The recognition that we are all at risk of disease and suffering and that we will all die is nothing new. What is new is our ability to extend people’s healthy life spans – but unequally and at increasing cost.
Life expectancy in China has gone from about 40 in 1950 to over 73 today. An improvement in human welfare on this scale and at this pace is unprecedented in human history, though it has come at a frightful cost of violence and oppression.
On the other hand, life expectancies for some groups in the U.S. are currently declining. The effect of policies on human health is an urgent practical matter raising both ethical and economic questions, some of which I address in teaching Contemporary Moral Issues.
For the last 15 years, I’ve applied my research at the boundaries between economics and philosophy to issues concerning the measurement of overall health, the ethical significance of inequalities in health, and the ethical problems of providing health care to everyone.
This grew out of work with an ethics consulting group at the World Health Organization and now dominates my research.
Congress recently considered a replacement for the Affordable Care Act, and the issue continues to simmer amid political divides. Any eventual decision should depend on understanding the determinants of health and the economic complexities of health care provision, and it must also reflect our common values.
I emphasize the multiplicity of relevant values. Efficiency and fairness are obviously important, so that health care dollars do as much good as possible, while treating everyone with respect. At the same time, we mustn’t overlook compassion, choice and solidarity.
Understanding these values is difficult, as is coping with conflicts among them.
We need to ask of policies: Are they compassionate? Do they express the concern citizens should have for one another? Do they give everyone a chance to live a meaningful life? Do they protect freedom and individual choice? Do they recognize our common vulnerability to suffering and death and bring us together?
An appreciation of the economic complexities of health care markets and the reasons why they work badly without regulations is equally important.
For example, the unpopular individual mandate of the Affordable Care Act, which requires everyone to have health insurance that meets minimum standards, limits individual freedom, which is an important value.
It appears to many people to be objectionably paternalistic – Uncle Sam telling individuals what is good for them.
It takes economic analysis to understand why the mandate is needed to enable those with pre-existing conditions to buy health insurance.
It also requires moral imagination to recognize that refusing to treat uninsured individuals who might be easily restored to health deeply offends against our compassion and solidarity. The mandate is the price that compassion demands we pay so that we do not turn our backs on one another.