December 12, 2012 | Posted By Wayne Shelton, PhD

Recently, I attended a debate between two very informed health care professionals about whether or not our country should have a single payer health care system. Each seemed to have their own philosophical or ideological perspective about health care as a basic service in our society and it through their ideological lens that each speaker viewed health care and brought to bear the facts to support their positions. It was striking that these two very informed and thoughtful individuals often disagreed about fundamental facts pertaining to our health care system. 

For example, the opponent of a single payer system supported his claim that turning over health care to the federal government would be a failure at least in part on the assumption government is incompetent to perform this task. He claimed, as other thoughtful conservatives do, that that Medicare and Medicaid are less efficient than private health plans. If the analysis in the first link below, which is part of the Ryan Plan, is true, then perhaps there are some facts to support their case.

On the other side, the defender of a single payer system presumed much more confidence in the efficiency of government, claiming Medicare and Medicaid operated with considerably lower overhead than private plans. This claim is often espoused by progressive supporters of universal health care such as Paul Krugman and others, as seen in the next link.

This is no small factual disagreement. If those of us interested in the health care debate in our country cannot reach agreement about basic facts regarding the cost of Medicare and Medicaid overhead, it is hard to believe we will find viable solutions for managing our health care system. What seems to be driving much of the disagreements between political opponents over health care is an unwillingness to see the facts of the world inconsistent with one’s own ideological preferences.  Sorting out the empirical truth apart from ideological biases is very difficult, but also very important. Is it possible to move in a more philosophical direction of being objective and fair about the facts of the matter relating to health care reform?

Since the way facts are interpreted so often reflect value-laden perspectives, the real place to start in this debate is to focus more explicit attention the moral perspective itself. For example, quite independently of the facts of the matter, there is the fundamental question of what is our vision of a good and just society? What do people deserve as a basic level of health care? How do we care for those least advantaged and most vulnerable? And given the limits of what can be provided for people at the private level, what is the role of government to ensure that care is provided? These are philosophical, value questions that can be addressed at least at a prima facie level apart from the facts. If we agree that society’s obligations are minimal and that individuals, including the most vulnerable, should fend for themselves and rely on the generosity of those around them, could we adjust our moral sensibilities accordingly? Could we view health care as a normal market service, which would be denied to people without insurance or the ability to pay? If, on the other hand, we agree that all citizens have a basic right to health care, then instead of an ideological debate about private insurance vs. single payer, could we pursue more pragmatic goals about how to design a system where all citizens have affordable, quality health care coverage at the primary care level? If quality, universal health care were a common value perspective, could we use data from scientific studies and credible sources to most effectively accomplish this goal? 

Until we get our value priorities better clarified and at least relatively agreed upon, the facts will never come into clear, common focus and we will never have a common moral vocabulary. Our only hope is for thoughtful, serious people who disagree about ideological perspectives, such as the two opponents I saw in the recent debate, to embrace a more philosophical bent and engage in real dialogue to see if they could arrive at least similar value laden goals; and, then discuss the facts of the matter in good faith to see how they could find common ground for practical solutions. Such dialogue is obviously not currently happening in our political debates in Washington. Until it does, we will continue to disagree about crucial facts and continue to face many obstacles in our efforts to improve the health care system.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

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