My friend and fellow economist, Kevin Frick (http://economistlens.blogspot.com/2009/09/moral-issue-or-economic-one.html), asks if the issues associated with health reform, particularly universal health insurance, are moral or economic and answers "both." I agree.
I think it was Plato who said that Ethics answers the question: How shall we live? Adam Smith, in Theory of Moral Sentiments, described the many aspects of what he called “sympathy” that would cause us to be concerned with the well-being of others. Amartya Sen, in his article Rational Fools, noted that if all we can offer those who have less is the guarantee that when all the trading is done, they will be in the “core of the economy,” i.e., the allocation is Pareto efficient, then we (and competitive markets) are not offering them much. In the same article, Sen described two conditions under which we would act in “sympathy” with others. One is purely self-interested and utilitarian, where our own well-being is enhanced by improvements in the well-being of others. Smith’s “impartial spectator” would probably also fall into this category since actions motivated by our IS contribute to self-love or self-approbation. Obvious examples are the overlapping utilities of families and friends, but could also include moral action that results in an improved sense of self-worth. The other is what Sen called “commitment” in which individuals are willing to act to improve the well-being of others even if it reduces their own well-being because of commitment to some higher principle, such as justice or fairness. Examples would be classically altruistic “Good Samaritan”-type behavior.
My friend, Kevin, is right that this "natural" tension between individual well-being and collective well-being must be resolved if the US is to answer the difficult questions about health care and how to allocate health resources. It is one aspect of a larger tension that must be resolved if the US is to remain a shining beacon of individual liberty and opportunity as well as democratic unity and discourse. Kevin is right that in order for it to be resolved we must take a broad perspective that includes both normative and positive aspects. Kevin is also right that economists are well-equipped to inform issues of economic side-effects and unintended consequences that have ethical impacts, in health and in finance and in many other areas that involve trade and commerce. And Kevin is right that we as a nation must begin and sustain intelligent, informed discourse aimed at answering Plato's question: How shall we (as a nation) live? One large part of that answer involves health and health care. Economics and ethics are both necessary to answer the question.
Comments