There is considerable consternation on the political left these days over whether Barack Obama failed to make a moral case for his signature health legislation. See Ted Marmor (gated), writing in the Journal of Health Politics, Policy and Law, Austin Frakt’s responses here and here and other views here and here.
I’m sure many readers are astonished that the question is even asked.
After all, how can there be a moral case for a 2,700 page bill that was shaped and molded by self-seeking interests, with no more regard for principle than one would find in a game of musical chairs? Isn’t asking for a moral defense of ObamaCare sort of like asking what is the moral case for the IRS Code?
Even if you believe that some of us have a moral obligation to others in the matter of health care, what does that belief have to do with legislation in which costs and benefits are strewn about with all the care of a drunken sailor? Isn’t the Affordable Care Act (ACA) self-evidently immoral? Or at least amoral?
I generally try to avoid ethical discussions with my friends on the left for two reasons. First, with respect to actual legislation they seem incapable of distinguishing what really happened from their ideal vision of what should have happened. More fundamentally, I find that people on the left seem incapable of thinking rationally about the ethics of public policy.
I realize that’s harsh. But it’s true!
Take the first issue. Ted Marmor thinks that the most important ethical justification for ObamaCare is that it provides “affordable health care for every American.”
Here’s the problem: Nowhere in the ACA is there any guarantee at all that health care will be affordable. More importantly, there is no guarantee that it will be accessible. And if it’s not accessible, that means that millions will find that alternative avenues for seeking care are unaffordable. As I have argued before, it is very likely that we will spend close to $1 trillion over the next 10 years and leave the poorest and most vulnerable segments of our population with less access to care than they would have had without any reform at all.
Even if we agree with Marmor that everyone should have access to affordable care, that couldn’t possible justify the Affordable Care Act. Almost everybody already has access to affordable care! At last count, there were about 22,000 Americans with serious health problems who could not obtain health insurance because of a pre-existing condition. (See here and here.) The ACA has solved their problems by providing good coverage for the same premium healthy people pay. While this change is no doubt very important to the people affected, it is relatively trivial in the great scheme of things.
What cries out for moral justification are the mandates and regulations being forced on the other 300 million people. Why are they being forced to pay more, or allowed to pay less, than the true cost of their insurance? What moral principle can justify that?
Search the world’s ethical codes and you will have a hard time finding any that are consistent with a health reform that:
- Gives people in health insurance exchanges up to 10 times as much federal subsidy as people at the same income level getting insurance at work.
- Forces young people to pay two or three times the real cost of their insurance in order to subsidize older people who have more income and more assets.
- Takes from low-income seniors in order to provide subsidized health insurance for non-seniors who have higher incomes.
- Takes from people who use tanning salons and people who need crutches and wheelchairs and pacemakers and gives to … well …. who knows?
Then there is the second issue. What does it mean to think rationally about the ethical foundations of public policy? It means beginning with the moral principles governing individual behavior (What do I owe you? What do you owe me?) and then deriving the implications for a proper political relationship.
Think of the long line of thinkers on the “right” (Locke, Nozick, Epstein, etc.) who have contributed to a rich literature defining, defending and promoting property rights, freedom of exchange and freedom of contract. Add to that the great body of work we call the “common law.” It is almost exclusively focused on who owes what to whom, given that we are all equal before the law and each of us has a right to pursue his own interests.
I know of nothing on the “left” that even begins to approach this level of seriousness.
Some might point to John Rawls and his theory of justice. Because of a quirky assumption, Rawls concludes that a just society is one organized to maximize the wellbeing of the least well off. As an economist, I can assure you that doesn’t mean socialism. In fact, if you consider the least well off indefinitely into the future (and it’s impossible to justify excluding them), Rawls’ theory implies an extreme form of capitalism — one that maximizes economic growth. Minus the quirky assumption, Rawls’ theory implies garden variety utilitarianism of the type embedded in neoclassical welfare economics.
In saying that the political left is virtually bankrupt when it comes to connecting personal ethics to public policy, I invite readers to prove me wrong. Show me a leftwing treatise on ethics that tells me what I owe, to whom I owe it, why I owe it, and why government should enforce the transfer. Who knows, if the treatise is convincing, I might just pay up voluntarily.
But I don’t think you can find such a work.
Bottom line: when it comes to the ethical foundations of public policy, on the left there is just no there, there.