In the third interview in a series on health care reform, Jeffrey Reiman explores the current reform debate from an ethical perspective. A professor in the Department of Philosophy and Religion, Reiman is the department's William Fraser McDowell Professor and director of the Philosophy and Social Policy Master's Program.
Do people have a moral right to health care?
This depends in part on how rich their society is. Any society can protect its citizens' right to property or their right to practice their religion, because basically all they have to do is avoid interfering with it. A right to healthcare requires, by contrast, that you to actually help me in some way. It's one thing to say, "I want you to let me practice my religion." It's another thing to say, "I want you to chip in some of your hard-earned money for my healthcare."
With this in mind, it seems to me that a reasonable standard of health care at a reasonable cost is a right that people have in a just society, dependant upon the level of that society's wealth. You can't expect, say, India to provide the same level of health care to its billion people as you can expect of America or France or Germany.
What could we consider a reasonable standard of healthcare?
Part of justice is a requirement of equal opportunity, and ill health is something that interferes with opportunity. If I don't have a certain level of health, I cannot compete in the job market or perform my job well. So, as a rough standard, we might say that people have a right to health care from their fellow citizens at the level that would provide for equal opportunity.
Now, it's one thing to provide equal opportunity if that means I need to be treated for a broken leg and will be good as new in a couple months. But what does equal opportunity mean for me if I am a paraplegic? Will my functioning ever be equal to many of my fellow citizens? In these situations, we should try to get everybody to the level at which they can function to the best of their ability.
Are the government and its citizens morally obligated to universally provide a reasonable standard of healthcare?
I don't think there's a difference between the government's obligations to its citizens and the citizens' obligations to their fellow citizens. The government is an instrument by which citizens' obligations to one another are realized. The government's only job is to serve its public, and part of this is to carry out what is morally required of its citizens.
So it always comes down to our obligations to one another. And an obligation to provide health care basically means that I have an obligation to either provide service to you or put some of my income toward providing for your health care.
One way to think about these kinds of obligations that has roots in the American tradition itself is to think of society as based on a kind of social contract. In this contract, you want to protect both your immediate and your long-term interests. Since these long-term interests are unknown, you want certain things to function as a kind of insurance. Health care can be thought of this way. We all share a common interest in our health care. Even people who don't want to pay for other people's healthcare want to know that, down the road, if they are in trouble someone will pay for theirs.