The health-care debate has caused a hurricane of hyperbole and hyperventilation.
Jerry Springer, the talk show host, compared Trumpcare to 9/11, saying that the Republican health-care act “will end up killing many more Americans than Osama bin Laden ever did.” Bernie Sanders has warned, “36,000 will die yearly” as a result of repealing Obamacare. A Washington Post headline stated, “Repealing the Affordable Care Act will kill more than 43,000 people annually.”
The rhetoric on the other side is equally heated. An article in the conservative National Review estimated that in 2015 there were 80,000 more deaths under Obamacare. This story took off in far right corners of the Internet under the headline “Obamacare Kills People.”
Data referenced on this topic are complicated, to say the least. The deaths under Obamacare cited in the National Review are linked to a general decrease in life expectancy in 2015. To conclude that Obamacare caused that decline is problematic. To imply that Obamacare actively killed people is absurd.
Killing usually involves an agent or direct cause. Insurance – or its lack – does not kill people.
But it also problematic to say, as Idaho congressman Raúl Labrador did this week to a chorus of boos, “Nobody dies because they don’t have access to health care.” That seems obviously false. People do die when they lack health care. But that does not mean that they are actively killed.
Killing usually involves an agent or direct cause. A shark or a gunman can kill you. Health care may make death more or less likely. But insurance – or its lack – does not kill people. Rather, the underlying disease does the killing.
Complex debates in medical ethics focus on the difference between killing and letting die. At the end of life, it may be permissible to withhold or withdraw treatment and let someone die. But in the United States, we don’t permit actively killing people to put them out of their misery. Not everyone agrees about this. Some argue that active euthanasia is more humane than letting someone slowly die. Others argue that we should always make heroic efforts to preserve life.
Out intuitions about euthanasia may help us decide whether health insurance is a basic right or something extra or heroic.
If quality insurance is extra special but not required, then removing it is not morally problematic. We are not required to be nice to people. We are only required not to violate their rights. We are not required to keep people alive. We are only required not to kill them.
On the other hand, if we think that health care is a right, then it would be wrong not to provide it. If there is a right to health care, then removing it is like depriving someone of oxygen or water.
In the heated health-care debate, the important question is who – if anyone – is to blame when people die from lack of health care.
Medical ethics also focus on the intentions behind our deeds. We ought to intend to benefit patients and fulfill their wishes. Killing becomes murder when there are malicious intentions.
So what are the intentions behind the health-care debate?
Liberals argue that Republicans intend to benefit the rich through tax cuts. But do Republicans actually intend to harm the poor? That is very unlikely. Republicans claim they want to benefit people and provide better care.
The question of intention is vexing. A person’s intentions are often unclear, even to themselves. We often have mixed motives. We can lie to ourselves. And as the proverb teaches, the road to hell is paved with good intentions.
In the heated health-care debate, the important question is who – if anyone – is to blame when people die from lack of health care. The related question is who – if anyone – has an obligation to save people from dying.
Liberals tend to think that society has an obligation to care for the sick. Conservatives tend to think that people should take care of themselves.
Now let’s return to Jerry Springer’s invidious comparison between Trumpcare and 9/11. More people may die without health care than were killed on 9/11. But that compares apples and oranges. Terrorists deliberately kill innocent people. Republican legislators do not have that intention.
Loose language and partisanship undermine critical thinking. Some provocateurs seem intent on killing rational debate with hyperbolic outbursts. The rest of us allow reasonable discussion to die when we fail to think critically and refuse to find common ground.
Andrew Fiala is a professor of philosophy and director of The Ethics Center at Fresno State: @PhilosophyFiala