Health Care: A Commodity or a Moral Issue?

Conservatives are often portrayed as thinking that health care is just like any other commodity that can be regulated by the free market.  On the other hand, liberals are described as seeing health care as a form of protection that is a moral obligation for government to provide. This characterization of conservatives is misleading.

Listen to the following conversation that took place between former President Richard Nixon and John Erlichmann:
Erlichman: Edgar Kaiser is running his Permanenente deal for profit. And the reason he can...all the incentives are toward less medical care, because...the less care they give them, the more money they make.

Nixon: Fine

Erlichman: and the incentives run the right way.

Nixon: Not bad!
In his book, The Political Mind, George Lakoff claims that conservatives generally identify positively with the above scenario--that it is okay for health insurance companies to deny coverage to claimants in order to maximize profits.  I hope that's not true.  If it's true, then I think we've had "death panels" much longer than just since Obamacare took effect.

But I don't think it's true, in two ways. First of all, I don't think conservatives view health care as a commodity that should be used by its purveyors as a way to maximize profits at the expense of the insured patient.  Secondly, I think Kaiser Permanente and Erlichman are wrong that "the less care they give them the more money they make." That attitude is a fundamental misunderstanding of the free market; for it to be and remain truly free, the market must first be moral.

Rudy Giuliani, while running for President, claimed that health care is a commodity, and that the market can regulate health care. Lakoff disagrees:
But health care is a matter of protection, not a commodity. It is a matter of pain and suffering, of life and death. Many people die, or suffer terrible pain, for lack of adequate health care. No one dies for lack of a flat-screen TV. Protection is a moral mission, for the government, but not for business.

The point, I think, at which conservatives and progressives disagree, is not whether provision of health care is a moral issue. It is whether moral issues should  be exclusively within the purview of government. I think health care is both a commodity and a moral issue, and I think most Conservatives agree with me. It is government regulation (and in some cases lack thereof) that have made it so that the large percentage of the 40 million people who want but don't have health care don't have health care.

Conservatives and progressives are more on the same sheet of music than we think. Both sides, I think, actually agree that ensuring that people have health care is a moral issue. It's just a matter of how best to solve that moral problem. I agree with most conservatives in that I don't think government can do it as well as the private sector, because, after all, our government is us. If we're not moral in private, how can we expect our government to be moral in public for us?


  1. Good article Frank. As my husband and I have paid for my own healthcare (insurance) now for 30 years I don't have a lot of sympathy for those who could buy it but don't, particularly young, healthy people. There are some very low cost health plans out there and really all many people need is a catastrophic type of policy. That is because people view health insurance as a right and not a cost or responsibility for their own health care costs. They have to buy mortgage insurance, car insurance, motorcyle insurance,business insurance and on and on. It is in many ways because of the litigious society we live in that this is so, and because we cannot afford the consequences if we have a terrible accident, or a health crisis. For those who are poor, they already receive medicaid and no one is denied health care in this country and the thing that isn't right is that I am responsible and there are many who aren't so I in effect end up paying for them. The reason I can't expect others to pay for me is that I have assets and the poor don't so one way or the other they will eventually get my money. So I have to be responsible but those who don't take responsibility are relying on me to pay for them and they have nothing to lose. Don't know the answers and apparently neither does anyone else as we can't seem to get this problem solved in a fair and equitable way. The Obama healthcare bill is chalk full of earmarks and all kinds of hidden things that no one knew about that have nothing to do with health care. So in my view, it should be repealed, we should find a way for government to work with insurance companies in a way that protects the consumer but let it remain in the private sector. Torte reform, selling across state lines, and dis allowing pre-existing conditions as a reason to charge more as for every person that have pre-existing conditions there are hundreds who don't so in reality it probably all evens out even though the insurance companies like to paint a different picture. Also, wellness incentives for those that rarely use their policies, reductions in cost for taking care of yourself with more frequent checkups, health habits, nutrition and so on. I have been blessed with very good health but continue to pay higher premiums just because, and I don't think that is fair. Also, opening up insurance pools for low cost clinics and low cost subsidies for the truly needy and doing away with medicaid. This could be done privately as well. As to medicare, it should be phased out at some point as more affordable insurance policies become available. If everyone were paying something for their policies it would create a much larger pool of revenue for insurance companies and they could pass that on to the consumer in the form of lower premiums. We need competition and we don't have it because we are required to only work with the companies within our state boundaries, it doesn't make any sense. So if government can do anything, it should be to change those things by matter of law and let the insurance companies comply or not and let those fail that continue to charge high premiums or bad policies. We have to pay for health care one way or an other and every citizen should have to contribute something, not the wealthy or middle class paying for everyone else. Of course it is the moral thing to do to take care of each other but by taking responsibility for ourselves we lessen the burden on society. Morality I believe involves accountability and responsibility so we can't say that it is just the rich who have a higher obligation to be moral than the less fortunate, it would seem to me that morality should be required of everyone. You cannot mandate compassion especially when it is only directed one way.

  2. The practical, capitalist argument for fixing health care is this:

    American companies and workers have to shoulder the burden of providing health care in an employer-based system that already costs double what the rest of the developed world pays, and costs continue to skyrocket despite the recent corporate-friendly "reform." That is an enormous self-inflicted competitive disadvantage.

  3. I speak to a great many conservatives who claim that the purveyors have the "right" to do whatever they want with their business, which seems to contradict the first of your two suppositions (at least among the conservatives to whom I speak, or whom I hear in the media).

  4. I take the position that health care is a human right. Everyone is entitled to receive the care they need, regardless of their ability to pay. No one should have to choose between necessary surgery and bankruptcy, or between necessary drugs and food. I am open to consider any system that will meet provide that care to all, but oppose any (like Obamacare) that fail to meet that test.

    We have had private sector health care and health insurance in this country since its founding and it is rather evident over the last few decades that our system has failed miserably at providing good care to all. I won't reject any solution simply because it doesn't fit with my political views as long as it does the job.

  5. I could go on and on but I'll try to keep it short. Essentially the US is failing for a lot of people. I have a chronic condition that got diagnosed about half way through my mission. Providence and luck had me in a mission that I could get the diagnosis, which may not have happened as quickly back home, and a cast of supporting characters including mission president so I was able to serve the rest of my mission. Another huge part is that my dad worked for a Utah company that wanted adult children going to college and on missions to be eligible to be covered on the health insurance plan.

    There is a saying that I'll butcher, but essentially don't tear down a fence before you understand why it was built. Tort reform is great as a bullet point, but if you understand why the big payouts happen then you would understand that you can't just artificially reduce them, you need to attack the disease, not the symptom.

    I have now found myself living in Sweden. I much prefer the medical system here. I wait less to see doctors here than I did in America. There is an emphasis on preventative care, that seemed to only get lip service in America. I'm on a newer, safer, better medicine here that was researched in Scandinavia and the UK. It's also a lot cheaper, so I feel less like a burden on society. It was once remarked to my doctor as a joke about my cost to society, which I used to feel cause of my programming as an American, being an immigrant here, and my doctor without skipping a beat replied that it would be silly for a society with the resources and technology to give me a good quality of life to not do so. This sentiment, though sometimes tempered with the reality that Sweden can't afford to take care of everyone, has been expressed by every Swede I've come across. Sure I pay more in taxes, but in reality I can now freelance, which I could never do before due to insurance reasons. One really funny thing to me is that my buddy's back in Utah who freelance end up with about the same percentage of what they bill per hour in their pocket as I do, after they've paid state and federal taxes and for the kind of insurance policy you can only get being a single healthy young male.

    There has been an interesting exercise in cognitive dissonance watching family and friends who think that I should be able to get the healthcare I need, affordably and without too much hassle, in America and being anti anything like Obamacare, when those are mutually exclusive things. The best was my cousin's wife who is a drug rep, trying to defend a system that pays her an exorbitant salary for what she does versus me doing something so crazy like wanting to live.

    I don't want a system that is just good for me, I want a system that is good for everyone. Mistakes will be made, there are limited resources in any system, even in the US. The rich and educated should feel safe that even in Sweden they are the group that tends to get better results from a public system (there is no definitive understanding of why, but factors like knowing when to go to the doctor, better understanding of what's going on, better able to take time off work all may play roles).


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