Morality, health care, and the Supreme Court

By Michael Yudell

There was a reason — a pretty noble one, in fact — behind Obamacare, as well as several earlier proposals, Democratic and Republican, to overhaul the health-care system. As the president put it in 2009, providing near-universal coverage for Americans is “a core ethical and moral obligation.”

That hasn't come up much recently, as soothsayers of all stripes had been predicting how the Supreme Court would rule Thursday morning. Most seemed to think that the Affordable Care Act, Obama's signature health-care legislation that expands coverage for millions of Americans, would be overturned. Bill O’Reilly was so sure of it that said he'd “apologize for being an idiot if the court rules otherwise.

O'Reilly was wrong. In a stunning 193-page opinion, the court upheld most of the law.

At stake were issues of jurisprudence, and they are complex. As former Chief Justice Earl Warren once said, however, “in civilized life, law floats in a sea of ethics.” Warren presided over Brown v. Board of Education, the decision that held the doctrine of “separate but equal” unconstitutional and ended legalized pubic school segregation. He knew that the court’s decisions were driven by — and could propagate — moral principles. Though the tone of the majority opinion penned by Chief Justice John Roberts is dispassionate, the outcome very much reinforces that it was indeed a moral decision

Law professor and health policy expert Robert I. Field, my colleague at both the Inquirer's health-care blogs (Check Up) and in the office (Drexel University), has posted extensively about the history and legal implications of the health-care law, and he will be hosting a live chat about the ruling at 2 p.m. Thursday.

So what is it that makes health care an ethical and moral obligation for our nation? I believe there are two factors.

First, not providing health care to all goes against our shared creed that we are all created equal, and that among our unalienable rights is that of life. People who get sick deserve a chance to get better regardless of who they are, what their station in life is, and whether they can afford health care. Our current situation of health care haves and have-nots is neither justifiable nor sustainable by any of the ethical, political, or religious creeds upon which our nation stands and thrives.

Second, by all accounts, the United States remains the only Western nation not to provide some form of universal health coverage for its citizens — a circumstance that now is scheduled to change when the health-care overhaul's key provisions kick in in 2014. It is appalling that we have spent a century trying to come up with a way to get universal coverage. And it is in this lack of protection that we see evidence to compel us morally, as there have been severe prices to pay, in the cost of human health and mortality, for this longstanding failure.

Several recent studies confirm the costs of not providing care to all. A 2009 study, for example, confirms that not having heath insurance increases your risk of death compared to those with insurance. It estimated that nearly 45,000 deaths in the U.S. every year are caused by lack of health insurance.

An Institute of Medicine report from 2002 found that the health of working-age Americans without medical insurance “would improve if they obtained coverage” because they “receive too little medical care and receive it too late,” they are “sicker and die sooner,” and they “receive poorer care when they are in the hospital even for acute situations like a motor vehicle crash”

Another study found that over a 17-year period those who lacked health insurance had a “25 percent greater chance of dying than did those who had private health insurance.”

Why does health insurance better our health? The Institute of Medicine suggests that it is because those with insurance get care when they need it, they have a consistent source of that care, and there is continuity of coverage between visits.

Given what I believe is our shared value for life, and given the suffering that lack of insurance causesI think that deep down most, if not all of us, believe in providing health care for all. And polling supports this. Even though Americans are, at the moment, opposed to the Affordable Care Act, we support most of its provisions. A large majority support banning insurance companies from denying coverage based on pre-existing conditions, requiring companies bigger than 50 employees to provide health insurance to its employees, and support allowing children up to age 26 to stay on their parents' insurance.

Most of the law has survived scrutiny by the Supreme Court of the United States. So now  the argument will shift back to politics. Congressional Republicans have long threatened to repeal it. So has the presumptive Republican presidential nominee, Mitt Romney.

But the moral question remains: Can we afford not to provide health care to all? Do we really want to be a nation that cheers in support of letting uninsured Americans suffer or die, as did some in the audience at one of the Republican presidential debates last September? Or are we a nation that finally finds a way to provide a basic degree of health and health security for all Americans?

With the legal issues resolved, the moral questions should take  center stage.

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