Acton Institute Powerblog

Healthcare–Don’t Forget the Morality of It

Share this article:
Join the Discussion:

One of the main arguments for nationalized health care is a moral argument: Health care is a right and a moral and just society should ensure that its people are taken care of–and the state has the responsibility to do this. Bracketing for the time being whether health care is actually a right or not–it is clearly a good, but all goods are not necessarily rights–whether the state should be the provider of it is another question.

But there is another question as well: It is often assumed that those arguing for national health care and socialized medicine have the moral high ground and those of us who oppose it are always arguing on economic terms. I would argue that this is a ground too easily given and not deserved. While the economics are pretty clear (see Hunter Baker’s post), the moral arguments against nationalized health care are sometimes overlooked. Here are a couple of reasons why nationalized health care is in fact not a morally pure as proponents would like us to believe.

1. Handing something off to the state so citizens don’t have to take responsibility for themselves and others doesn’t doesn’t really contribute to the moral fabric of a society.
We love to talk about solidarity and the common good but too often solidarity gets turned into “let the state take care of it.” A broader and I would argue morally rich concept of the solidarity and the common good would look to human flourishing and a rich civil society and turn to the state only as the last resort.

It hurts the common good to have the state take over responsibilities that we should bear ourselves or for our fellow citizens. A large nanny state contributes to the “individualism” that Tocqueville warned about: a turning into self that isolates us from everyone but our nearest circle. If the state does everything for us then we don’t need to care about our brothers and sisters and fellow citizens. This means the breakdown of guess what–solidarity. Solidarity is the driving principle behind subsidiarity, voluntary organizations, and charity. Love of neighbor should prompt us to help each other not pass it it off to the state.

From a moral point of view, having the state take over health care breaks down solidarity and harms the common good.

2. At least equally important–how moral is a health care system based on utilitarian cost benefit calculus and consequentialism? Not very, but that’s how nationalized healthcare operates.

Think about what this means for a minute. Health care decisions are made based on cost benefit and utility which itself puts us on dangerous moral ground. This danger becomes clear when when we realize the consequences. A utilitarian, data driven or what ever you want to call it system ends up by putting pressure on the weak and especially targets the disabled and the elderly. Why? Because if decisions are make based on utility then why would we want to spend health dollars on the disabled and the elderly when their “usefulness” is minimal. Keeping the elderly and the disabled alive costs money. For Christians or other who accept the inherent dignity of life the value of this is obvious, but for secular utilitarians and a utilitarian health care system this is a waste of money–which means that after a time within a national health care system, pressure will mount to euthanize the elderly and infirm. If this sound ridiculous and conspiratorial to you I suggest that you look at Europe and what is beginning to happen there. After years of population decline Europe is a demographic disaster and guess what? Euthanasia has been legalized in three countries (Holland, Belgium, and Luxembourg), is widely practiced in a fourth (Switzerland) and many pro-euthanasia advocates are starting to introduce cost-effectiveness arguments into their position.

The facts are that a state run health system, while sounding very moral, actually undermines the common good and ends up putting pressure on the unborn, the elderly, and the disabled.

Proponents of nationalized health care attempt to make emotional arguments because economic and medical data supporting their position doesn’t exist. Let us not grant them the moral high ground on this debate. Nationalized health care is scientifically, spiritually, and morally bankrupt—oh yes as Europe is demonstrating, financially bankrupt as well.

Michael Matheson Miller


  • Roger McKinney

    Excellent post!

    If I may add just one more potential argument: The state has a role in defending life, liberty and property and can legitimately collect taxes to perform those functions. But if it steps outside of its role, then taxation becomes theft.

    States can be immoral. Just read the Old Testament. Kings and princes in ancient Israel thought they had absolute authority and could do anything they wanted. God disagreed.

    States don’t have the right to do just anything that pops into the heads of bureacrats. Americans have fallen victim to the cult of democracy that says anything the majority decides is legitimate and good. But if the majority decides to take one man’s wealth and give it to others, that is theft and it doesn’t matter that the majority agreed to it.

  • Steve

    I have been working as a licensed nurse the past six years for the bulk of my living. I had to do it because of the DOC-COM bust. I am spread so thin labor wise it is immoral. People are not getting the level of care on par with what they have paid- the patients health care needs are not getting meet in a reasonable manner. I have to go go and go to do what I can to provide treatment for them -Yet My work is never done — only about 1/3. Thus, three times the labor would be needed to do the job . It appears that the money in the business just does not exist. Many nurses in Long-Term Care (LTC) are single Moms and women who could not get more training– they are aides and LPNs (one year training)– they are stuck in these jobs- These women have very little social power that is very little voice for change. Due to their social status their complaints do not motivate improvements among the powerful management. The labor shortages in LTC are amazing, and I see no change in sight.

  • You said: “Bracketing for the time being whether health care is actually a right or not–it is clearly a good, but all goods are not necessarily rights–whether the state should be the provider of it is another question.”

    In response, I would say that there is a negative right to health care. By that I mean that the citizen of the state should not be subjected to the states will when it comes to health care. A positive right would be where the state is obliged to act on behalf of its citizens. For example, military and police protection, property rights, right to legal counsel when accused, etc. are all obligations of the state to act on behalf of the citizen’s. Negative rights are where the state is obliged NOT to interfere, such as a citizen’s right to worship, right to keep and bear arms, freedom of speech, and in this care freedom from restrictions to access of health care.

  • political jules

    Excellent article and very well researched. I just have a bit of contstructive critisism. There are several repeated words and a few mispellings that I found when I cut and pasted the article to send to friends. Admittedly I am not the best speller in the world and do not have a good grasp of grammer, but my spell-checker and grammer-checker on outlook found the article’s mistakes. I just think the message (which is very good) might get lost when people start to find those kinds of little mistakes. Please know I am not trying to offend. Just trying to help get your message accross.

  • Uninsurable

    You made some good points, and I’ll be the first to agree that socialized medicine (as we’ve seen it happen in the rest of the world) is not desirable. And I understand that we should not pass the responsibility of individual citizens off to the state.

    However, when something simply ISN’T BEING DONE BY ANYONE, how is it immoral for the state to say, “Well, fine then; you citizens aren’t caring for the poor and uninsured adequately so we’re just going to have to step in”? I’m not saying that the government’s solution is the most efficient or the best alternative… but you can’t deny that we have a growing problem that isn’t being fixed.

    Incidentally, it’s not just the indigent who are suffering under the current system. I have tried to buy private insurance but am always told I’m uninsurable due to pre-existing conditions. Now, if that’s not a cost-benefit analysis, then I don’t know what is. I’ve just resigned myself to a mountain of medical debt that never goes away, because ongoing costs are so high. Maybe someday I’ll be lucky enough to marry someone whose insurance will cover me; or maybe the government will forbid private insurance companies from denying coverage to those who are willing to pay for it.

  • DavidW

    What would be a proper solution from a market perspective for Uninsurable and people with similar problems?
    Could there be a proper solution from the non-profit-sector which is so important, when it comes to other needs in society?
    And: Wouldn’t THAT be a place for the churches to step in in a joint effort?
    Remind you: in the beginning of the Church, it was in part that THEY cared for the sick and desperate, whereas nobody else did, which made the Church grow quickly.

    True, “why should Washington turn the health care industry upside down for all 300 million Americans in order to help 45.7 million? In fact, as Pacific Research Institute President Sally C. Pipes demonstrates, public policy should concentrate on a far smaller group of hard cases.”
    (@, quoting
    and Neo tells us her touching story, a strong argument pro-market: see August 3rd, 2009
    “Chronic pain, health insurance, and me”.

    But some are simply left out. A market-compatible solution? (deflating the government’s argument for interference?)

  • Roger McKinney

    The real problem with healthcare is its cost, and the state drives up costs by its intervention. In a truely free market, primary care physicians wouldn’t make $190k/yr, and surgeons wouldn’t make $500k because the supply of such doctors would drive down salaries. But the largest share of the medical bill goes to hospitals, who aren’t allowed to compete on price. Excess capacity in equipment with shortages in available hospital beds makes it possible for hospitals to charge $1,000/night.

    If the state did it’s real job and ensured a free market in healthcare, then costs would be dramatically lower and people would have an easier time paying bills. For those who still couldn’t pay, then charity should step up and help.

    In a free market, taxes would be much lower and individuals much wealthier, so they would have more money to give to charity. Total charitable giving in the US is about 2/3 of the federal budget, but most of it goes to education. If the state didn’t provide healthcare for the poor, charity probably would.

  • DavidW

    “If the state didn’t provide healthcare for the poor, charity probably would.”
    Two questions to that:
    1. Uninsurable might have a decent income, but still vastly exceeded by his medical bills. So, technically, he wouldn’t count as poor, in monetary terms. Who would help cover that?
    Shouln’t there be a chance to get insurance coverage? How could that look like under free market conditions?
    2….”charity probably would.”. But what for NOW?
    Are there initiatives? Is anybody around trying to forge such an initiative?

    Roger, thank you for your input by the way. Constructive and fact-oriented as I know it from your other posts. (… took notes of some.)

  • Roger McKinney

    David, Insurance was intended to restore people from the damage of random events. It only works with random events, like house fires. If you already have a medical condition, then you’re not seeking restoration from a random event, you’re seeking to shift your costs onto someone else. That’s sort of like trying to buy insurance on your house after it burned down.

    That’s another reason health insurance is so ridiculously expensive. The law keeps insurance companies from charging the elderly what they really cost, so younger, healthier people have to pick up the extra costs in their premiums.

    In a truely free healthcare market, Uninsurable’s costs might not exceed his income. But if they did, then the church and charity should be there to help out. However, keep in mind that his family has the first responsibility to help, also. We tend to forget family obligations in the West.

    As for now, some drug companies have efforts to help people who can’t pay for prescriptions. You can save a lot of money on prescription medicine by going to Mexico or buying from mail order. Hospitals overcharge insurance companies quite a bit so that they can afford to write off the bills of those without insurance. You can negotiate with most hospitals on charges.

    Then there are children’s hospitals, like St Jude and the Shriner’s hospitals that pay for the entire bill of sick children.

    Uninsurable needs to talk to family and church and get what help he can from them. Also, talk to the drug companies and negotiate with the hospitals. But I also don’t mind the state helping out people who have none of the options above. The state has messed up the healthcare system so badly that until it allows a free market it should help out those hurt the most by the damage it has done.

  • WDay

    Younger Healthier People get older!!! and will need more care as they age.

    Random Events.. Okay lets test everyone’s DNA, then we can say this person should not get health care because eventually he will die. Then why have insurance at all.

    Talk to family, church (ha! most churches do NOTHING, they are more interested in building projects). Talk to drug companies, yeh right like a multi billion dollar corporation is going to care, if the society does not care.


  • Roger McKinney

    WDay, Try to imagine a world in which people saved money in order to pay their own healcare bills in their old age. In that case, younger people would not have to subsidize the insurance premiums of older people, and insurance in general would cost less. Greater savings would make more funds available for businesses to invest in new equipment and new ventures, thereby increasing employment and wages and making saving for health care needs even easier.

    The current system focuses exclusively on consumption. No one saves. Young people transfer money to older people in order to subsidize their healchcare.

    In spite of what mainstream econ says, we cannot consume our way to prosperity.

  • marc

    WDay –

    Actually, I’d prefer that the government not take the social security money out of my paycheck in the first place. You work on that, m’kay?