The other day I was having a conversation about health care with a friend in the labor movement. We were discussing various problems with the implementation of the Affordable Care Act, the pressures on hospitals to cut costs and the negative effects of workers those pressures create, and such things. I looked at my friend and said, “Tell me if I am wrong here, but it seems to me that all the problems we have with the delivery of health care are more or less symptoms of one core problem: We treat health care as if it were a commodity like other commodities.” He replied, "You are exactly right."
This insight of mine is not novel. Indeed, it came to me largely from my recent reading of Angus Sibley’s new book Catholic Economics: Alternatives to the Jungle which I will be reviewing at week’s end. As I shall discuss in greater depth then, Sibley thinks one of the central problems of our economic thinking today is that we treat labor like a commodity, and our economic models are all calibrated to limit costs, so labor costs are often first on the chopping block.
There were other antecedents as well, such as the recognition that when California’s legislature passed physician assisted suicide last year, it was decided that the state’s health care program for the poor, MediCal, would cover the costs of assisted suicide but it does not cover the costs of palliative care. California is a state in which Democrats, the party that is supposed to look out for the poor, control all levers of government. The state government also must seek to balance its budget. I am not suggesting that the legislature hopes that the elderly poor will start killing themselves rather than seeking labor-intensive care, but who are we kidding? Look at the way the push to legalize marijuana, whatever one thinks of the issue on the merits, is now driven by the anticipated tax revenues the sales of pot will generate.
The other item running through my mind has been the debate about health care reform between Secretary Hillary Clinton and Sen. Bernie Sanders. On the merits, Sanders is one thousand percent correct: We need a single payer system, Medicare for all, just like every other major industrialized country. But, as I have noted, citing the experience of other countries is not a moral argument and Sanders will never convince the American people, or even a majority of Democrats, with an argument that can be caricatured as “we should be more like France.” In this regard, as well as in culinary tastes, we should be more like France, but it is not a winning argument.
Sen. Sanders, and all Democrats, do assert that health care is a right not a privilege, and rights’ language does have a moral basis. But, rights’ language has been debased by the left from overuse and misuse. Its association with identity politics has produced the backlash of hostility to “political correctness.” The fact that rights’ language is never tethered to a discussion of corresponding responsibilities has not burnished its value in framing policy options or political choices. And, because too often the invocation of a right is viewed as a conversation stopper, because rights are understood as absolute, calling health care a right does little to advance a proper concern for the human dignity of the ill and the elderly, those most heavily involved in the health care system. By way of example, advocates for gun rights assert the right to bear arms as an absolute right, untethered from other social concerns, that can never be infringed. Is that helpful?
If I were working for Team Sanders, I would ask why he does not make the more fundamental, moral argument for a single payer system. It goes like this. A person can buy a big fancy, flat screen TV, or an old used TV, or even decide not to have a TV at all, depending on what they want to spend. But, when you have a heart attack, you need surgery, and no matter what you can afford to spend, you should get the best care available and, certainly, the same care that a rich person could afford. Why should a young woman have to calculate the cost of a pregnancy, and does the fact that abortion is cheap and childbirth is not, give Republicans who claim to be pro-life pause when they fight any expansion of health coverage by non-market means? When my mother was being released from the hospital after my parents’ care accident, we researched the available nursing homes – she was never going to be able to return home given the severity of her injuries – and I was shocked to see the disparity in nursing home care between those hospitals that relied mostly on Medicaid patients and those that had patients who paid out-of-pocket.
The rich will always find ways to get better care. The uber-rich will find ways to get care at home. But, really, isn’t it morally obscene that decisions of life and death are so often limited or expanded, and always controlled, by the amount of money a person has on hand?
The delivery of health care, its affordability, and how we allocate the resources our society is willing to commit to health care, all these issues will only grow in intensity in the years ahead as the baby boomers reach their twilight years. It is vital that those of us on the left side of the political spectrum avail ourselves of a more convincing moral framework, which is one reason I am so desirous of rekindling the relationship between the Catholic Church and organized labor. Both groups look at social problems with an eye towards building solidarity. Both recognize that treating everything like a commodity is wrong per se and leads to dreadful consequences. Both the Church and labor recognize that technological advances, whatever their other merits, can lead to de-humanizing consequences, indeed, that it is precisely the failure to recognize the human value of social relationships that is at the heart of what is wrong with contemporary economic thinking and, consequently, much political thinking. The left can start be asserting not only that health care is a right, but that it is not a commodity, it is a public good, essential to the common good, a key attribute of human dignity, and crafting policies that treat it differently from cars and TVs and smartphones. If our political discourse needs anything, it needs to recognize that an economic bottom line is not a moral or social or political bottom line.