Symposium on Sen's philosophy at Erasmus
The Indignity of the Health Care Bill (A Reply to Wight)

Health Care Reform Passes!

Jonathan B. Wight

I’m a supporter of health care reform, largely for utilitarian reasons. Expanding access to health insurance will (in theory) lead to greater prevention, and more kids will be covered in the womb and in infancy—when critical brain development happens. That is a good thing for promoting long run economic growth, and will be cost effective. The net benefits of spending on social services in a child's infancy likely far exceed that at any other age (think of the cost of incarceration).

In addition, current health spending is disproportionately geared to administrative expenses—to identify and avoid clients with pending health needs.  How many people stay in their miserable jobs simply because they would lose insurance if they left? With reforms that prevent denial based on pre-existing conditions, many people may reallocate their labor to pursue entrepreneurial dreams.

Part of making all this work is that everyone will be required to acquire health insurance, and subsidies will be provided for those unable to pay full freight. The Attorney General of Virginia is planning to sue the federal government on this point, claiming that no citizen has previously ever been forced buy a product.  But is that true?  Since the 1930s every working American has been forced to “buy” retirement benefits in Social Security.  Everyone who drives a car is forced to buy head restraints and air bags.  So, this argument doesn’t cut it for me. 

However, there is a troubling point for me: Nancy Pelosi and President Obama have argued for health care based on it being a “right” and not a privilege.  What do you readers think about that?  A negative right (forbidding others from harming me) is much easier to argue than a positive right (forcing others to give me a benefit).  Interestingly, the Geneva Convention on Prisoners of War entails both: no torture is allowed, and reasonable health care must be provided. 

I like Bentham’s observation that rights theory is “nonsense on stilts.”  Still, rights theory is a useful platform for motivating political reforms. In other words, rights theory can be helpful in a utilitarian way.


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I would say the difference is I am not required to purchase a product by a private company with social security. (You could even make the wider argument that if I do not work, and therefore pay no taxes, I am not required to "buy" social security.)

And I am not required to own an car, airbags or not.

This is a unique time in that we now are legally required to purchase a product from private firms in order remain a citizen in good standing. From a pure utilitarian point of view, this might be desirable, but that doesn't make it any less strange.

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