Here's the very basic question I ask when evaluating any reform of the health-care system: what are the moral principles that stand under the proposed system and drive its inevitably tough choices?
Given the answer to this question, I ask another: what system of laws, regulations, incentives, etc. will be used to implement these moral principles?
In the current debate it seems to me that the proposals under review are based on a highly objectionable utilitarianism; that is, the reforms proposed rely on a variety of cost-benefit analyses that require those making medical decisions to commodify human life. If those making the decisions are not the ones who will suffer the consequences of the decisions made, then the utilitarianism in use becomes nothing short of immoral.
If, as a 95 year old Dominican friar, I decide to forego cancer treatment that will cost my province $150,000, that's my right as a person. However, having this decision made by a government accountant is simply wrong. I may use cost-benefit analysis to determine whether or not I will receive medical treatment. The government cannot. If the argument is made that the government will be paying for the treatment, therefore the government gets to decide on the treatment's value for my life, then I would retort: get the government out of the health-care business!
My fundamental worry is this: I simply do not trust the government to do the right thing, meaning I do think that the government is the proper body for deciding on the relative value of medical treatments. In order to be fair, such decisions would have to be made on objective criteria. We can't have the government deciding life and death issues based on circumstance and intention. This breeds injustice and inequality. Given this, it falls to bureaucrats to establish objective guidelines for decision-making, guidelines that ignore everything that makes me a person created in the image and likeness of God by placing a monetary value on my life. I am reduced to the value of my life expectancy and weighed against monetary costs of extending my life beyond a pre-determined point.
At some point between now (at 45 years old) and my expected age for death, I reach a tipping-point and become an potentially expensive liability to the public treasury. And the only thing that seems to matter is my age. Wholly ignored as irrevelant in the decision-making process is my potential to create something of value after a certain age; and worst of all, my inherent value as a person created by God to flourish is never even considered. Under a utilitarian cost-benefit analysis this inherent worth has no monetary value whatsoever.
So, do the proposals currently under debate respect the inherent worth of the individual person created and sustained by a loving God? Are the proposed medical decision-making processes grounded in the notion that patients have the freedom of conscience inherent to being persons? Will these processes reduce the person to a monetary value or treat persons as inherently valuable?
I don't think so.