Since the release of the 2006 Census results, the American public has been inundated with media campaigns such as the American Medical Association’s (AMA) “Voice for the Uninsured” campaign. A variety of interest groups, associations, and politicians— including but not limited to HealthCare-NOW, the American Medical Student Association, Senator Hillary Clinton (D-NY), and John Edwards—have argued that the 47 million Americans without health insurance is an unfair byproduct of our society and have pushed to institute universal healthcare. Senator Hillary Clinton (D-NY) declared this September, “That is the tragedy at the heart of our health care system—The devastation when one stroke of bad luck undoes a lifetime of hard work…The only way to guarantee affordable coverage for everyone is to cover everyone, and that is the choice we need for America.”

The AMA media campaign argues that the uninsured have no voice, as depicted by the AMA ads in USA Today, Newsweek, the New York Times, and US News and World Report, all of which show uninsured Americans whose mouths are covered by a stethoscope. “1 out of 7 doesn’t have health insurance…But we all have a voice. And a Vote,” reads one ad.  The AMA website encourages Americans to “vote with these issues in mind in November 2008 and help drive change in the American health care system.”

But West Virginia University Professor Daniel Shapiro questions whether current welfare policies even bring quantifiable benefits to American society.  His new book, Is the Welfare State Justified?, examines the philosophical underpinnings of government programs such as Social Security, Medicaid and Medicare, and Temporary Assistance to Needy Families (TANF).

Shapiro argued at an October CATO book forum that the antecedents of egalitarianism, which stresses “fairness” as the highest social virtue, have produced policies out of sync with their original ethical reasoning. “The key idea in contemporary egalitarianism is that inequalities which arise through no choice or fault of one’s own are unfair and should be rectified in some way,” said Shapiro. This produces a dichotomy within egalitarian thought. On one hand, some people are disadvantaged because of “bad, brute luck” including socioeconomic status, mental and physical disabilities, or they attend schools which provide poor education. In such cases, egalitarians argue that disadvantaged individuals are “entitled to compensation,” argues Shapiro.

Shapiro asserted that the other, less touted conclusion of egalitarianism is that “Where people make genuine choices, we need as a matter of respect for the person’s individual rights and fairness requires that people be held accountable for the cost of their choices.” “And the flip side of this for egalitarians is that people actually have a right to their advantages that have been obtained that way,” he added. If one considers lifestyle choices such as eating unhealthy foods, smoking, and sedentary living legitimate choices exercised by a free public, then allowing Americans to suffer the consequences of lacking health insurance might also then fall into this second category of “fairness.”

Some economists believe that Census data indicates that many Americans have voluntarily opted out of health insurance.  Presidential Economic Advisor and Harvard Professor of Economics, N. Gregory Mankiw wrote in a November New York Times column that the projected 47 million uninsured includes “about 10 million residents who are not American citizens,” as well as 18 million individuals from households earning $50,000 or more annually. In addition, he notes, the inflated numbers include “millions of the poor who are eligible for Medicaid but have not yet applied,” ending with a “few percent of the population of 300 million” American citizens actually involuntarily uninsured without government-sponsored recourse. He urges policymakers to “carefully focus on [the involuntarily uninsured] to avoid disrupting the vast majority for whom the system is working.”

Instituting a universal healthcare system would undermine citizen’s positive rights by placing their healthcare choices under bureaucratic government control, argues Shapiro. “All national health insurance [programs] promise a very general right to medically-necessary care….or right to access whatever the system offers. However, judicial remedies when care is denied are non-existent or weak,” in countries with universal healthcare systems, he says. Shapiro also believes that such a system would benefit the rich and well-connected, many of whom would be able to afford better, more prompt healthcare. “You have to ask yourself, who is going to get to the front of the line?,” he said. It’s certainly not going to be poor West Virginians, he argues.

In addition, studies show that reliance on government welfare programs may also contribute to higher levels of depression among Americans. According to the University of Michigan 2001 Panel Study of Income Dynamics (PSID), Americans on welfare were more than twice as likely to feel “worthless” or “hopeless.” “Holding constant all of one’s personal characteristics, including whether or not one is employed, we find that receipt of public assistance by itself pushes up the chances of saying you have been inconsolably sad over the past month by about 16 percentage points,” writes American Journal writer Arthur. C. Brooks on the subject. “No other single factor—not income, age, education, or anything else—comes close to predicting this much of one’s unhappiness,” he added in his September article, “I Love My Work.”

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