Health care economics—and ethics

Both John McCain and Barack Obama have presented their health care plans, both of which emphasize variations on a market-based approach. McCain's plan seems to emphasize tax credits supplemented by assistance to help high-risk patients gain insurance, while Obama's plan seems to provide a more controlled market in which insurance providers are required to insure high-risk patients and there is a broader safety net, particularly for children. But in many ways, the language that they use and their basic ideas—"portability," "prevention," "reducing costs," "streamlining"—are the same.

Of course, neither knows exactly how they will pay for the plans. The New York Times suggests that McCain's program will most likely cost more than he says it will, though Obama's is probably not any better.

In a significant book, Charles Dougherty has noted the ways in which health care economics is an ethical issue as well. That is, we need not only to understand the efficiency of the health care market but also the unexamined, and perhaps more fundamentally disturbing, ethical question that the American health care system often presupposes: Is health care a fundamental human right, and if so, what does that mean for the delivery and access of health care in the United States?

Dougherty examines a variety of perspectives, not to choose the "best" but to survey the options:

• Utilitarianism: Is health care a means for ensuring the greatest happiness for the greatest number of persons? If so, then the most aged and infirm must be allowed to die or perhaps euthanized.
• Egalitarianism: Does the intrinsic value of human life require us to do absolutely everything to preserve and extend it? If so, then the health care system risks becoming bloated and unsustainable.
• Libertarianism: Should people be allowed to exercise the maximum amount of freedom in making health care decisions through the development of a free market? If so, one should be prepared to live with inequalities in access that arise from mental deficiencies and economic disparities.
• Contractarianism: Should the health care system emphasize a level of access to care that all reasonable persons believe to be "fair"? If so, one must commit oneself to an on-going discussion about what constitites "fair" in a pluralistic society that has shown itself to be unable to begin such a discussion on anything, let alone come to an agreement.