Monday, June 29, 2009

A Duty to Die?

Coming to you sooner than you may think. Don't get old in Obama's America. Withdrawing at least some care from the elderly is going to be very tempting once costs balloon they way they will

About twenty-five years ago, then-Colorado Governor Richard D. Lamm stirred up a bee's nest of controversy with his assertion that elderly, terminally ill patients have “got a duty to die and get out of the way.” While the Governor has since waffled on whether he actually meant the words he actually said, plenty of others have not on this issue. A good example of this, and perhaps a good gauge of where the debate in this country is headed as we come closer to the reality of a one-payer system for health care is the claim by British Baroness Warnock that dementia patients “should consider ending their lives because they are a burden on the NHS [National Health Service] and their families.”

How does one get to the point of saying that some members of society have an actual duty to die? What moral reasoning lies in back of such a stance? While it is possible to produce a full-blown Marxist-Socialist argument in support of such a position—for example that these people cannot actively support and indeed may actually hinder Marxist Revolutionary progress, hence they have a duty to get out of the way—in Western Society, arguments underpinning a “duty to die” have usually arisen instead from the moral theory of Utilitarianism. Not itself a Socialist Ethic, it more often than not comes down with the same moral prescriptions as Socialism because like it, Utilitarianism emphasizes the supposed general good of society over the interests of the individual.

Invented in the nineteenth century by philosopher Jeremy Bentham as a means to provide moral support for reforms to the British legal system, Utilitarianism has become one of the dominant systems of secular ethics. Its deceptive simplicity has lured many into its camp for, under this view, we as human beings have only one all-encompassing moral duty: to act so as to promote the greatest good (as far as the consequences of our actions are concerned) for the greatest number of people (be it those immediately affected by what we do or society as a whole).

Its founder Bentham originally understood as ‘good’ that which increases the overall balance of happiness in society or at least lessens unhappiness. Optimistically, Bentham initially thought that we could work out our moral duty with near mathematical precision by comparing the consequences of two possible courses of action in terms of their production of overall societal happiness. Unrealistically, he thought we could talk about it in measurable units. This turned out to be a non-starter because we cannot know whether we have two or ten of something until we know what counts as having one of that thing. And how can we say with any precision what is to count as one unit of happiness?

Enter the Cost-Benefit Analysis. While we may not be able to specify with any precision what counts as a unit of happiness, we do know what counts as one dollar. Because of the impracticality of talking about moral right and wrong in terms of the promotion of human happiness, a number of modern utilitarians have tied together their theory with the business practice of developing a cost-benefit analysis. Here the morally right course of action then becomes what on balance produces the greatest benefits for the costs involved. This marriage of an essentially value-neutral accounting practice with utilitarian moral theory produces a deadly combination. For now, in the realm of health care spending, it is not just financially prudent—a matter of good business sense—to make decisions in terms of what produces the most benefits for the costs involved, it is our moral duty to do so!

The costs of treating elderly patients whose prognosis is poor and who have much less to give back to society than those much younger, even if their course of treatment is successful, result in insufficient benefits to justify them for the utilitarian. In a health care system governed by the free market, individuals may nonetheless choose to incur these costs of treatment because they are spending their own money either directly or for insurance premiums to their private insurer. But in a single-payer system, the costs of health care for individuals are the costs of it to society. If in it officials deciding on the allocation of care see it as their moral obligation to do so in a way that produces the most benefits for society for the costs involved, then elderly patients whose treatment will likely produce far fewer benefits will invariably lose out and be denied care. But moralists like Baroness Warnock argue that they should accept this consequence as their moral duty to society as it reduces society’s costs and the emotional burden on their families. It is, she argues, their moral duty to die!

At this point, some readers may want to ask, “But isn’t human life itself an unqualified good, to be preserved no matter what the costs? Does not this patient have an inalienable right to life that alone would justify his or her treatment?” What would a utilitarian say of an appeal to this right? For utilitarians, rights are derivative on duties, any rights we have are derived from duties others have toward us and these duties are determined by what produces the greatest good for the greatest number of persons. If it does so to provide members of society with universal health care, as some utilitarians would claim, then society has a duty to do so. As a result, individuals have a right to expect this provision from society. Utilitarianism can thus support this supposed positive right to universal health care. Conversely, however, we have no rights that are not derived from our sole obligation to promote society’s greater good and, what is more important, can have no rights that would conflict with this obligation. So, if providing care to an elderly, terminally ill patient conflicts with this obligation then that patient has no right to expect such care. Thus, utilitarianism is destructive of rights like the right to life —as will be government-administered universal health care.


Beware New York Times Polls, “46 Million Uninsured” and Other ObamaCare Hoaxes

If Barack Obama’s health care overhaul is such a good idea, why must its proponents resort to deception when advocating it?

When something can stand on its own merits, there is obviously no need to prevaricate. And the fact that efforts to socialize America’s health care sector cannot stand on their own logical merits betrays the dangerous nature of Obama’s scheme. The latest example came this past week, when ObamaCare proponents trumpeted a New York Times/CBS News opinion poll purportedly showing that large majorities of Americans support government-run health care.

The June 12-16, 2009 poll indicated broad, substantive support for Obama’s plan, as 72% of its respondents favored a government health care provider to compete with private insurers. Suspiciously, the poll also reported that by a 57% to 39% margin, respondents are “willing to pay higher taxes for insurance for all.”

Revealing its predictable ideological bias, CBS News’ website could hardly contain its enthusiasm: “A clear majority of Americans – 72 percent – support a government-sponsored healthcare plan to compete with private insurers, a new CBS News/New York Times poll finds. Most also think the government would do a better job than private industry at keeping down costs, and believe that the government should guarantee healthcare for all Americans. The new poll shows the idea of a government-sponsored plan, or ‘public option’ to be fairly non-controversial.”

It turns out, however, that the poll was stacked with a disproportionate number of Obama supporters. Of the poll’s 895 respondents, some 48 percent stated that they voted for Obama this past November, whereas only 25 percent reported they voted for Senator John McCain. That disproportionate two-to-one margin contrasts with the actual November 2008 election results, in which Obama’s margin was 53% to 46%. If the CBS News/New York Times poll had been representative, Obama would have defeated McCain by a 66% to 34% margin last November. As polling expert Kellyanne Conway noted, “was the vote 66 to 34? You tell me.”

Of course, this is merely the most recent instance of distortion in the current healthcare debate. Perhaps the most pernicious deception advanced by those who allege a health care “crisis” and advocate a socialized system is that 46 million Americans are uninsured. But a closer examination reveals the dubiousness of that claim.

First and foremost, approximately 21 percent of that number, or 10 million, are not American citizens. Is it the responsibility of American taxpayers to subsidize health insurance for ten million non-citizens? Of course not.

Second, it’s estimated that as many as 14 million of the 46 million are already eligible for existing government insurance programs, such as Medicaid and S-CHIP, but for whatever reason have failed to -- or have chosen not to -- enroll.

Third, approximately 19 million of the uninsured are people between the age of 18 and 34, according to the National Center for Policy Analysis. As they note in their study, “most of them are healthy, and know that they can pay incidental expenses out-of-pocket. Using hard-earned dollars to pay for healthcare they don’t expect to need is a low priority for them.” Consequently, they have little incentive to insure themselves, and instead refrain from buying coverage unless and until they suddenly need emergency care.

Fourth, 9 million of the oft-cited 46 million live in households with incomes above $75,000 per year, and another 9 million in households earning above $50,000. While nobody would contend that these income levels qualify as “wealthy,” both levels far exceed the federal poverty level.

Together, these realities expose the deceptive nature of the “46 million” statistic routinely cited by advocates of government-run health care. Moreover, scientific polling regularly shows that between 70% and 80% of Americans are actually satisfied with their level of healthcare. In fact, a recent USA Today/ABC News/Kaiser Family Foundation survey reveals that 89% of respondents were pleased with their plan.

Accordingly, improvements to the nation’s health care system must focus on free-market principles and empowering individuals and families, not stifling government takeovers. Through medical tort reform, for example, we can limit the litigation costs and frivolous “jackpot justice” awards that drive up medical costs. We can also allow citizens to purchase insurance policies across state lines, which would drive down insurance costs and provide individuals and families the freedom to choose health care coverage that best suits their needs from a national marketplace.

In any case, beware the fraudulent numbers cited by those who advocate a wholesale government takeover of the American health care system. The fact that they must resort to deception is the surest sign that they’re prescribing the wrong medicine.


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