Mark raised an important question, “Does health care have special moral status?” Mark answers in the negative, using strong intellectual arguments. These arguments are not wrong but I suggest here they are incomplete because they fail to consider important aspects of human nature.
There is a moral sentiments argument for health care that is plainly made by Adam Smith in The Theory of Moral Sentiments (III-3.4):
Smith starts with the famous line: “Let us suppose that the great empire of China, with all its myriads of inhabitants, was suddenly swallowed up by an earthquake…”
Smith says that a person of great humanity in Europe would care very little about this calamity if he were far removed from the suffering. Hence: “If he was to lose his little finger to-morrow, he would not sleep to-night; but, provided he never saw [those suffering], he will snore with the most profound security over the ruin of a hundred millions of his brethren….”
But Smith goes on to show that if offered the choice of sacrificing a finger to save those hundred million Chinese, the moral imagination swings actively into gear. “Human nature startles with horror at the thought,” that if we could easily prevent suffering, that we would sit by and do nothing.
Hence: “When our passive feelings are almost always so sordid and so selfish, how comes it that our active principles should often be so generous and so noble?” (emphasis added).
The bottom line is: The obvious lack of health care in some citizens, when it is widely viewed as resulting in pain that could be easily prevented or ameliorated, produces emotional shock that leads to active engagement to address the problem. The same is not true for most other products.
Example: Let’s consider the case of last summer’s Copiapó mining accident in Chile. A purely intellectual analysis might conclude that Chileans (and others from all over the world) should not have devoted all those massive resources to saving the lives of the 33 trapped miners nearly a half-mile underground. The miners understood the risks of taking the job, and were presumably paid a premium for that risk.
Using cost-benefit analysis, one could show fairly easily that the money used to save these miners could save far more life-years used elsewhere. Yet the reason the miners were saved is because the moral imagination was aroused. This can be inefficient (it certainly is) and unjust (it likely is)—but it is an integral part of human nature.
Hence, the pure libertarian view fails to consider the “externality” effect that pain causes on other citizens. A pure libertarian might say, “Let them suffer—they made their own choices.” But that runs counter to human biology (our mirror neuron system) as well as to religious injunctions (see the parable of the prodigal son). Health care really is different because of the moral sentiments it arouses.