The Moral Argument


Ezra Klein asks: what happened to the moral argument for health care reform?

It seems this argument was key to getting national health care passed in Sweden and Taiwan.  While opponents were talking in cold economic terms, proponents were talking about ethical obligations.  In T.R. Reid’s words:

Both countries decided that society has an ethical obligation — as a matter of justice, of fairness, of solidarity — to assure everybody has access to medical care when it’s needed. The advocates of reform in both countries clarified and emphasized that moral issue much more than the nuts and bolts of the proposed reform plans. As a result, the national debate was waged around ideals like “equal treatment for everybody,” “we’re all in this together,” and “fundamental rights” rather than on the commercial implications for the health care industry.

Frankly, I doubt how well that would work in America.

For starters, and most fundamentally, we’ve never quite cleared ourselves of Adam Smith thinking.  I’m referring not  to Smith’s notion of free markets, but to Smith’s moral philosophy that undergirded and justified it.  Smith’s argument was not just that free markets work best economically, but that they result in morally correct outcomes: everybody rationally pursuing their own best interest results, in the aggregate, in morally correct outcomes.

Thus, the distinction between economic arguments and moral arguments that Klein and Reid presuppose is one a lot of Americans still do not make.  (On this front, Max Weber remains extremely relevant, I think.)  I don’t mean to suggest that most Americans (or Swedes or Taiwanese) consciously think in or about these categories.  Only that most American thinking still runs very much within the grooves laid down by Smith, and those grooves never separated economics from morality.

Since Smith’s economics and his moral philosophy were individualistic (because rooted in his individualistic anthropology and epistemology), most Americans’ moral thinking and economic thinking are, likewise, identically individualistic.  Notions like solidarity and “we’re all in this together” just don’t carry much weight.  Public policy arguments based on them have never been terribly successful, except during some of our wars.

Say “solidarity” to 10 Americans over the age of 30 and you’re likely to be called a Communist at least 3 times.

Similarly, arguments featuring “equal treatment for everybody” don’t do all that well.  A big chunk of Americans don’t much believe in that — don’t believe in it at all on economic issues like being able to access health care.  Nor do they much favor “fundamental rights” in the economic sphere.  The only fundamental right is to an equal shot at working to make enough money to buy yourself some health care.

I’m not sure if that kind of thinking is still a majority mindset in America, but it very clearly is the mindset of at least a large, vocal, and pretty organized minority, that happens to pull the strings of one of our 2 major political parties.

So while I share Klein and Reid’s view that there’s a moral argument here, I don’t think the health care reform effort would be notably better off if proponents relied more on that argument.


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One Response to “The Moral Argument”

  1. jazzbumpa Says:

    Points well taken. I think the American ideal – or myth – of the rugged individualist (think Marlboro Man) is tightly tied to the belief in American exceptionalism.

    This guides morality into the Smith groove.

    So, instead of “we’re all in this together,” we have: “Screw you. I got mine!”

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