Morality and health care

Is there a moral duty to provide health care?

Doctors think so. Most interpret the Hippocratic Oath as meaning you first provide care. You don't let someone die because they're indigent, or you think their lifestyle caused their illness. It's a caring profession.

This sets up a dilemma policy makers have yet to come to grips with. When faced with more demand than supply, the natural economic impulse is to ration supply. A doctor's ability to ration is limited by compassion.

Market mechanisms are not intrinsically moral. The market rations health care differently than a politician or a doctor or an ethicist might. And the involvement of all these interests, especially the moral interest, bothers many people.

I know this is true because, when I bring up the idea of any non-market mechanism for rationing care here, the pushback is immediate.

What makes this more complex is the simple fact that non-market rationing may be more economically efficient. Countries which guarantee a basic level of care spend less, and have better outcomes, than in our market-based system.

As Ian Welsh wrote over the weekend, Canadians get better care than Americans and pay 50% less, except for "non-essential surgery waiting times."

If a Canadian needs non life-saving surgery they could be in pain for weeks or months, while an American's care is determined by the state of their checkbook. The primary reform Canadians want in their system is optional insurance which will take them outside the lines.

Thus morality and economics are conspiring against the free enterprise bias of the American medical system. This pressure will remain regardless of how our elections turn out, as large businesses seek to cut costs.

The fact this might result in a more moral system may be quite incidental, as America applies the golden rule which is he who has the gold makes the rules.