SOC 120 Introduction to Ethics & Social Responsibility
Many countries around the world, including our neighbors to the North, Canada, have implemented some form of universal health care. In fact, the United States is one of few developed countries not currently offering some form of government funded, universal health system. Nearly the entire developed world offers universal health care, from Europe to the Asian powerhouses to South America's southern cone to the Anglophone states of Australia, New Zealand, and Canada. The only un-developed outliers are a few still-troubled Balkan states, the Soviet-style autocracy of Belarus, and the United States, the “richest” nation in the world. (Fisher, 2012) Universal health care has been a much debated topic in the United States recently, due to the health care bill that was passed in May of 2010. As I explore this heated topic, using the tenants of utilitarianism theory, contrasted with the perspective of emotivism, proving that health care could be viewed by many as a right or a privilege, even if I believe it is a privilege. For instance, let us explore further, the current bill; nicknamed "Obama care," the official name for "Obama care" is the Patient Protection and the Affordable Care Act. This bill was signed into law to reform the health care industry, which promises many things in its attempt to provide universal health care ("Obama care facts: facts," 2013). Most notably, this bill offers government mandated insurance requiring individuals to purchase health insurance. It also offers a government-funded "exchange" to better assist people in purchasing insurance through private companies. Additionally, the government will offer assistance to families, whose income is equal to or less than 400 percent of the poverty line, by subsidizing health insurance. While there are many other inclusions in the bill, such as government regulation of the health care industry, improved care and increased guidelines, the main points of contention revolves around the idea of mandated insurance. (Soper, 2011) Health policy experts say guaranteeing coverage for all Americans may cost about $1.5 trillion over the next decade. That would be more than double the $634 billion 'down payment' President Barack Obama set aside for health reform in his budget. About 48 million people are uninsured, and the problem is only expected to get worse because the cost of coverage keeps rising. Still, administration officials have pointedly avoided providing a ballpark estimate for Obama's fix, saying it depends on details to be worked out with Congress. ("Universal health care," 2009) The potential for runaway costs is a rising concern among Republicans, and some Democrats, as Congress prepares to draft next year's budget. The U.S. spends $2.4 trillion a year on health care, more than any other advanced country. And some experts estimate that a third or more of that goes for tests and procedures, rather than prevention and treatment. ("Universal health care," 2009) However, the health care plan Obama offered, while in his recent candidacy, would have cost nearly $1.2 trillion over ten years. This statistic is according to a detailed estimate last fall by the Lewin Group, a leading consulting and policy analysis firm. The campaign plan would not have covered all the uninsured, as most Democrats in Congress want to do. But that $1.2 trillion is still merely a starting point for lawmakers. ("Universal health care," 2009) John Sheils, a senior vice president of the Lewin Group, said about $1.5 trillion to $1.7 trillion would be a credible estimate for a plan that commits the nation to covering all its citizens. That would amount to around 4 percent of projected health care costs over the next 10 years, he added. The cost of covering the uninsured is "a difficult hurdle to get over," Sheils said in an interview."I don't know where the rest of the money is going to come from," he added. The overall cost matters because the expansion of health coverage is meant to be a permanent reform. That means future generations will have to bear the cost. ("Universal health care," 2009) Using the view of Utilitarianism, the fundamental principle that one should choose to do that which produces a better outcome for the largest number of people (Mosser, 2010), it is easy to call “Obama care” a huge step in the right direction for the greater good. More people in the United States do not have health insurance than those that do have it. Utilitarianism would say that universal health care is an improvement on previous laws and serves to increase the sum total happiness and welfare of the majority in the state. Previously, the United States' government did not require insurance companies to justify price increases, allowing private companies to exploit consumers and charge exorbitant premiums for insurance policies. With this new law, the government will be implementing its "exchange" option, subsidizing health insurance for some, as well as requiring insurance companies to publicly announce and defend any increases to premiums of more than 10 percent. This should provide more insight into a company's actions, resulting in lower prices and an increase in the quality of health insurance providers. Not only will "Obama care" help decrease prices, but it will also provide more widespread and available health care and Medicare to those who previously could not afford it. If more people have access to health insurance then more people will be able to receive regular health care which will increase happiness as well as utility. Utilitarianism would say this is the best course of action for our country (Soper, 2011) Utilitarianism would resolve the problem of health care. Everyone would buy into the idea of health care because everyone would adopt this view. However, it is important to note that, even if the right to health care is accepted, there are still many issues with making health care a right, not a privilege. When it is a right, everyone gets to have it, which means companies would be servicing individuals it may not have the capacity to serve. In fact, it would be literally impossible to provide the highest level of medical care and range of procedures to every citizen. This will leave the advocate who is providing medical services to everyone, with one glaring question: what level of health care are the hospitals going to provide? There would have to be a decent minimum, and it is very hard to define what that would look like. When healthcare is viewed as privilege, as it is right now, there is a certain, high level of care expected by those who work hard to pay for their health coverage. This expectation, and the use of the supply versus demand principle, can also argue that giving coverage to everyone lowers the quality of the supply of care. Health care is an unethical system (Alaback & Brewer, 2010). Under the coverage of current health care, people still often suffer needlessly. Often, health care companies will refuse care, until the patient has a referral from another doctor, delaying the rapidity of care. The flaws in the current system are the result of inefficiency or high fees paid to doctors. The context of our health care system includes a budget with enormous allocations for defense, bailouts for the savings and loan industry, and other kinds of payments which dwarf the allocations for actual health care. The savings and loan crisis of the 1980s and 1990s (commonly dubbed the S&L crisis) was the failure of about 747 out of the 3,234 savings and loan associations in the United States. A savings and loan or "thrift" is a financial institution that accepts savings deposits and makes mortgage, car and other personal loans to individual members. As of December 31, 1995, RTC estimated that the total cost for resolving the 747 failed institutions was $87.9 billion. The remainder of the bailout was paid for by charges on saving and loan accounts—which contributed to the large budget deficits of the early 1990s. ("Financial audit: resolution," 1996) Given that arguments can obviously be made to both sides of the argument, right versus privilege, I will weigh in on my personal belief on the issue. I believe that a “right” to healthcare stems from a generational bent of "entitlement". Entitlement rights are necessarily limited by a society's willingness and ability to provide the entitlement. In other words, entitlement depends on a society's resources and the choices it makes about how those resources are used. Personally, I believe our country has the resources to provide health care for all, but I believe people need to be contributing members of our society in order to receive health care. I do not think that it should be available to those individuals who do not work and take advantage of government assistance. In my personal opinion, I do not believe health care will solve the “wants” of the people. If you give them an inch of assistance, they will take a mile. Desiring universal health care or other universal assistance is based on the concept of Emotivism. Emotivism offers a perspective on our ethical claims that eliminates much of the traditional kind of argument based on reason. Emotivism, instead, sees our moral evaluations (whether something is good or not) as simply the expression of whether we respond to a given act by liking it, or not liking it. Furthermore, emotivism says that something is good, if it is something about which we feel good; something is wrong if it is something about which we feel bad. (Mosser, 2010) I think that people’s stance on health care will change once they actually see what is going to happen. Right now, it sounds great to Americans, but what they do not know is the amount of money it is going to take to fund “Obama care”. Once people realize that “Obama care” is not going to help the poor, I am sure they will change their stance on this issue, unless they are very ignorant. Here is how ‘Obama care” is going to work. For individuals, several groups are exempt from the requirement to obtain coverage or pay the penalty, including: people who would have to pay more than 8% of their income for health insurance, people with incomes below the threshold required for filing taxes (in 2009, $9,350 for a single person and $26,000 for a married couple with two children), those who qualify for religious exemptions, undocumented immigrants, people who are incarcerated, and members of Indian tribes. The penalty for people who forego insurance is the greater of two amounts: a specified percentage of income or a specified dollar amount. The percentages of income are phased in over time at 1% in 2014, 2% in 2015, and 2.5% starting in 2016. The dollar amounts are also phased in at $95 in 2014, $325 in 2015, and $695 beginning in 2016 (with annual increases after that). ("Obama care - the," 2012) Let’s take this a step further. Let’s say we have a couple with two children. The husband and wife both work, and their combined income is $100,000/year. Their employers make a business decision to drop their insurance coverage. If they want insurance, they turn to the state Exchange. Using a calculator, their annual premium is $12,130, (12.13% of their income) of which the government will subsidize $0, since they are 427% above the poverty level. While Obama care does not require you to purchase or pay a penalty if the premium is above 8% of your annual income, the family still has to pay if they want health insurance. ("Obama care - the," 2012) Recent research by McKinsey and Company, “How US Health Care Reform will Affect Employee Benefits“ indicates that the Obama care subsidy will encourage companies to re-evaluate and potentially drop their employer-sponsored insurance (ESI). The Congressional Budget Office originally estimated the number of employers dropping coverage at 7%; McKinsey’s number is at 30% or more. The survey found, however, that 45 to 50 percent of employers say they will definitely or probably pursue alternatives to ESI in the years after 2014. Those alternatives include dropping coverage, offering it through a defined-contribution model, or in effect offering it only to certain employees. More than 30 percent of employers overall and 28 percent of large ones, say they will definitely or probably drop coverage after 2014. ("Obama care - the," 2012) Obama care will also fundamentally alter our choices in how much we are allowed to spend on healthcare for ourselves and family members. One of the most contentious pieces of the legislation is the Independent Payment Advisory Board (IPAB), which has been termed “death panels” by many. This is because Obama care targets the senior population. This group of regulators “is directed, starting in 2015 and every two years thereafter, to make recommendations to limit the ability of Americans to put resources into healthcare so that they stay below certain goals set forth in the legislation.” IPAB sets a price cap, a dollar amount beyond which Americans cannot pay for care. ("Obama care - the," 2012) If I had to choose, I would have to say I relate to emotivism. As of right now, I do not think Obama Care is going to be good for America. I think it is “wrong” because I work very hard for my health coverage. I also believe it is just one more step in the direction of a Socialist state. Socialism is a theory or system of social organization that advocates the vesting of the ownership and control of the means of production and distribution, of capital, land, etc., in the community as a whole ("Socialism,"). Therefore, I do believe that health care is a privilege for those that have worked hard to be able to afford it. If Americans were willing to work hard for their healthcare, then they would not have to rely on the government to provide it. Personally, I have been on both sides of the fence. I went almost 10 years without health care, but I never thought that tax payers should have to pay for me to be able to go to the doctor on a regular basis. Therefore, having explored utilitarianism and emotivism, as they relate to solving the healthcare problem, I believe both arguments could be correct. Even though, I believe health care is a privilege.
Alaback, P., & Brewer, C. (2010, March 10). Health care: current system is unethical. Retrieved from http://missoulian.com/news/opinion/mailbag/article_667358ea-38ec-11df-a468-001cc4c002e0.html Financial audit: resolution trust corporation's 1995 and 1994 financial statements. (1996, July). Retrieved from http://www.gao.gov/archive/1996/ai96123.pdf Fisher, M. (2012, June 28). Here's a map of countries that provide universal health care (america's