My question for Ron Paul: Autonomy and health care

Earlier this year at the Tea Party debate, Wolf Blitzer asked Ron Paul if a person who chose not to buy health care should be left to die. Paul responded that this person’s friends and community could support him and pay his bills. Many in the audience seemed to be all right with letting this person die.

Conservatives and libertarians both express a strong commitment to autonomy, which they sometimes refer to as freedom. The new health care law is unacceptable they say, because it requires individuals to purchase insurance. People should not be required to purchase insurance, but they should be responsible for the consequences if they do not have insurance. Of course, this scenario is rarely a problem for anyone, and Blitzer asked the wrong question.

I would want to ask a different question. I want to know about the person who has worked all her life and been successful. After 20 or 30 years, she decides to expand her opportunities by starting her own business. Remarkably, her business is profitable in its first year. She can afford to buy insurance, but she cannot buy adequate coverage because she has preexisting conditions that every major insurance carrier refuses to cover. When she contracts a serious illness, she is driven into bankruptcy because of medical bills that are astronomical but quite common. Should our country let her die? Should she be permitted to slide into bankruptcy?

Autonomy is not quite as simple a question as it apparently seems to Republicans and libertarians. Philosopher Isaiah Berlin described two types of liberty: one is negative and the other is positive. For conservatives, it is imperative that individuals not be forced to do something they may not want to do and no government intrusion is acceptable. This is negative liberty. For liberals, such liberty is meaningless if one is unable to make the choices he or she desires, which is positive liberty.

Describing the liberal view of positive liberty, Berlin says,

“It is true that to offer political rights, or safeguards, against intervention by the state, to men who are half-naked, illiterate, underfed, and diseased is to mock their condition; they need medical help or education before they can understand, or make use of, an increase in their freedom. ”

While conservatives will not force someone to purchase insurance, liberals want to ensure that everyone has the option to have health care. Everyone who needs health care and cannot obtain it becomes a liberal in an instant.

The number of uninsured in the United States is said to be around 50 million, but many more than that have inadequate insurance. Unfortunately, most people do not realize they are underinsured until it is too late. Many people only learn that their treatment will not be covered by insurance after they have received the treatment. What kind of autonomy is this? What is the value of liberty if it leaves one with no options to avoid bankruptcy, untreated illness, and death? Is this really what we want to be?

The Personal is Political

For decades now, feminists have been telling us that what goes on in the private sphere affects the public sphere. The rallying cry of “The personal is political!” was heard by many. Some, such as Susan Okin, even predicted the problem this would cause for men. In order for women to enter the public sphere, men would have to enter the private sphere. If women were paid less and given less respect because their commitment to their jobs was diluted somewhat by family obligations, employers were likely to be even more harsh with fathers who wanted to be part of family life.

Though the warnings were unheeded, they were not unjustified. Katherine Reynolds Lewis has just published an article describing the struggles modern fathers face. It was assumed in the past that fathers would rather not take responsibility for changing diapers, taking sick kids to the doctor, and going to meet with teachers. This assumption turned out to be false. Fathers in the past were afraid that if they were more involved in the private sphere of home and family, they would be punished by their employers. Their fears have been realized. Fathers have been passed over for promotions and even fired after insisting on taking leave to be with their children.

Liberating women for equal pay will require liberating men as well. As society we should assume that all parents love their children and want to be with them to ensure their healthy development. Some fathers and mothers are not good parents to be sure, but rewarding rather than punishing those who are will benefit us all.

What can ethics courses achieve?

In a Houston Chronicle commentary titled “Where’s Right and Wrong in Ethics?,” Donald Bates explores why required university courses in ethics fail to produce ethical business practices. Bates lists many familiar examples of unethical behavior in public life (Enron and WorldCom, for examples) and blames them conveniently on the separation of church and state.

Bates claims that ethics is taught from a position of Utilitarianism (the greatest good for the greatest number), egoism (what most benefits the long-term interest of the individual), rights (deontological forms of duty to others or entitlements for oneself), or abstract principles of justice. This is his first mistake. University ethics courses teach the theories listed by Bates, although his list is far from exhaustive, but ethics instructors are not wont to teach “from a perspective.” To understand the study of ethics, students must be familiar with competing theories, but universities provide education, not indoctrination.

Bates goes on to say, “Trying to teach ethics without a religious underpinning means absolutes do not exist, everything is situational.” This is his second mistake. The fact that many competing ethical theories (and religions, for that matter) have emerged over the centuries is not evidence that absolutes do not exist. It is evidence only that absolutes are extremely difficult to discover and agree upon. Teaching ethics from the standpoint of a “religious underpinning” is to teach from a standpoint of absolute knowledge of right and wrong and good and bad, which would require professors to claim to know the mind of God, a claim that would be met with suspicion for good reason.

Expecting ethics courses to make the world more ethical is a little like expecting professional athletes and pop stars to be good role models. Ethical solutions and agreement are not easy to come by. Claiming that the state should enforce morality founded in religion begs the question of which religious perspective is correct and who will decide on the proper perspective. Rational people of good will disagree on ethical practices each day, and this is a good foundation of a pluralistic society.

If we are lucky, we might be able to teach a few students a little humility and respect for the efforts of others to discover right from wrong. Many students will claim that ethics is just a matter of common sense. Oddly enough, Bates seems to agree. In each case he presents, he believes there is a universally accepted opinion of what is right and wrong. If he is correct, students do not need to be taught what is right, they need to be prevented from being evil. It is unlikely that the leaders of Enron and WorldCom made a mistake in ethical thinking. More likely, they decided to do something that showed no concern for the harm it caused others.

An ethical society requires skeptical humility from its leaders and educators, recognition of the humanity of others, and a desire to limit harm to all. This lesson is not easily taught but it is easily shared by the way we live.