Universal Healthcare: A Constitutional Promise

On Peter Singer’s essay “Why We Must Ration Health Care“

We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common Defense, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.”

When I read this preamble to our sacred founding text, a prominent note for me is the implication of our promise as a nation “to promote the general Welfare.” This clause implies that when our governing bodies make legislative, executive, and judicial decisions, those decisions should be on behalf of the greater good. Somewhere along the line this sense of interdependent duty to each other has gone awry. This lost sense of obligation to the general welfare is painfully obvious in the current discussions over healthcare reform. The issue of “rationing” healthcare is one such area where our individualism is getting in the way of our Forefathers’ promise to provide for the common good.  Bioethicist Peter Singer entered the debate today with his essay in today’s New York Times “Why We Must Ration Health Care,” where he attempts to form a logical rationale for the necessity of “rationing” healthcare as part of our future healthcare policy:

In the current U.S. debate over health care reform, “rationing” has become a dirty word. Meeting last month with five governors, President Obama urged them to avoid using the term, apparently for fear of evoking the hostile response that sank the Clintons’ attempt to achieve reform. In a Wall Street Journal op-ed published at the end of last year with the headline “Obama Will Ration Your Health Care,” Sally Pipes, C.E.O. of the conservative Pacific Research Institute, described how in Britain the national health service does not pay for drugs that are regarded as not offering good value for money, and added, “Americans will not put up with such limits, nor will our elected representatives.” And the Democratic chair of the Senate Finance Committee, Senator Max Baucus, told CNSNews in April, “There is no rationing of health care at all” in the proposed reform.

While I’ll agree that the term “rationing” has become the partisan equivalent of yelling “boo” whenever the issue of healthcare arises, I find that its use as a wedge in the discussion portrays the moral bankruptcy of our independent spirit. The corporatists and profiteers have done very well in building a cultural belief system that makes it morally acceptable to look the other way while someone else dies – under the guise of “it’s *their* problem and I should not be required to spend *my* money to save them.” Singer’s argument feasts upon this sense of self we’ve cultivated, where we view each other in the context of the individual and not the collective. I guess doing so makes it much more palatable when we hear someone like Singer say:

“…suppose it’s not you with the cancer but a stranger covered by your health-insurance fund. If the insurer provides this man — and everyone else like him — with Sutent, your premiums will increase. Do you still think the drug is a good value? Suppose the treatment cost a million dollars. Would it be worth it then? Ten million? Is there any limit to how much you would want your insurer to pay for a drug that adds six months to someone’s life? If there is any point at which you say, “No, an extra six months isn’t worth that much,” then you think that health care should be rationed.

Peter Singer is an ethicist who espouses a utilitarian view of ethics, meaning that his interpretation of general welfare extends to an economic calculation of costs versus benefits. For example, he proposes that it is acceptable to identify specific measures of when a treatment is effective enough to warrant the cost of providing such treatment:

Rationing health care means getting value for the billions we are spending by setting limits on which treatments should be paid for from the public purse. If we ration we won’t be writing blank checks to pharmaceutical companies for their patented drugs, nor paying for whatever procedures doctors choose to recommend. When public funds subsidize health care or provide it directly, it is crazy not to try to get value for money. The debate over health care reform in the United States should start from the premise that some form of health care rationing is both inescapable and desirable. Then we can ask, What is the best way to do it?

First, it is critical to note that healthcare is already “rationed” in our country. It is “rationed” each and every day when the uninsured or under-insured are denied the same high quality treatments afforded to those without financial constraints. Anyone who has seen Michael Moore’s movie “Sicko” saw through this film the soulless rationing of treatment in our country such as how the poor and indigent were treated by a for-profit hospital that dumped them on a street corner after providing only minimal care. I will never forget the morning I broke down in tears after reading about a man in our community who had cancer, lost his job and with it his health insurance. His statement “I’m just waiting to die because I cannot afford the chemotherapy drugs” exposed the unimaginable truth that our society is willing to allow people to die with little protest from its citizens.  If this is already unacceptable, why would we want to factor such a strategy into any plan we devise?

Now, I have a great deal of respect for Peter Singer and his general view of the world, but his utilitarian ethical approach to healthcare reform in our country is one I cannot embrace; and the reason I cannot embrace it is because our political leaders do not use a utilitarian view when dealing with banks, Wall Street barons, and corporations. How does a society continue to exist when those who have little are turned away from life saving treatments while the wealthy live in a world where money is no object? There is something inherently wrong with standing before a nation and acting as though there is no limit to the funds our country should expend so that banks and Wall Street traders are allowed to continue to feed at the trough of excess, yet a discussion over saving the lives of our fellow citizens erodes into debate over cutting costs.  Yet this is exactly what our legislators and president are doing to us on a daily basis — on both sides of the political aisle.

The unassailable truth is that our priorities are all wrong. Our political leaders have lost their souls as they engage in deceitful rhetoric that professes concern for the common man while every act they engage in benefits only the rich and well connected. What will it take for those of us at the bottom of this pyramid to stand up and demand real change? I’m not talking about “change” you can write on a campaign poster. I’m talking about real social change. What if it were your son, daughter, spouse, parent, or friend that faced “rationed” healthcare because our government felt it was more important to feed Haliburton’s or Goldman Sach’s coffers than it was to make sure live-saving drugs and treatments were available to all who need them? What would YOU pay?

The question is not whether or not we should ration. The question is why it’s even a question. Make sure that we live up to the promise of our founding fathers “to provide for the general welfare.”  Universal healthcare, regardless of economic status, is implicit in that promise.

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