A Multi-ethical Response to the Universal Health Care Debate

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copyright by Dillon Naber Cruz

The issue of providing single payer universal health care for all American citizens is surprisingly contentious and has lead to many heated arguments among people who find themselves on opposite sides of the issue. I have heard everything from the idea that healthcare is a human right and that no one should go bankrupt because of a medical issue to arguments from others who proclaim that universal health care is socialism and takes away or limits our freedoms. The arguments against it are surprising to me given that our neighbor to the north provides universal coverage to its citizens as do many of America’s allies in Europe, many of whom rank much higher in the indices of happiness as measured by the Sustainable Development Solutions Network of the United Nations. (1) America is experiencing a drastic drop in rates of happiness, in large measure because of an insistence upon policies that promote economic growth while subsequently cutting social support benefits thus creating angst among American citizens. Nordic countries experience much greater happiness despite lower GDP (2) and the long, cold winters of their northern latitudes. Scandinavian countries feel happier in some respects because they need not fear losing everything as a result of injury, illness, or the birth of a child.

The focus of this essay is to answer the question, “Should the U.S. guarantee health care to all of its citizens that is sufficient to cover all of their medical needs?” I will be arguing in favor of so doing from both the deontological and teleological ethical frameworks. Briefly defined, deontological ethics are those focused upon rules, and teleological ethics are based upon the consequences of a given action. For example, from a deontological perspective one might say, we must drive the posted speed limit regardless of circumstance because that is the law; while from a teleological perspective one might say, it is important to drive the speed limit because doing so lessens the number of accidents and helps to save our limited fossil fuel resources. Thus my argument in favor of single payer universal health care for all Americans from a deontological perspective will be focused on certain rules already in place within the government and within Abrahamic religions and from a teleological perspective will be focused on a variety of outcomes some of which have already been shown elsewhere to be favorable.

The Deontological Case for Universal Health Care

The law in the United States requires its citizens to pay income taxes based upon how much one makes in wages, salary, interest earned on certificates of deposit or savings accounts, as well as earnings from the stock market, inheritance, or winnings from legalized gambling. Because this is the law of the land we as citizens must pay our taxes whether we, or the Republicans and Libertarians amongst us, like it or not. Taxes are a fact of life and the money generated in taxes goes towards a wide variety of social services that make the United States a “first world nation.” From a Kantian perspective (3) then, the intention is for the government to use the revenue generated from income taxes to run the machinery of government for the benefit of American citizens while providing services to the public in the areas of national defense, veteran’s programs, the State department and foreign aid, disaster relief, social welfare programs such as food stamps, infrastructure, medicare, and medicaid, as well as transportation, social security, and funding NASA amongst others. Americans therefore have a moral obligation to pay their taxes to help run the government so that the government can provide the services to society that it intends to provide.

Taking this one step further, paying taxes can be seen as a Kantian categorical imperative in that doing so should always be applied to those who make enough money to pay taxes for the reasons outlined above. Do I want everyone who earns enough taxable income to pay taxes in order that the government can function as intended so as to provide the societal benefits that tax dollars finance? Yes I do, therefore paying taxes should be a universal maxim that everyone who makes enough taxable income should follow. (4)

From a deontological perspective then it has been established that we must pay our taxes. That in turn begs the question, where should those monies be applied? How to answer that question for people of faith seems relatively easy to me. What does our scriptural tradition say? Rosenstand notes that the Golden Rule is “certainly one of the most widespread rules of ethics in existence, finding expression in religions and moral teachings throughout recorded history.” (5) This is certainly the case within Judaism and its offshoots Christianity, Islam, and the Baha’i faiths. As one who is both culturally and a practicing Christian, albeit imperfectly, I will focus on the expressions of the Golden Rule as found within the Jewish scriptures and other writings as well as those in the Christian testament. (6) Leviticus 19:18b commands that Jews “shall love your neighbor as yourself” while in Tobit 4:15 it reads, “And what you hate, do not do to anyone.” (7) The Talmud says, “What is hateful to you, do not to your fellow man. This is the law: all the rest is commentary” Talmud, Shabbat 31a. (8) Jesus of Nazareth seemingly concurred with this Talmudic statement in Matthew 7:12 where he is said to have stated, “In everything do to others as you would have them do unto you; for this is the law and the prophets” and again in Luke 6:31 he offers the maxim, “Do to others as you would have them do to you.” (9) He further expands on this theme in the prelude to the parable of the Good Samaritan when the lawyer responds to Jesus’ question with quotes from Deuteronomy 6:5 (“You shall love the LORD your God with all your heart, and all your soul, and all your might.”) in conjunction with the afore quoted Leviticus 19:18. Our neighbors according to Jesus are even those people whom we may otherwise despise as was the case between Jews and Samaritans in Jesus’ day. These passages show that the Golden Rule and its close scriptural cousin, the Greatest Commandment, are foundational to the Christian faith and find their roots in the the Jewish scriptures and other writings that Jesus quoted. They are also nearly, if not completely universal maxims as is attested by their presence in some form in faiths as disparate as Hinduism and Satanism. (10) Because these rules are so foundational to Christianity and Judaism it is incumbent upon Christians and Jews alike to follow them for it is a religious duty for adherents of those faiths.

According to the Pew Research center, Christians as of 2014 make up almost 71% of the U.S. population. Other religious faiths make up nearly 6% of the population while those who identify as atheist, agnostic, or nothing in particular make up the remaining almost 23%. (11) Those numbers point to an overwhelming majority of the American population who by their own admission identify with faiths which have as a foundational tenet the Golden Rule. Because this is the case then, it follows that the adherents of those faiths, be they political representatives or constituents, should as a matter of course want their tax dollars to go towards programs such as universal health care. I know of no person who would want themselves or family members to be at risk of going bankrupt due to inadequate health insurance. I know of no person who would like to face paying the excessive costs of buying out of pocket health coverage in the wake of losing a job during difficult economic times. I know no person who would want a loved one or dear friend to die simply because the costs of treatment are too high to pay for. In other words, I do not want myself or any of my family members to be put in the position of financial ruin or premature death because healthcare is too expensive. Therefore, I want my tax dollars to be reallocated so that all Americans regardless of age or economic status are fully covered and according to my understanding of the Golden Rule all Christians should want the same thing. We cannot avoid taxes so let us pay taxes in ways that allow us as people of faith to follow our faith more assiduously.

The Teleological Argument for Universal Health Care

We now turn to the teleological or consequentialist ethical argument for universal health care. One of teleological ethics champions was Aristotle who believed that to be virtuous was to be happy. (12) Utilitarianism’s proponents on the other hand see their “moral guideline a rule that encourages them to make life bearable for as many people as possible.” (13) Another way of looking at teleological ethics is to say that “the ends justifies the means” and do those results save more than the harm potentially created. In other words, does it work? (14) What would be the consequences of Americans applying the Golden Rule in regards to providing single payer universal health care for all American citizens?

As previously mentioned, Americans are becoming less happy despite comparatively high income levels and standard of living. In 2017, the predominant global superpower and self styled greatest nation on Earth ranked 14th in happiness having dropped down one place from 2016. Co-editor of the World Happiness report, Jeffrey Sachs, stated, “As demonstrated by many countries, this report gives evidence that happiness is a result of creating strong social foundations. It’s time to build social trust and healthy lives, not guns or walls. Let’s hold our leaders to this fact.” (15) Given that health and happiness go hand in hand (16) it is not surprising that Scandinavian countries with universal health care rank so high on the list of World’s Happiest Countries (though that is not the only reason for their happiness.) (17) Also notable is the fact that in rich nations mental health issues are highly problematic (18) and it can readily be inferred then that without adequate health care those mental health problems cannot be addressed appropriately thus leading to further unhappiness. In light of these facts, it stands to reason that one of the consequences of universal health care would be an increase in the happiness of American citizens and with all the benefits being happy provides, that can only be a good thing.

Looking beyond the borders of the United States, implementing single payer universal health care could benefit the global community as well if the budget for national defense was drastically reduced in order to pay for the implementation of single payer universal health care. In recent years according to Politifact.com, discretionary spending on the U.S. military takes up 54% of the budget while overall spending on “defense” is at around 16% while discretionary spending on health and human services is at 9% and overall spending in that category is at 28%. (19) For 2017, the discretionary spending budget for the Department of Defense proposed by the Obama administration was $582.7 billion. (20) If Christians take Jesus’ teachings in the Sermon on the Mount seriously, this number must needs be seen as obscene in light of the fact that U.S. has not been invaded by a foreign power since 1812 and was last attacked by a foreign country on “American” soil in 1941. (21) Additionally, the United States outspends the next several countries combined in terms of “defense” spending.

Further consideration too must be given to the fact that war is a money making scheme and often robs military members of their lives or all too frequently leaves their bodies and minds irreparably damaged. Major General Smedley Butler, who retired from the Marine Corps after 33 years of service as the most decorated Marine in history, proclaimed that war is a racket that seeks only to enrich a few people without regard to the cost in lives. (22) The consequences of America’s interventionist military policies at home and abroad is absolutely staggering in terms of lives lost, physical and mental injuries such as PTSD, not to mention the ecological degradation, infrastructure destruction, and loss of historically and culturally important sites and artifacts that results from dropping tons and tons of ordinance on poor people in countries who are no threat to the people or landscape of the United States of America. In President Barack Obama’s last year in office alone, the American armed forces dropped 26,171 bombs (23) and just this week it was reported that in Mosul American bombs inflicted an estimated 200 civilian casualties there, (24) one of many such murderous incidents within the past several decades. This kind of state sponsored terrorism is a direct violation of the Golden Rule, the Greatest Commandment, and Jesus’ other teachings regarding peace and treatment of the poor and marginalized, who are most often the hardest hit by war as is evidenced by the current refugee crisis. I know of no sane person who would want bombs to be dropped in American cities,  nor do I know anyone who would want to sacrifice a family member or friend so that a defense contractor can increase its earnings for its shareholders. I can imagine no one if full possession of the facts that would say adding another $50 plus billion to the DoD budget would be a good idea. Why then would Christians sanction the dropping of bombs upon our neighbors elsewhere?

Reallocating funds from the bloated $582.7 billion discretionary budget for the Department of Defense to a comprehensive single payer universal health care program for all Americans would doubtless have a substantial effect on the nation and the world. Americans should have an informed say in where their tax dollars go and currently that say is far too small because of politicians in league with war profiteers and the media outlets who are enriched by increased advertising revenue when reporting on military actions abroad. A healthier America would be a happier America and we could use a boost in happiness as is plain to see by the anger being shouted from people of various political views. With universal health care people with preexisting conditions could get them treated, and those who are waylaid by illness or injury would know that they at the very least have true access to excellent care and therefore a good chance of recovery if the conditions are not terminal.

The ripple effects globally would be far reaching once the U.S. contracted the size and scope of its military and military operations around the world. As of 2015 there were over 150,000 members of the U.S. Armed Forces stationed overseas. (25) Bringing those troops home and having them serve here in a variety of capacities such as infrastructure improvement, disaster relief, and other ways of utilizing their military occupations would benefit local economies and communities as well as costing less. Fewer military operations and dropped bombs benefits everyone and would no doubt go a long way towards improving America’s standing internationally. America’s Christians would also be able to implement more faithfully the basic tenets of the faith personally and at a national level thus becoming more virtuous Christians that treat their neighbors with the love that Jesus said we are to enact towards our neighbors and our supposed enemies. Providing universal health care is a good place to start that process.

My View

The above arguments constitute my actual view regarding universal health care. I  lived in the United Kingdom for two years and while their system at that time was not perfect, it was far superior to the system in the United States in that no one went bankrupt or died because they could not afford to pay. I believe that healthcare is a human right that should be given to all people without regard to ability to pay out of pocket. As taxes are a fact of life, I want to see tax dollars going towards things that are uplifting to individuals and to our society at large. I take the Greatest Commandment and Golden Rule seriously. These basic tenets of my faith are the rubric from which I attempt to live my life and how I want to see Christians around the world engage with our neighbors. I am also a firm believer that to be a Christian is to be a pacifist because that is what Jesus explicitly taught and he is my locus of authority in matters of faith. Though I am only just beginning to understand mimetic theory, I have enough of a grasp on in it to believe that we must make non-violence the root of our behavior so that it can be mimicked by people around us thereby ending the horrific cycles of violence around us thereby making more people agents of shalom. (26)

Being non-violent as a nation would mean that we could spend hundreds of billions less on warmongering and resource grabbing around the world and use that money to take care of the ‘least of these’ along with everyone else in America. We have systems in place that can facilitate the allocation of funds into a single payer universal health care system. America can benefit from looking at the models in place in other nations whose universal health care programs are already successful and serving their citizens well.

In addition to major cuts to the DoD budget, it is imperative to increase the tax income from corporate profits. Too many companies are making huge sums of money and then exploiting loopholes to avoid paying much if anything in taxes. (27) Once again Norway can provide knowledge in this area because their corporate tax revenue as a percentage of their GDP is the highest in the world and four times higher than the United States’ rate. (28) They also taxed corporations at 25% as of 2016. (29) If companies making billions in profits annually were taxed at 25% then tax revenue would clearly increase exponentially making funds available for programs of social uplift rather than war. We as a nation are approaching spiritual death as a result of the nation’s spending habits and constant cuts to social safety nets. (30)

Cutting the “defense budget” and taxing profitable corporations responsibly would move the US political scene from the Randian ethics espoused by Republicans such as Paul Ryan to a much more overtly progressive one that would finally put people over profits. I firmly believe too, that those who have been duped by the Randian wolves in sheep’s clothing, would soon see the virtue in social safety nets when people become happier, healthier, and less riddled with angst and anger. It is of course anachronistic to suggest that Jesus would have been a progressive politician but I cannot read the gospels and be anything other than a progressive in today’s postmodern world and that for me means advocating for single payer universal health care among other social safety nets designed to help the least of these who are Christ’s children.

(1)  Jeffrey D.Sachs. “Restoring American Happiness” in The World Happiness Report eds. John Helliwell, Richard Layard, and Jeffrey Sachs.  https://s3.amazonaws.com/sdsn-whr2017/HR17-Ch7_lr.pdf,  accessed 3/27/2017.

(2)  Jeffrey D.Sachs. “Restoring American Happiness” in The World Happiness Report eds. John Helliwell, Richard Layard, and Jeffrey Sachs.  https://s3.amazonaws.com/sdsn-whr2017/HR17-Ch7_lr.pdf,  accessed 3/27/2017

(3) Nina Rosenstand. The Moral of the Story: An Introduction to Ethics 7th edition, (McGraw Hill: New York, NY, 2013,) 282-3.

(4) Rosenstand, The Moral of the Story, 286.

(5) Rosenstand, The Moral of the Story, 573.

(6) I use the term Christian testament as opposed to New Testament because I am uncomfortable with the term “Old Testament” to refer to the scriptural writings of the Hebrew people. Without an old there can be no new.

(7) Leviticus 19:18, Tobit 4:15, quoted from The New Oxford Annotated Bible: New Revised Standard Version with the Apocrypha, (NOAB4) ed. Michael Coogan, (Oxford University Press: Oxford, 2010,) 171, 1375.

(8) Ontario Consultants on Religious Tolerance. “The “Golden Rule” (a.k.a. Ethics of Reciprocity)Part 1: Passages in religious texts in 14 faiths from the Bahá’í Faith to Satanism” http://www.religioustolerance.org/reciproc2.htm, accessed 3/27/2017.

(9) NOAB4, 1756, 1841.

(10) ReligiousTolerance.org http://www.religioustolerance.org/reciproc2.htm, accessed 3/27/2017.

(11) Pew Research Center, “America’s Changing Religious Landscape.” http://www.pewforum.org/2015/05/12/americas-changing-religious-landscape/, accessed 3/27/2017.

(12) Rosenstand, The Moral of the Story, 457.

(13) Rosenstand, The Moral of the Story, 231.

(14) Dr. Lee Barrett, Ethics class lecture, Lancaster Theological Seminary, 2/15/2017.

(15) Katia Hetter. “Where are the World’s Happiest Countries,” http://www.cnn.com/2017/03/20/travel/worlds-happiest-countries-united-nations-2017/index.html, accessed 3/27/2017.

(16) Carol Graham. “Happiness and Health: Lessons-and questions- for public policy.” on http://content.healthaffairs.org/content/27/1/72.full, accessed 3/27/2017.

(17) New York Health Insurers Daily blog roll.  “The world’s happiest countries and their health care systems” September 13, 2013, https://www.nyhealthinsurer.com/2013/blog/the-worlds-happiest-countries-and-their-health-care-systems/, accessed 3/27/2017.

(18) Richard Layard quoted in “Where are the World’s Happiest Countries,” http://www.cnn.com/2017/03/20/travel/worlds-happiest-countries-united-nations-2017/index.html, accessed 3/27/2017.

(19) Lois Jacobson. “Pie chart on ‘federal spending’ circulating on the Internet is misleading.” August 17, 2015 on http://www.politifact.com/truth-o-meter/statements/2015/aug/17/facebook-posts/pie-chart-federal-spending-circulating-internet-mi/, accessed 3/27/2017.

(20) U.S. Department of Defense Press Release. February 9, 2016 Release No. NR-046-16 https://www.defense.gov/News/News-Releases/News-Release-View/Article/652687/department-of-defense-dod-releases-fiscal-year-2017-presidents-budget-proposal, accessed 3/27/2017.

(21) I place American in quotes here because while Hawai’i was a U.S. territory in 1941, it was illegally annexed in 1893 largely at the behest of Sanford P. Dole, the pineapple magnate. Having lived for 7 years in the Hawaiian Islands studied Hawaiian history and being a liberation theologian I am sensitive to the injustices perpetrated against the native Hawaiians whose lands were stolen without recompense and without giving Native Hawaiians the same federal recognition that other indigenous peoples get.

(22) Smedley Butler. War is a Racket, https://www.ratical.org/ratville/CAH/warisaracket.html, accessed 3/27/2017.

(23) Medea Benjamin, “America dropped 26,171 bombs in 2016. What a bloody end to Obama’s reign.” The Guardian Online US ed. https://www.theguardian.com/commentisfree/2017/jan/09/america-dropped-26171-bombs-2016-obama-legacy, accessed 3/27/2017.

(24) Tim Arango and Helene Cooper. “U.S. Investigating Mosul Strikes Said to Have Killed Up to 200 Civilians” New York Times Online, March 24, 2017. https://www.nytimes.com/2017/03/24/world/middleeast/us-iraq-mosul-investigation-airstrike-civilian-deaths.html, accessed 3/27/2017.

(25) Julia Zorthian and Heather Jones. “This graphic shows where US troops are stationed around the world.” Time. October 16, 2015. http://time.com/4075458/afghanistan-drawdown-obama-troops/, accessed 3/27/20107.

(26) For more on mimetic theory from a Christian perspective see Michael Hardin’s The Jesus Driven Life: Reconnecting Humanity with Jesus 2nd ed. (JDL Press: Lancaster, 2013.)

(27) Mike Krantz. “27 giant profitable companies paid no taxes.” USA Today, March 7, 2016. http://www.usatoday.com/story/money/markets/2016/03/07/27-giant-profitable-companies-paid-no-taxes/81399094/, accessed 3/27/2017.

(28) Mark Provost. “US Fiscal Debate Could Learn From Norway.” Truth Out, February 8, 2013. http://www.truth-out.org/opinion/item/14434-us-fiscal-debate-could-learn-from-norway, accessed 3/27/2017.

(29) Trading Economics. “Norway Corporate Tax Rate 1981-2017.” http://www.tradingeconomics.com/norway/corporate-tax-rate, accessed March 27, 2017.

(30) Dr. Martin Luther King, Jr. “Beyond Vietnam: A time to break the silence.” April 4, 1967. http://kingencyclopedia.stanford.edu/encyclopedia/documentsentry/doc_beyond_vietnam/, accessed 3/27/2017.



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