A Fundamental Moral Decision: How can we, in good conscience, deny health care to anyone who's sick? We can't.

by E.J.Dionne Jr.

The term “pro-life” is used with great seriousness in politics, and also as a political cudgel. If ever there were an issue on which those words have clear relevance and resonance, it is health-care reform.

Pro-life activists are deeply engaged in controversies around what care should be given at the end of life, and I strongly share their opposition to physician-assisted suicide. But who pays for end-of-life care when someone lacks health insurance? What sort of care can that uninsured person expect at the end of life? What good does it do to raise a ruckus around a general principle and not ask how the basic requirements of the sick can be met?

If a young woman is making up her mind about whether or not to have an abortion, is she not far more likely to choose life if she knows that she will receive decent health care while she is pregnant? Will she not feel more confident if she knows that both she and her baby will be able to see a doctor regularly after the child is born?

If we believe that all life is sacred, does that not mean that everyone should receive medical help in the early stages of an illness, before the illness becomes life-threatening? If we believe that human lives should not be bought and sold, doesn’t that require us to limit the impact that wealth and income have on access to life-enhancing and life-saving health care?

There is a terrible gap between the rhetoric people use in the health-care debate and the reality of our health-care situation. In particular, there is an enormous disconnect between the anti-government pronouncements we hear from opponents of universal coverage and the fact that government is already deeply enmeshed in our health-care system.

According to 2006 figures from the Organization for Economic Co-operation and Development, government expenditures on health care in the United States already amounted to 7 percent of our Gross Domestic Product. That was identical to the Canadian government’s share, and not far off from Sweden’s 7.8 percent, Germany’s 8.1 percent, or France’s 8.8 percent. In other words, our government already spends a great deal on health care, and yet 45 million to 50 million of us still lack regular insurance.

As a society, we agreed more than 40 years ago that it was unconscionable for the elderly to lack health coverage. With Medicare, we socialized—yes, I used that word—the provision of health care for all senior citizens.

Medicare is not perfect, but what a world of good it has done. But why offer that guarantee only to the elderly? Shouldn’t their children and grandchildren have the same right to regular medical care that they do? Isn’t that what the elderly themselves want? How can so many who say they oppose “government meddling” in health care at one moment go on to declare their firm support for Medicare at another? They cannot have it both ways, although they keep trying.

Medicaid has also brought needed care to many poor Americans. But isn’t there something terribly arbitrary about saying that one group of poor Americans can rely on government for help, while members of another group, nearly as needy, are left to fend for themselves? What principle is involved here?

One of the best pieces of legislation signed into law by President Obama this year was the substantial expansion of the Children’s Health Insurance Program. It was an excellent step in the right direction. But what do we say about the parents of those children? If a parent gets sick and has no health care, how does that affect a child—even if the child is insured?

There are many roads to universal coverage. There are many practical reasons—related to controlling costs to government, businesses, and individuals—for supporting reform. But the most compelling argument, finally, is moral: A country that values life should not be placing so many obstacles in the way of those seeking health care.

An essential book for this fall is T.R. Reid’s The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care. Reid, a former Washington Post reporter, embarked on an international search for better approaches to health coverage. Here’s what he concluded:

Those Americans who die or go broke because they happened to get sick represent a fundamental moral decision our country has made. Despite all the rights and privileges and entitlements that Americans enjoy today, we have never decided to provide medical care for everybody who needs it. In the world’s richest nation, we tolerate a health-care system that leads to large numbers of avoidable deaths and bankruptcies among our fellow citizens ...

All the other developed countries on earth have made a different moral decision. All the other countries like us—that is, wealthy, technologically advanced, industrialized democracies—guarantee medical care to anyone who gets sick. Countries that are just as committed as we are to equal opportunity, individual liberty, and the free market have concluded that everybody has a right to health care—and they provide it.

And we should, too.

E.J. Dionne Jr. is a syndicated columnist and senior fellow at The Brookings Institution in Washington, D.C.