Monday, July 2, 2012

The Ethics and Economics of Health Care

by John W. Robbins


I would like to begin my talk on the ethics and economics of health care by telling two stories, one of which I am sure you have already heard.

A certain lawyer stood up and tested him, saying, “Teacher, what shall I do to inherit eternal life?”

He said to him, “What is written in the law? What is your reading of it?”

So he answered and said, “You shall love the Lord your God with all your heart, and with all your soul, and with all your strength, and with all your mind, and your neighbor as yourself.”

And he said to him, “You have answered rightly; do this and you will live.”

But he, wanting to justify himself, said to Jesus, “And who is my neighbor?”

Then Jesus answered and said, “A certain man went down from Jerusalem to Jericho, and fell among thieves, who stripped him of his clothing, wounded him, and departed, leaving him half dead.

“Now by chance a certain priest came down that road. And when he saw him, he passed by on the other side. Likewise a Levite, when he arrived at the place, came and looked, and passed by on the other side.

“But a certain Samaritan, as he journeyed, came where he was. And when he saw him, he had compassion on him, and went to him and bandaged his wounds, pouring on oil and wine; and he set him on his own animal, brought him to an inn and took care of him.

“On the next day, when he departed, he took out two denarii, and gave them to the innkeeper, and said to him, ‘Take care of him; and whatever more you spend, when I come again, I will repay you.’

“To which of these three do you think was neighbor to him who fell among thieves?”

And he said, “He who showed mercy on him.”

Then Jesus said to him, “Go and do likewise” (Luke 10:25-37).

Christ’s parable is a gold-mine of instructions about the ethics and economics of health care. Let me unpack a few of its implications.

First, the possession of health and the administration of health care are always individual. There are no such things as “national illness” or “national health care,” for nations cannot and do not get sick or injured; nations cannot and do not care; only individuals can and do.

Second, the politico-religious establishment, represented in the parable by the priest and Levite, is uninterested in actual health care. Perhaps the priest and the Levite were hurrying to a national health care discussion.

Third, the good Samaritan appears to be a businessman on a business trip: He had an animal; he was carrying oil, wine, and money; and he was making a round trip.

Fourth, the Samaritan businessman used his own resources and spent his own time helping the victim.

Fifth, the Samaritan businessman paid the innkeeper for his trouble. He apparently did not think that the innkeeper had an obligation to help him or the crime victim without being paid. The good Samaritan was not an altruist who believed that need creates an entitlement to the property of another. He acted out of compassion, not compulsion, and he did not try to compel anyone else to be kind.

Sixth, the Samaritan businessman spent the night in the inn with his victim, making sure he would recover, and after the emergency was past, he continued on his trip, leaving the victim in the care of the innkeeper. The good Samaritan did not organize a lobby to agitate for a National Health Plan, for that has nothing to do with love for one’s neighbor. Instead, he continues on about his business. This traveling Samaritan was the good neighbor by sharing both his own goods and his own time with the crime victim, and it is his example, not that of the political and religious leaders, that Christ commands us to imitate.

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