Healthcare Reform: Confounding Moral Obligation and Supererogation

In the aftermath of signing the new healthcare bill into law this March, President Obama has presumptuously hailed the reform a measure that “represents a basic middle-of-the-road solution to a very serious problem” as well as one that “incorporates ideas from both Democrats and Republicans.”[1] Really? What “middle-of-the-road” solution fails to gain even an inkling of Republican support in both the House and Senate, and, at the same time, results in a third of the country going to court? Indeed, from Alabama to Idaho, Florida to Washington, fourteen states in all are challenging the constitutionality of the new health care law, which offers subsidies to help low-income people buy insurance and imposes financial penalties on those who do not comply by 2014. [2]

Attorney generals claim that the Patient Protection and Affordable Care Act encroaches on the sovereignty of states. Because the Constitution does not contain a mandate that requires citizens to have health coverage, the power to decide should be reserved to the states, as explained by the Tenth Amendment.[3] Virginia is also filing its independent lawsuit, based on the Virginia Health Care Freedom Act passed with bipartisan support earlier this month, which states “no individual, with several specific exceptions, can be required to purchase health insurance coverage.” [4]Clearly, momentum is growing to block the changes as the reform continues to be challenged on legal grounds.

Unfortunately, legal issues are not the only ones that surround the Patient Protection and Affordable Care Act. Ethical questions must also be taken into consideration. Let us suppose that people do not consider mandatory healthcare an issue — that they are willing to have the government mandate health coverage for every citizen. In fact, it is probable that the majority of the 32 million uninsured Americans will support such a plan. But does wanting healthcare entail a moral and legal right to it? It does not, especially if the bill is estimated to cost taxpayers $938 billion over the next ten years. (You might want to have your w-4 calc handy!) Nevertheless, many may make the argument that the tax increases only impact the wealthier population, namely individuals who earn at or above the $200,000 threshold and couples who collectively earn at or above the $250,000 threshold. [5]

Certainly, people with incomes in these ranges may not be significantly impacted by these tax increases to help the poor. Nonetheless, they should not be required by the government to do so. Consider a simple example. Two kids are eating lunch at school. One child finds to his delight several pieces of candy in his lunchbox while the other finds no such treats. While the less fortunate child longingly looks at the candies, the lucky child needs to decide whether to share. In this case, one can certainly say that it is better if the child shares. However, it is absurd to claim that the child is morally obligated to share because while sharing is good, the act is supererogatory and thus not morally required to be done. Still, supporters of the new healthcare reform may resort to the argument that only the wealthiest of individuals will be impact by the tax increases, and that these increases will truly be only trivially impactful, if at all. Though such an assumption may be true, it is nonetheless irrelevant to the argument. Consider again the previous example. If one child finds ten pieces of candies instead of a mere several, he would still not be morally required to share with the other child because the candies belong to him; he is entitled to and have a right to them. Similarly, people have a right to their income, given that it is obtained through just means. There is no logical reason to believe that this right diminishes as the magnitude of one’s earnings increases. It is also important to make a distinction between increased taxation on the affluent in order to make healthcare more affordable to everyone and other types of taxation such as those that help maintain public works including roads and bridges. The latter kind need not be scrutinized because it is not redistributive in nature and thus does not impact people with varied incomes differently to give anyone an unearned advantage.

Another argument proponents of the healthcare reform may find appealing is the idea that as members of a functioning society, people have a right to be healthy as it is strongly correlated to less controversial rights including those to life and happiness. Although this premise may be supportable, the conclusion that people have a right to healthcare is unsound because the right to be healthy does not entail the right to healthcare. The distinction is essentially one between a negative and a positive right. The former right is negative because it requires others to refrain from interfering with the right. For instance, a healthy individual has the right to remain healthy; others must respect this right by refraining from causing the individual bodily harm.

Healthcare, however, is a positive right, if it is a right at all, because it requires others to act in order to uphold the right. In this case, higher taxes are required of individuals who earn above certain threshold salaries. The following problem then arises: In protecting certain people’s positive right to healthcare, others’ negative right to their own property, in this case earnings, is compromised. Despite this seemingly irresolvable conflict, there is reason to believe that negative rights outweigh positive rights, mainly for the reason that refraining from violating others’ rights is a basic moral obligation while actively doing good deeds to protect others’ positive rights appears beyond the call of one’ moral duty. Certainly, society may advance to become more virtuous and less calloused in the future, and what we deem supererogatory deeds currently may one day be considered morally obligated ones. As for now, the President should value public opinion more and idealize complex situations less; perhaps then would he realize the impracticality and ill-suited nature of universal healthcare in the US at the present time.


[1]. Nicholas, Peter and Michael Muskal. 2010. “Obama Still Stumping for Healthcare” Los Angeles Times.

[2], [3]. CNN Wire Staff. 2010. “14 States Sue to Block Health Care Law” CNN.

[4]. McDonnell, Bob. 2010. “Governor McDonnell Signs Virginia Healthcare Freedom Act Legislation”

[5]. Khan, Huma. 2010. “Health Care Bill: What Does it Mean for You?” ABC News.