A Philosopher's Blog

Health Care & Compulsion

Posted in Business, Ethics, Law, Medicine/Health, Philosophy, Politics by Michael LaBossiere on March 21, 2012
President Barack Obama's signature on the heal...

President Barack Obama's signature on the health insurance reform bill at the White House, March 23, 2010. The President signed the bill with 22 different pens. (Photo credit: Wikipedia)

The United States Supreme Court will soon be ruling on the constitutionality of the Affordable Care Act. This ruling will, of course, settle the legality of the matter-at least until it is challenged. While the constitutionality (or lack thereof) of the act is certainly interesting, my main interest as a philosopher is the ethics of the matter.

While the law is 2,400 pages long, I will just focus on the ethics of a key part, namely that the law requires people to purchase health care insurance. Opponents of the law assert that this is the first federal law that requires citizens to purchase a product and they typically assert  that this goes beyond the legitimate power of the state. Proponents of the law retort by arguing that the state is acting legitimately. As such, a key moral issue is whether or not the state has the right to compel citizens to buy a product in general and insurance in particular.

On the face of it, the idea that the state has a right to compel people to buy a product seems to be absurd-even when such a purchase would be a good idea. After all, buying and consuming fresh fruits and vegetables is a good idea, yet one would be hard pressed to present an argument in favor of compelling this by law (the Broccoli and Orange Act, perhaps).

To present a more substantial argument, I will begin by noting that I favor a a presumption in favor of liberty. That is, the burden of proof is upon the state to show that the intrusion on liberty is legitimately warranted. While spelling out the various conditions under which intrusion would be warranted goes beyond the scope of this essay, one obvious justification is that the intrusion prevents an individual or group from inflicting unjust harm onto others. Thus, the restrictions on murder, theft and defective products are warranted. Intrusion that are done merely for the good of a person would not be justified, at least if we follow John Stuart Mill’s classic arguments regarding liberty. After all, if I am sovereign over my self, then the state (and others) have no moral right to intrude on my actions when they impact only me. As such, while the state can justly prevent me from selling tainted broccoli, it would not seem warranted in compelling me to eat broccoli-despite the fact that doing so would be good for me. This line of reasoning, interestingly enough, would also forbid the state from making the use of marijuana illegal and would also make laws forbidding same sex marriage morally wrong since they impose on liberty solely to impose a specific religious/moral view rather than to prevent people from harming one another. In fact, the principle that the state cannot compel except to prevent harm would entail a host of libertarian positions on various issues-something that should be duly considered when using such a principle.

Of course, it could be argued that while the state has a right to compel people to not do various things even when they are not harmful to others, it does not have the right to compel people to take positive action. That is, the state can be justified in telling me what not to do, but it has no legitimate right to tell me what to do. As might be imagined, this approach is often taken by folks who want the state to compel people to not do various things (like smoke marijuana or marry someone of the same sex) but who are against this specific act.

While justifying specific acts of compulsion can be challenging, this approach does seem consistent. After all, the principle is that the state cannot compel taking action and can only compel people to not do things. As such, while the state can, for example, forbid abortion, it cannot morally  compel people to buy health insurance.

Naturally, if this principle is used to argue that forcing people to buy insurance is wrong, it must be applied consistently-namely that the state is wrong to compel action and it can only forbid. This would entail that compelling young men to sign up for selective service is wrong. It would also entail that compelling people to pay taxes is wrong. Forcing automakers to include seat belts, air bags, and brakes would also be wrong. Forcing women to undergo an ultrasound before getting an abortion would be wrong. So would forcing children to attend school. Compelling people to serve on a jury would also be wrong.  And so on. Naturally, this might have considerable appeal to some people, but this path would seem to take us into the realm of the absurd (although some, such as the anarchists, would say we are already there and doing this would take us out of the absurd).

The obvious counter is to insist on narrowing the principle from “the state has no moral right to compel” to “the state has no moral right to compel people to buy a specific product.” The challenge, of course, lies in justifying this principle. As might be imagined, the reply that “the state has not done this before, so doing it is wrong” is not a good argument. After all, the mere fact that something has not been done before is no indication of whether it is good, bad or indifferent. This sort of “reasoning” could be seen as a variant on the appeal to tradition fallacy, in that the idea is not that something is good because it is a tradition but that something is bad because it is not.

What, then, is needed is something that shows that the state lacks the legitimate authority to morally compel people to have health insurance while it does possess a right to compel people to do things. The challenge is to show a relevant difference between the insurance case and the other cases in which state compulsion is (allegedly) morally acceptable. The obvious thing to point to is that the state would be forcing people to buy a  product. However, the mere fact that this is different does not entail that it is a relevant difference that make this specific compulsion wrong. After all, the state does compel us to pay for Medicare, Medicaid and Social Security and is thus compelling us to buy what amounts to health and retirement insurance.

Naturally, it could be argued (as some have) that the state should not do this-that being forced to pay for Medicare, Medicaid and Social Security involves an unjust compulsion and thus the state should not do this. This view would allow someone to consistently oppose the Affordable Health Care Act’s compulsion to buy health insurance but at an obvious price-namely the need to be opposed to these three things.  As such, those who do not want to be rid of these things will need another line of attack.

The most fruitful one is that the the health care coverage is a private product rather than a state product. This, of course, does provide a significant difference between the state’s “products” and health care coverage. Of course, it does not provide an argument against the state compelling people to pay into a national health care insurance (as it does with the current national health care insurances, Medicare and Medicaid). As such, focusing on the fact that the product is a private one would seem to help shore up the view that the state should instead compel people to buy national health care-after all, this seems to be well within the legitimate power of the state (at least as it is currently conceived).

Nations other than the United States do, of course, have national health care. Of course, this sort of thing is presented as a worse demon than forcing people to buy private insurance. But this is a matter for another time.

 

 

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28 Responses

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  1. ajmacdonaldjr said, on March 21, 2012 at 7:18 am

    Philosophically, I see little difference between the state forcing me to buy health insurance and the state forcing me to buy a pack of cigarettes, except that the first forces me to pay for the heath care costs associated with those who smoke and the second forces me to pay for a product that is dangerous to my health.

    As I’ve said before, when it comes to federal health care, where are the majority of the citizens of America helping to serve America?

    If anything should be compelled by the state it is public service.

    Bring back the draft, along with a nonviolent alternative, which provides a federal health care benefit for life for all who serve.

    This is what I did – served my country – which entitled me to federally funded health care for life through the VA.

    No public service, no health care.

    I’m sick of people riding for free upon the backs of others, and so are a lot of people.

    People in America have little sense of public service these days, but they are ALL ABOUT entitlements, although they have NEVER served their country, which I find quite pathetic.

    • anon said, on March 21, 2012 at 8:56 am

      “I’m sick of people riding for free upon the backs of others, and so are a lot of people.”
      God damn children always wanting a handout. I hear quadriplegics are whiners too, always needing to be fed by others, why can’t they do anything by themselves. I hear this line again and again as if MILLIONS upon MILLIONS of people are doing this (which isn’t true). In ANY system there will be people who do little to nothing and still get by upon the backs/work of others. This happens in nature among and between other species as well. You have to understand that you can NEVER get rid of all waste in a system (especially when people are involved).

      “People in America have little sense of public service these days”
      Have they EVER had a lot of sense about public service? Probably not except in war time (and how much did they even have then).

      “, but they are ALL ABOUT entitlements, ”
      Really or are you just repeating a specific political party’s platitude about why they shouldn’t help others? You seem really ENTITLED to get health care of limited military service. Why are you ENTITLED to continued medical care since you are no longer in the military. Shouldn’t the people who are in it now be ENTITLED to it, not you since you are no longer providing a “public service”? Why are you ALL ABOUT entitlements?

      “although they have NEVER served their country, which I find quite pathetic.”
      It sounds like to you “service to ones country” is mostly about being in the military. Apparently one can’t possibly “serve” their country by being a good, decent, honest, tax paying citizen striving to make the country/world a better place.

  2. T. J. Babson said, on March 21, 2012 at 7:45 am

    The constitutionality of the ACA is the real issue. The federal government clearly does not have the power under the constitution to compel an individual to engage in commerce.

    • Michael LaBossiere said, on March 21, 2012 at 3:05 pm

      It says it has the power to regulate commerce. This is vague enough to allow for compulsion. After all, regulations can forbid and compel. I’d say that the law is constitutional in that it does not violate the constitution. Whether it is a good law or not is quite another matter.

  3. T. J. Babson said, on March 21, 2012 at 7:47 am

    What is happening is that all limits to the power of the federal government are being removed.

    • Michael LaBossiere said, on March 21, 2012 at 3:06 pm

      All the limits? This repeals the bill of rights?

      • T. J. Babson said, on March 21, 2012 at 3:31 pm

        If the government can kill US Citizens with no due process, which the current policy of our government, I think that one can argue the bill of rights has effectively been repealed.

        • dhammett said, on March 21, 2012 at 5:24 pm

          As we skirt the outer fringes of Mike’s main topic. . .This seems to be a pretty compelling argument that the killing was justified and did not “effectively” repeal the Bill of Rights::

          “But Kenneth Anderson, an international law scholar at American University’s Washington College of Law, said U.S. citizens who take up arms with an enemy force have been considered legitimate targets through two world wars, even if they are outside what is traditionally considered the battlefield.

          “Where hostiles go, there is the possibility of hostilities. The U.S. has never accepted the proposition that if you leave the active battlefield, suddenly you are no longer targetable,” Anderson said.

          In early 2010, the director of national intelligence, Dennis Blair, told a congressional hearing that the U.S. was prepared to kill Americans affiliated with al-Qaida, without mentioning al-Awlaki by name.

          Vote: Should U.S. be able to kill its citizens overseas without due process?

          “If we think that direct action will involve killing an American, we get specific permission to do that,” by which he meant authority from the executive branch, not the courts.

          Blair said the military and intelligence agencies had authority to kill U.S. citizens abroad who were engaged in terrorism if their activities threatened Americans. Since then, U.S. officials have said that al-Awlaki’s role in al-Qaida in the Arabian Peninsula (AQAP) had shifted from propagandist to operational tactician and strategist.

          The State Department’s senior legal adviser, Harold Koh, plainly stated last year the Obama administration’s view that it had authority to undertake drone attacks in countries where al-Qaida operatives were located.”

          http://openchannel.msnbc.msn.com/_news/2011/09/30/8063632-can-us-legally-kill-a-citizen-overseas-without-due-process

          The article presents other views as well (with the understanding that there are such things as opposing views about the Constitution and the Bill of Rights out there in the real world)

          • T. J. Babson said, on March 21, 2012 at 6:44 pm

            I’m not arguing that the killings were unjustified, but that there was a lack of due process. Giving the president carte blanche authority to decide which U.S. citizens deserve to live and which deserve to die isn’t sufficient for me. There is more due process involved in getting a wiretap than in a targeted assassination of a U.S. citizen.

            • dhammett said, on March 21, 2012 at 8:58 pm

              The process described here:
              http://openchannel.msnbc.msn.com/_news/2011/09/30/8063632-can-us-legally-kill-a-citizen-overseas-without-due-process
              “In early 2010, the director of national intelligence, Dennis Blair, told a congressional hearing that the U.S. was prepared to kill Americans affiliated with al-Qaida, without mentioning al-Awlaki by name. . . .
              “If we think that direct action will involve killing an American, we get specific permission to do that,” by which he meant authority from the executive branch, not the courts.”

              The way this reads, it seems the process does not begin with the executive branch. It begins with the Director of National Intelligence. The DNI is subject to Senate confirmation. He is in charge of supervising gathering of information against the intended target. Presumably, at some stage he and *his* advisors determine—doing their spy thing— that the suspect is dangerous to national security. At that point, if assassination seems necessary, the DNI takes his recommendations to the executive branch to get the go ahead.

              Now, that may not be “due process”, but it seems like a more efficient and more accurate process than might be achieved through the courts. At any rate, it is not as simple as the president “having carte blanche authority to decide which U.S. citizens deserve to live and which deserve to die”. If the President had such authority, he could wake up one morning and order the killings of citizens chosen at random from the phone book or from his enemies list (like the one NIxon had).

            • Michael LaBossiere said, on March 22, 2012 at 11:11 am

              It still worries me, given that the execution of an American for crimes is something that should be handled through the court. Much of my concern rests on the fact that the war on terror is a very nebulous sort of thing and that this vagueness creates a real risk of the execution power spreading from this amorphous war to other areas, such as the war on drugs.

            • Michael LaBossiere said, on March 22, 2012 at 11:09 am

              I would agree that the killing was probably morally justified. But what worries me is that the legal justification undermines the notion of due process. They could have killed him all the same, but this should have been handled by the courts. It is one thing to target an enemy CO in times of war, quite another to kill a citizen who belongs to what amounts to a criminal organization. After all, if we can kill Americans because they are associate with terrorists groups, the groundwork is being laid to take out Americans with ties to criminal groups because they pose a threat from abroad.

        • Michael LaBossiere said, on March 22, 2012 at 11:04 am

          At least that particular right (some does not entail all). There should, I think, be more outrage over what amounts to executive execution power. I suspect that many folks one the right are reluctant to say anything because 1) they often favor trading liberty for security (the Patriot Act, etc.) and 2) focusing on this would undermine their claim that Obama is a weak appeaser of our enemies. On the left, folks are probably somewhat reluctant to make this an issue because Obama is, well, Obama.

      • T. J. Babson said, on March 24, 2012 at 9:42 am

        Drip, drip, drip…

        WASHINGTON — The Obama administration is moving to relax restrictions on how counterterrorism analysts may retrieve, store and search information about Americans gathered by government agencies for purposes other than national security threats.

        Attorney General Eric H. Holder Jr. on Thursday signed new guidelines for the National Counterterrorism Center, which was created in 2004 to foster intelligence sharing and serve as a terrorism threat clearinghouse.

        The guidelines will lengthen to five years — from 180 days — the amount of time the center can retain private information about Americans when there is no suspicion that they are tied to terrorism, intelligence officials said. The guidelines are also expected to result in the center making more copies of entire databases and “data mining them” using complex algorithms to search for patterns that could indicate a
        threat.

        https://www.nytimes.com/2012/03/23/us/politics/us-moves-to-relax-some-restrictions-for-counterterrorism-analysis.html?_r=2&hp

  4. T. J. Babson said, on March 21, 2012 at 10:56 pm

    “If the President had such authority, he could wake up one morning and order the killings of citizens chosen at random from the phone book or from his enemies list (like the one NIxon had).”

    Exactly what I’m worried about.

    “…by which he meant authority from the executive branch, not the courts.”

    Authority from the executive branch = president.

    All very self referential.

    We will see how you feel about all of this when a Republican occupies the Oval Office.

    • dhammett said, on March 22, 2012 at 10:58 am

      The word is “If”. The process as I understand it and I’ve tried to describe it involves the Senate (in the approval of the DNI), the hard work , dedication, and recommendations of various intelligence gathering agencies and ultimately the recommendation(s) of the DNI to the executive branch (yes, that would be the sitting president). At that point, the executive may choose to kill or not.

      I’m not worried. I am, however, worried about “captain” George Zimmerman.

      • T. J. Babson said, on March 22, 2012 at 12:15 pm

        “I am, however, worried about “captain” George Zimmerman.”

        Are you worried about all the death threats he is receiving?

        This case is quite interesting in the way the race card is being played by both sides. Zimmerman was initially identified in the press as being white, but it turns out that he is actually Latino and he is making a big issue of this because if he is Latino his chances of being convicted of a hate crime go way down.

  5. ajmacdonaldjr said, on March 21, 2012 at 11:43 pm

    Who, honestly, believes the US Supreme Court is properly interpreting the US Constitution? Please, be serious! LOL you cats are straining at a gnat and swallowing a camel. I have zero respect for our federal government, because they DO NOT uphold JUSTICE : (

    Does anyone here, including the Professor, know what JUSTICE is? In less than ten words?

    The best place to start is at the beginning, because if if DON’T KNOW what JUSTICE is this entire conversation is something like medieval scholastics arguing about how many angels can dance on the head of a pin, or listening to Nero fiddle while Rome burns : (

    • Michael LaBossiere said, on March 22, 2012 at 11:12 am

      I’ve read the Republic, so I have to say that I know that I do not know. But I know it when I see it…being violated.

  6. dhammett said, on March 22, 2012 at 10:46 am

    Everyone here who thinks we should have a Constitutional Convention to correct the Founding Fathers’ obvious errors and create new ones of our own raise your hands.
    I’m for making only those revisions that fit my view of the world. How about you?

    So, if I could tell you what ‘justice’ is in a million words, is there a chance in hell that you’d agree with me? If you’d give me your condensed version, is it any more likely that I’d agree with you? In either case would you really gain respect for the federal government? Perhaps things would be better if we were 50 separate little countries? What if we were 13 little countries, and we had never crossed the Appalachians?

  7. ajmacdonaldjr said, on March 22, 2012 at 10:52 am

    Here’s what I think is a VERY SIMPLE question, especially for a philosopher and those who are interested in (and have studied) philosophy: What did the Rev. Dr. Martin Luther King MEAN when he wrote, from Birmingham jail, the following words: “One has a moral responsibility to disobey unjust laws”?

    Since this essay revolves around JUSTICE, this SHOULD be VERY easily answered, whether one agrees with Dr. King or not.

    • Michael LaBossiere said, on March 22, 2012 at 11:18 am

      Well, to steal from other philosophers, an unjust law would be a tyrannical law. One that does not aim at the good of the people, but at things like the private advantage of the governors.

      This, of course, raises the question of what is the good of the people.

      • ajmacdonaldjr said, on March 22, 2012 at 11:13 pm

        That’s good. Eight words :) Justice is: to render to each that which is their due. According to Cicero, Augustine, Aquinas, the Founders, and Dr King, an unjust law is a law that is out of harmony with the divine moral laws of the universe. A court or a legislature may only pass those law which line up with this natural law, which was presupposed from ancient Roman times until about 50 years ago. Since that time we have witnessed a stead slide into legal positivism, which means the law is simply whatever a court or legislature says is law, even when such laws are out of line with natural law. Such laws are, in fact, not laws at all but are, as you said, despotic and tyrannical, which is why it is not only our right but our duty to disobey such unjust laws.


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