Adam Smith meets the rich young ruler

For more than sixty years American presidents have tried to reform our health-care system, to no avail. In the same time period, all other developed nations have set up systems that insure all their citizens, that spend less per capita than we do, and that have better outcomes in almost all categories. Why are American still lagging behind?

Ethicist Daniel Callahan diagnoses our problem in the most recent issue of Commonweal magazine and comes to this conclusion: we suffer from “the absence in this country of a solid common-good tradition.”

In his thoughtful article "America' Blind Spot: Health Care & the Common Good," Callahan points out that the absence of a common-good tradition is not ideologically based—it is felt at all points on the political spectrum. “In their opposition to liberal reform efforts,” Callahan writes, “conservatives invoke freedom, choice, and competition as their leading values. Liberals—and the Obama administration in particular—have no agreed-upon set of countervailing values.”

Instead of the common good, says Callahan, liberals have appealed to rights, obligations, and justice—fine concepts, but without much curb appeal. Conservatives invoke radical individualism, even though one of their heroes, Adam Smith,

believed that markets could not flourish without a strong underlying moral culture. Smith believed that such a culture is animated by empathy and fellow-feeling, by our ability to understand our common bond as human beings and to recognize the needs of others.

And all of us argue about the bottom line.

Sunday’s Gospel reading was about a man who asked Jesus what he needed to do to inherit eternal life. Jesus told him to sell his possessions and give them to the poor. “At that statement his face fell, and he went away sad, for he had many possessions” (Mark 10:22).

I confess: I don’t want the poor to take any more of my possessions. I pay taxes. I give to charities. In the wake of the recession, our income has taken a serious hit, and a tax increase would hurt. I would much rather offer the poor someone else’s possessions. Why not help them, as many European countries do, by restricting doctors’ income and insurers’ profits?

Strangely, my cardiologist’s office doesn’t want to lose any of its possessions either. A recent mailing urges patients to oppose health-care reform and Medicare changes, warning that their lives may be endangered if cardiologists are prevented from making big bucks from overusing expensive diagnostic equipment (this is not, of course, how they phrase it).

Oddly enough, insurance companies would like to hang on to their possessions too (though almost everybody in America thinks that Aetna’s CEO probably doesn’t need every cent of the more than $24 million he made in 2008). No wonder they are doing their best to scare us into keeping the present system.

Without a shared belief in the common good, who among us will go first? Or will we do nothing, hang on to our possessions, and go away sad, leaving health care unreformed and the poor uncared for?

Here is how Callahan concludes his fine analysis:

Suffering, disease, and death are our common lot. They ought to be dealt with as our common problem. It is a shame that the kind of empathy and mutual support that Adam Smith understood to be a requirement of morality have not, in our culture, been extended to health care—extended to one another in the recognition that we all have bodies that go awry and fail. Instead we are offered a consumer model, a national Walmart of medical choice where we are all sharp-eyed purchasers getting the best possible deal for ourselves. A construal of the common good as the freedom of consumers to get what they want, indifferent to the fate of others, is a cheap substitute for the real thing.

Callahan expertly diagnoses our problem, but he does not offer a solution. National revival comes to mind, but America already has a much higher percentage of church-going Christians than the countries that take care of all their poor and suffering. Maybe we won’t really care about the common good until more of us Americans experience poverty and suffering first hand.