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A Catholic Defense of Health Care Reform

October 7, 2009

Daniel Callahan over at Commonweal posted an outstanding piece on health care today. While I am a strong proponent of universal health care, I do share Callahan’s skepticism about the liberal claim that the costs of serious reform will be minimal. Even the modest reforms currently under consideration would probably raise the deficit, despite Obama’s claim to the contrary. Surely, a public option would help hold down costs and judicious cuts to Medicare would add revenue. Still, given that Social Security, Medicare, and Medicaid account for almost half of all government spending, it seems highly likely that extending coverage even further would be pricey.

Callahan’s point is that the strong emphasis on individual liberty in American political discourse leaves little room for an appeal to the common-good, which is probably the best defense of reform we have. The idea of an individual making sacrifices — in the form of rationing or higher taxes, for example — for the sake of others is unthinkable to many on the Left and Right alike:

The thought that we might have to ration health care in the name of the common good—even to ensure that others get a fair share—is objectionable to most Americans, and our politicians have not dared to talk about it. It is the medical equivalent of not-in-my-backyard. Americans understand that in a flu pandemic a shortage of vaccines might require rationing and priority-setting. In such a case, where our backs are against the wall, the good of the community self-evidently comes first. Not so with the health-care system overall. Rationing is tolerable only in an emergency. We are a rich country, even during a recession; we can afford expensive wars abroad and McMansions. So why should we have to limit health care?

Liberals mostly ignore the question. They like to say that the real problem with health-care costs is waste and inefficiency, curable with better management and better incentives. No one needs to give up anything. Conservatives say that the market by itself can do the job by leading people to make more careful health-care choices. If insurers were forced to compete, everyone would have a wide range of options, and the net result would be lower costs. Again, no one needs to give up anything. Both the Right and the Left have their fairy tales; both refuse to face reality.

Our major political parties refuse to face reality because, despite their many and important differences, they share a common ideology: individualism. I don’t mean to say that the parties consistently embrace individualistic positions: the Republican desire for national unity (vis-a-vis multiculturalism) and family-values stems from a collectivist impulse, as does the Democratic desire for generous welfare benefits. Rather, the nation’s obsession with liberty renders it difficult for either party to defend these collectivist positions, for the obvious rebuttal — “who are you to tell me what to do?” — remains unanswerable.

G.K Chesterton once observed that the modern world is full of the Christian virtues gone mad: “The vices are, indeed, let loose, and they wander and do damage. But the virtues are let loose also; and the virtues wander more wildly, and the virtues do more terrible damage.” I would add that no virtue has wandered more wildly or done more damage in the United States than individual liberty.

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