(originally written on January 16, 2017, still relevant today)
I have been meaning to write this for a while now, first as the Affordable Care Act (ACA) was originally being debated, then again as some in congress were trying to change or disrupt the ACA soon after it was passed, and now again as a new administration provides those against universal healthcare with the support necessary to destroy one of the most significant changes in healthcare policy in the US.
The arguments often brought against the ACA, and universal healthcare in general, are both moral and economic in nature. The moral arguments generally object to the federal government telling people what to do, even if it is good for them. The economic argument is that the burden placed on our economy by healthcare expenses will bankrupt the country.
Healthcare in economic terms
I will come back to the morality of healthcare policy, but for now let’s explore the economic argument. This argument has been made throughout the history of civilization. As I was growing up I often heard that in certain Russian villages, old people were euthanized by their family as soon as they were unable to go work the field. A similar anecdote was related to me about the special meaning of the 60th birthday in Asian cultures — the claim being that the elderly left the home after that age so as not to burden their families. Whether or not these anecdotes are true (and most likely they are not), the fact that they exist highlights our own ingrained belief that economic arguments can and should guide end of life decisions.
This concept struck me the most when reading the Voyage of the Beagle by Charles Darwin. When describing the native people of Tierra del Fuego, Darwin relates: The different tribes when at war are cannibals. From the concurrent, but quite independent evidence of the boy taken by Mr. Low, and of Jemmy Button, it is certainly true, that when pressed in winter by hunger, they kill and devour their old women before they kill their dogs: the boy, being asked by Mr. Low why they did this, answered, “Doggies catch otters, old women no.” This boy described the manner in which they are killed by being held over smoke and thus choked; he imitated their screams as a joke, and described the parts of their bodies which are considered best to eat. Horrid as such a death by the hands of their friends and relatives must be, the fears of the old women, when hunger begins to press, are more painful to think of; we are told that they then often run away into the mountains, but that they are pursued by the men and brought back to the slaughter-house at their own firesides!
This disturbing account is the epitome of economic arguments related to health care. The death of elderly women is justified as otherwise the tribe’s livelihood and existence would be at stake. Someone will die, so it may as well be those who contribute the least to the economic life of the tribe.
Let us take the same reasoning to today’s world, the same way as the opponents of the ACA and universal healthcare do. In economic terms everything is assigned a value, then these values are clinically analyzed to decide the optimal strategy. To do so we must assign monetary values to human lives — only then will we be able to know when it is worth protecting, prolonging, or ending one’s life. As long as the economic value produced by a person outweighs the cost of keeping them alive, all’s good. Otherwise, the logical solution is to terminate the under-performing entity. In this zero sum game that is proposed to us under moral and economic terms, we’d rationally choose to keep a CEO alive but not a janitor, we’d choose a man over a woman (the latter make less money so they must be less valuable), and a white man over a black man (again, we’ve assigned a value as demonstrated by the wage gap between the races).
I feel sick just writing these words, especially knowing that some half of the US population (if not more) implicitly agrees with them. Yet these arguments are based on a flawed premise — that the cost of healthcare is bankrupting our economy and threatening our own lives. After all, the tribes in Tierra del Fuego made their gruesome choice because their life was threatened otherwise. Is this truly the case in the 21st Century USA? Is there really nothing else we would give up to save one or more lives? We pay athletes and their coaches tens to hundreds of millions of dollars even though they only give us entertainment. Is a caught pass truly worth the life of a child? We pay hundreds of dollars for “smart” phones that can barely make a phone call, and hundreds more for TV screens that can cover a whole wall. We pay thousands of dollars each year for the privilege of finding out if one can truly find sex in the city. Is that worth the life of child in rural West Virginia, or inner city Washington, DC, or sub-Saharan Africa? When we say that universal healthcare is an economic issue, we implicitly argue that our entertainment is more valuable than life. And that’s a moral question, not an economic one.
The morality of healthcare
The moral arguments against universal healthcare are on an equally shaky ground as the economic arguments outlined above. The most common objection is that the federal government, and actually any government at all, does not have the right to force us to do anything we do not want to do. This argument invalidates all rule of law, and vacates the need for any government at all, yet those who subscribe to it are more than eager to avail themselves of government services — from roads, to telecommunication, to police, and ultimately healthcare and education.
Many of the opponents of universal healthcare also support the sanctity of life by opposing the right of women to make reproductive choices, yet are comfortable with the lives lost due to the lack of universal healthcare. Many of the pro-life advocates are even supporters of the death penalty. The hard and fast moral stances, frequently derived from the immutable teachings of one of the three major religions originating in the Middle East, are quite fluid when push comes to shove. All animals are equal but some animals are more equal than others — Orwell had stated so presciently.
In the end, what makes us human is a respect for human life. This respect is enshrined in most of the world’s religions, and the taking of another human’s life is seen in most cultures as one of the ultimate sins. In this context, the only moral stance one can take is to support universal healthcare, allowing all, irrespective of income, gender, or race, access to affordable and effective care, and treating all lives as equally important.