One of the things that makes the debate over health care policy so interesting is that it has such sweeping implications. We can look at the issue, for example, and ask economic questions, such as, "How much is the Affordable Care Act helping the economy?" We can look at the same issue and ask fiscal questions, such as, "How important is it that 'Obamacare' is reducing the national deficit by hundreds of billions of dollars?"
We can look at the issue from a political perspective. And an ideological perspective. And a sociological perspective. And given extreme circumstances, maybe even a national security perspective.
But at its root, for many involved in the debate, the angle that matters is a moral one. Policies like the ACA tend to do extremely well on substantive questions, and quite poorly on political ones, but when we strip away the layers, we're often left with the morality of either providing or denying families access to basic medical care. Confronted with the question, either the dial on your moral compass spins or it doesn't.
This came up in a big way over the weekend, when the American Enterprise Institute's Michael R. Strain made a curious argument about mortality rates in the Washington Post. The headline on the piece read, "End Obamacare, and people could die. That's okay."
In a world of scarce resources, a slightly higher mortality rate is an acceptable price to pay for certain goals -- including more cash for other programs, such as those that help the poor; less government coercion and more individual liberty; more health-care choice for consumers, allowing them to find plans that better fit their needs; more money for taxpayers to spend themselves; and less federal health-care spending. This opinion is not immoral. Such choices are inevitable. They are made all the time.
In fairness to Strain, he almost certainly did not write the jarringly callous headline, but he did write this quoted excerpt. In fact, his piece went on to say that if Republican policymakers successfully repealed the federal health care reform law, it "could" result in more American deaths, "but it clearly would not be immoral."
I can appreciate why Strain feels the need to make this case. For proponents of reform, there's considerable focus on consequences: if Republicans -- either on the Supreme Court or in Congress -- destroy the law, the potential for catastrophic shockwaves are quite real. As a practical reality, if millions of families are stripped of the benefits, an untold number of Americans will die unnecessarily. Their crime? They got sick.