Paternalism and Health: Some diseases such as Alzheimer's inhibit our abilities to make decisions and lessen our quality of life.
What is it
Do we have a right to healthcare, and to good high quality healthcare, in any precise and defensible sense? Or is the "right to healthcare" just a nice way to say it would be very nice if everyone had healthcare? John and Ken take a philosophical lens to the alleged right to healthcare and health insurance with Laurence Baker from the Center for Health Policy at Stanford University.
Despite the title of today’s show, neither John nor Ken believe healthcare to be a constitutionally guaranteed right. Yet, Ken believes, the title helps to frame the issue of entitlement: Given that our society is rich, healthcare is widely available, supported in many ways by our taxes already, shouldn’t everyone be guaranteed at least basic healthcare? The current healthcare bill before congress is not a revolutionary change, but an amendment to the current system. The main change is that, while everyone can be treated without paying cash out of hand, we all also will have a duty to buy insurance. But, as John points out, this duty leads us to an entitlement—for it would be an immoral compulsion if one could not afford health insurance. Thus, the government must pair that duty with a way to provide affordable insurance. But the debate is far from straight-forward, for, even if we are entitled to a certain “basic” healthcare, what level of healthcare should that be?
Laurence Baker joins the conversation, pointing out that our current system has great strengths in addition to great weaknesses. Our system has been incredibly innovative, providing very advanced healthcare to a large swath of our population. But, at the same time, many are left without insurance, unable to pay for even basic care. He also points out that the inherent quirkiness of our system is largely due to historical accidents. For example, the current employer-employee mode of insurance was stumbled onto during World War II, in which economic policies were introduced to encourage employment during the war.
Ken points out that the healthcare debate brings up some genuine issues about the nature of class in this nation. Most Americans would agree that richer people ought to have more privileges than poorer, such as larger houses, more cars, etc. Yet healthcare feels somewhat different from these luxury goods. Laurence comments that one way to think about the debate is that healthcare can be similarly divided into certain categories, basic goods that everyone deserves access to and luxury goods that one ought to have to elect to pay for. Some treatments may be easy to put in one category or the other. Antibiotics seem pretty basic, whereas Botox is clearly a luxury good. But certain expensive, exploratory treatments can be difficult to deny individuals in practice, although the economics of care might dictate that they cannot be offered to everyone in the system.
- Roving Philosophical Reporter (seek to 5:40): Zoe Corneli interviews someone who has neither the right nor the privilege of healthcare. Michael always felt that health insurance was important, but, as a part-time worker in Portland, he simply could not afford private insurance. As an Oregon resident making below $9000, Mike was able to get insurance through the Oregon health plan. But when his part-time jobs began paying slightly more, Mike felt he was forced to lie about his income in order to remain on the plan.
- Philosophical Conundrum (seek to 42:25): Brian is a well-meaning neighbor of an elderly lady, and (through a benign accident) he has come into possession of a very personal page of her diary, one in which she expresses some deeply emotional feelings about the death of her mother. What should he do? John feels that he should avoid the possibly traumatic confrontation by discreetly returning it without her knowledge. Ken disagrees, exhorting Brian to show some moral courage by returning the letter to his neighbor’s face.