are taxed in order to spread the burden of these societal needs among all that benefit from them. Health care for those who are disadvantaged in some way, or whose health problems challenge the ability of the health care industry to make a profit, is clearly one of those externalities.

But therein lies the rub – most Americans are not aware of these larger pictures; instead, they hold onto only a myopic view of “what’s good for us and ours.” In addition, we have to work out our differences with regard to what we think government needs to take care of and how much tax we can afford to pay without discouraging the free enterprise that creates our country’s standard of living. This additional need requires that we have some understanding of our political system and that we take the responsibility to vote or to otherwise voice our values. Unfortunately, I think it is pretty clear that many people in our society don’t have a grasp of the larger picture, nor do they understand the need or the ways to participate in resolving society-wide problems. A certain level of consciousness, of responsibility, of awareness of our connectedness is necessary to enable the larger view and to motivate action.

We are all pretty good at knowing when the system is failing us, or when it feels unfair to us, or when too many people that we know or come into contact with are suffering. And this awareness brings moral outrage to our lips when doctors charge so much money, or when insurance companies deny our claims or deny us coverage, or when insurance or pharmaceutical companies are making such large profits. If we can lift our vision above our own or our family’s health, we also don’t want people that we know and care about to be denied essential services. We don’t think it is fair that people who are wealthy get that new heart they need, while those who are middle class or below can’t afford basic medical care.

So, what are the ethical issues? The health care debate has brought forth questions about fairness, about caring, about inequities, about responsibility. It is about how money impacts choices (for instance whether the best quality care is provided, or whether prevention is fully funded to prevent medical crises), and whether those choices take into consideration what is the best for the long run, rather than only the short run. It is about whether everyone gets a fair and equal vote on decisions to be made, rather than “money doing the talking” and the financially disadvantaged having little voice. It is about how to have respectful, responsible, even-handed dialogue about important issues, rather than disparaging other people and ideas. What will you do related to the health care debate that takes into consideration these ethical issues?

Remaking America (March 2009)

Perhaps I am a little late with this blog about the inaugural address. But it still rings through my heart, and is resuscitated each time I receive an email or video from the Obama machine. I can only hope that you too were encouraged and enlivened and inspired by Obama's call to "remake America." And did you notice his call to character as central to this effort, that he rejected the false "choice between our safety and our ideals." Did you notice his call for justice, hope, virtue, humility, restraint, and depending on the "force of our example." He urged us to return to the truths upon which our success has always depended: honesty, courage, fair play, tolerance, curiosity, loyalty, patriotism, faith, determination, selflessness. I have rarely heard values and ideals ring so centrally in a politician's speech.

Obama urged us to return to the "ideals of our forbears," the ideals and virtues that shaped our country, the ideals that kept the country's founders struggling and sacrificing and working "'til their hands were raw so that we might live a better life." "Those ideals still light the world and we will not give them up for expedience sake," he said. "Greatness is never a given. It must be earned." The "journey has never been one of shortcuts or settling for less. It has not been the path for the faint-hearted" or the lazy or the greedy. He urged us to give our "all to a difficult task" "brave once more the icy currents and endure what storms may come." He pointed to the courage that would be necessary for the journey to greatness, including the courage to make "unpleasant decisions."

Obama also stressed the strength of our "patchwork heritage" and the need to cooperate and value diverse points of view and talents, because America is "bigger than the sum of our individual ambitions; greater than all the differences of birth or wealth or faction." We must strive for "common purpose and humanity" and offer "opportunity for every willing heart . . . because it is the surest route to our common good." We need to choose "hope over fear, unity of purpose over conflict and discord," and to end "petty grievances and false promises." We aim to "move beyond narrow interests," and to use "imagination" to surmount the "stale political arguments that have consumed us for so long."

And Obama refused to settle for caring for ourselves at the expense of others. He pointed out the need to reach out to those less fortunate: "we can no longer afford indifference to the suffering outside our borders, nor can we consume the world's resources without regard to effect." We must "embody the spirit of service: a willingness to find meaning in something greater than" ourselves. And by doing so, we will carry "forth that gift of freedom and deliver it safely to future generations."

Whatever our politics, can we really disagree with these aims? Perhaps we don't know how it will be done yet. Perhaps some will point to the unrealistic nature of these lofty ideals. But without the light shining in front of us, without pushing ourselves to the limit, without inspiring everyone to take part in "remaking America, how will we have the courage or strength to keep going for the long haul, to reach for the best, to make the optimal a reality? Wouldn't you rather live in a world that held these values central? Wouldn't you rather work with people whose aspirations rise above the drudge? Wouldn't you rather live in a neighborhood in which a focus on such ideas draws you together in a common effort? Aren't you more inspired by Obama's vision than you have been by any other in a long time? I certainly am.

Our Better Angels (January 2009)

What a tremendous moment in history!! -- Martin Luther King's birthday falling one day before his success is demonstrated in the inauguration of Barack Obama, Black people and members of other historically oppressed groups traveling to Washington D.C. to celebrate a victory over oppression, and Obama taking up Martin Luther King's "torch" for service. I have always voted in the presidential elections, but rarely have I believed my vote for the presidency was anything more than voting for the lesser of two evils. Not this time! History is being made, and as a result of Obama's use of emails and the internet to include all of us, we can claim ownership in the history that is being made. We are part of it. And Obama shares the victory, telling us that we made it happen.

Obama also appeals to all of us to participate in solving the problems that America faces, claiming that it cannot be done without all of us taking part. Republican or Democrat, no one can argue the need for all of us to reach out in service to create better communities. No one can argue the need for ethics and character to infiltrate business and government, to lead people and organizations toward a higher good, to be the "fore" thought, rather than the after thought. No one can argue the need for parents and other adults to "teach the children well," to raise them to be people of character, to serve as role models, so that the next generation will inherit a better world, a safe world, an environmentally livable world.

And so, when Obama says, What's required is...an appeal not to our easy instincts, but to our better angels," we are inspired to think about what's best, not what's easiest, to consider the paths of angels (or what they represent) rather than the opposite, to become active, rather than reactive or complacent. No longer should we apologize for living "the good" (as in good character) life, for loving "the good," and for advocating that everyone around us pursue "the good." Of course, what is "good" or best is not always easy to decide. But that doesn't let us off the hook for choosing "the good" when it is apparent, for aiming for what is best in each situation we encounter.

So, what will be your first step? What is the good you will to pursue this week? We get to choose and act. No one else imposes this on us. My choice is to more consistently speak kindly and gently to friends and family members. What will your choice be?