Health Care and Human Rights

November 19, 2009

Senate Democrats have just released their proposed health care reform bill. The good news: their proposal is estimated to cost $200 billion less than the bill proposed by House Democrats. The bad news: the cost will be $849 billion over ten years.

Of course, as was true with the House bill, the Senate bill actually projects a net reduction in the federal deficit over ten years, to the tune of about $130 billion. Much of the cost savings comes from projected cuts to Medicare reimbursement. Anyone who thinks that substantial reductions in fees paid to the providers of seniors' health care will actually take place may be interested in purchasing from me a toasted cheese sandwich that has an image of both Jesus and Harry Reid.

In principle, health care reform may be all well and good, but unless you're getting commissions on NINJA loans, you can't get something for nothing. We are already operating under huge budget deficits. Our national debt is approximately $12 trillion, and climbing rapidly. Huge chunks of that debt are owed to foreign governments, most notably China. If health care reform winds up costing us money -- and this is highly probable -- how are we to pay for it?

CFI has officially endorsed universal health care coverage -- of some sort. One reason for our endorsement is that sound scientific evidence establishes that when patients receive appropriate care in a timely manner, more serious and costly medical problems are often prevented. However, CFI studiously avoided endorsing any particular health care reform bill. Following our standard practice, CFI decided not to take a position on an issue where there is not only a wide divergence of views among humanists and skeptics, but these divergent views all can be considered reasonable.

But from my personal perspective, I believe both the current House and Senate proposals lack some necessary provisions. Tort reform, such as a cap on damages in malpractice cases and use of arbitration instead of litigation, could save billions. Everyone recognizes physicians order many unnecessary tests because of the fear of being sued. Price Waterhouse Cooper has estimated that $240 billion was spent on "defensive medicine" just last year.

Another change that should be required is an increase in taxes for most income groups, not just the super-rich. If health care reform is something we really want, we should be willing to pay for it -- instead of placing all the debt on the government's magic charge card, with the bills coming due when our children and grandchildren reach maturity. If we are not willing to pay an additional 2% or 3% in taxes to fund health care reform, then perhaps it's not that important to us.

Access to health care is often labeled a human right. I have some doubts about the use of "rights" claims in this context, but leave that point aside. In any event, there are other, arguably more fundamental, human rights, such as the right to free speech, the right of assembly, and the right to petition one's government. Moreover, humanists have been reminding themselves over the last few years that we have global moral obligations, that is our circle of ethical concern does not stop at our national borders but extends throughout the world. The direct implication of this view is that we should be working to advance basic human rights in all countries.

But running up our national debt limits our ability to do that. China is our largest lender. China is also run by a brutal, authoritarian government whose lack of respect for human rights was made manifest by the Tiananmen Square massacre of 1989. Some have criticized Obama for not pressing the Chinese hard enough on human rights during his recent visit. Actually, the wonder is that he raised the issue at all. A debtor does not typically march into a creditor's office and start hurling loud accusations -- not when that creditor can call in the debt at will. To influence the Chinese, we need leverage, and it's difficult to obtain leverage when one is in debt bondage.

With respect to one's own household, one has a moral responsibility to live within one's means, especially if one has dependents. That same responsibility extends to one's political household. We should not support policies that require us to make expenditures that can be funded only by increasing our debt. Fiscal responsibility is one aspect of moral responsibility.