Friday, September 4, 2009

A moral issue or an economic one

This afternoon, one of my favorite local public radio talk shows had two guests talking about the advantages of a single payer system and the moral issues that accompany a discussion of health care reform.  I've commented a few times on single payer system options before.  Today I'll focus a bit more on the moral issue.  Here is an interesting question that was posed: is health care reform a moral issue or an economic issue? 

My answer: it is both.

If we try to deal with it only as an economic issue, we must ask what the objective is?  Profits for hostpials, physicians, and insurers?  Maximizing the health of the population (whatever that means) within a budget?  Providing a given level of health at a minimum cost?  There are many differnt possible objectives.  They invarialby have to do with money.

If we try to deal with it as a moral issue we can talk about who should have access?  If everyone has access, to what should they be given access?  Does everyone get the same access?  Should people be allowed to "buy their way to better access"?  These are interesting questions. 

I think it is both because we ultimately can make the moral focus points at least part of the objective but then decide how to get to that objective within the limits we have.  Let's try an example.  Maybe the goal is to give everyone at least minimal access.  If we adopt that as the objective we ultimately come to the economic question: how much is our society willing to spend on health care.  We can't provide all the care that everyone might want without choosing not to do some other things as a society.  We have to have limits.  The limits may be more than a lot of people are getting right now, but we have to make that decision as a society.

There has been a posting on Facebook the past few days " one should die because they cannot afford health care, and nobody should go broke because they get sick."  This is a wonderful goal at the individual level.  However, if we go to a system with more government influence (and there is already plenty of government influence) we will have to decide what care society can afford and at what point our entire economy might go "broke".  Ultimately, there will be people in the population who die becuase there are things that society as a whole cannot proivde and there is a risk to the economy as a whole if we do not have incentives to allocate resouces efficiently.  It is a question of the level at which we place the risk.

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