The US government has a track record about as good on implementing successful social programs (effectiveness measured by fiscal responsibility and positive results) as Pol Pot had on humanitarianism. Or, as successful as Teddy Kennedy's on rescuing blondes who he'd driven into the pond off of Chappaquiddick (too soon?).
Social Security is ineffective and inefficient. Not to mention, it's almost completely bankrupt. Not to mention, I'm paying into the biggest Ponzi scheme the U.S. has ever seen, and so are you! The problem is that, eventually, the money is going to run out. Unfortunately for those defenders of the program, that time is coming very soon. Not to mention that it is wrought with fraud and abuse, costing several billion dollars per year (of yours and my money). Not to mention that the benefits are rarely necessary, and when they are, they're hardest to come by. Is any of this ethical?
I was raised on Welfare for a large portion of my childhood. Without going into the sob story (a story for which I'm eternally thankful, as it has made me a stronger, more willful person, and has led to a great deal of personal success... but that's not what this is about), I saw from the inside just how broken these programs are. Families that actually need benefits are often audited or denied, while others (like my own) are provided benefits despite the obvious (and gratuitous) abuse of the benefits. Without any screening or auditing, my family received benefits intended to take care of my siblings and me, and those dollars (and food stamps, etc.) went to drugs. Ironically, a private, Catholic charity finally got involved and offered both personal support AND actual, usable and enforceable benefits. Tell me, which one is ethical, and which one is abusive and unethical?
Private charities are struggling these days. Personal incomes are flat while expenses continue to rise, so donations are down. Government is trying to pay for impersonal (and relatively ineffective) programs by decreasing tax deductions for charitable donations (read: raising taxes). Because expenses increase while primary employment isn't providing higher incomes, many are seeking out secondary employment, taking away opportunities for volunteerism. Bureaucrats seem to be the only people getting pay increases these days (you know, other than our congressmen and women). Nevermind the fact that government makes private charity almost impossible in many cases. Thanks, government! :-)
Yet, despite being poorly funded and under-staffed, private charity has a track record (both statistically and from my own personal experience) that shines far brighter than government's. Churches (not all, but many) tend to have a more positive effect on the social and economic situation of a family than government programs, and they cost far less. Yet, churches are often restricted from receiving federal funding for programs unrelated to religious services simply because they're religious organizations (and, you know, because government wouldn't be able to take credit for the positive effects of their work). More homeless are housed in poorly funded (but well run) shelters run by religious and community organizations with little or no federal funding than are housed in public shelters that are relatively well funded, but horribly poorly run. More hungry Americans are fed by the generosity of middle-class (and even some of those stingy rich people) private citizens and private charities than by extensive (and expensive) public programs. More poorly-clothed Americans are clothed by Salvation Army volunteers and donors (along with hundreds of thousands of other private charities) than any government program. In fact, more sick Americans are treated with higher quality (and lower cost) emergency care in religiously-affiliated hospitals under charity care than are treated under a number of government programs at publicly funded (and poorly run) public clinics. And, these private charities all have a more positive net outcome (at least to the eyes of anyone honestly evaluating the situation) than their better-funded (you're welcome!) government counterparts.
Ethics (as used in this context) is that branch of philosophy dealing with values relating to human conduct, with respect to the rightness and wrongness of certain actions and to the goodness and badness of the motives and ends of such actions (thanks, dictionary.com!). So, ethics isn't only about motives, but also outcomes. While it is true that government programs are more far-reaching than most private charities, they are also far more wasteful and, on a case-by-case basis, less effective.
So, let's apply this to healthcare. We've yet to see our government have a charitable program (SSI, Medicare, Medicaid, CHIP in all its forms, Welfare in all its forms, Cash for Clunkers, VA, etc.) that has been measurably successful, especially, more so than its less-funded private counterparts. Let's assume that they dazzle us and make the largest (and fastest-implemented, if the Prez and his buddies have their way) public investment in our lives as effective as SSI. Benefits will be hard to get, bureaucrats will get in the way of treatment (maybe not "death panels", but coverage will be standardized on a wider scale than private insurance companies could dream of) and those who are currently insured will have less access to timely healthcare. While it is true that the poor would be less financially responsible for what medical treatment they require, it is also true that more Americans would then be responsible for more people's healthcare (in the form of new taxes or lower wages due to higher employer-side taxes), and would receive a lower quality product than they currently have.
Tell me, all of you fledgling ethicists: would it be less ethical to have 1/6 (being generous to those who like to quote inflated stats on the uninsured) of the country have access only to emergency care (as they currently do) while being fully financially responsible for it (due to lack of health insurance) or to lower the bar for the 5/6 of the country who have coverage currently and include the uninsured 1/6 in this lower quality product?
Intent is one thing. President Obama (at least on the surface) seems to have a genuine interest in doing what is best for the least fortunate Americans when it comes to healthcare. But, just because I want to save the world, if my plan is both unproven and unsustainable, does my intent make my actions ethical? Remember, just as productivity is not measured by intent, but return on investment, ethics are judged not only on intent, but on the ends of the actions taken. Universal healthcare is a wonderful dream, but it is not something we can pull off. The ethical thing to do would be to offer the best solution to the most amount of people.
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