A Response to Atul Gawande, re The Morality of President Obama's Healthcare Law

As expected from someone as brilliant and thoughtful as Atul Gawande, his recent piece (link below) on the morality of President Obama’s healthcare act was an insightful read.


And on a personal level I will confess that over the past couple of months, I’ve had a few unique interactions that have brought home the human-side of healthcare access and pre-existing conditions.  These are deeply personal issue, with truly complex moral dimensions.

But that doesn’t help Gawande’s attempt to belittle the “jeopardy” argument against the President’s healthcare law. The fact remains that we are in the early innings of a global debt-crisis, where the “developed” world’s unsustainable financial commitments are finally being challenged by the people needed to finance them. The inevitable default & deleveraging process that has started is still in its early innings, but it is already impacting economic growth.  And the worst-is-yet-to-come.

In the US specifically, prior to this new healthcare entitlement being enacted, the existing debt + new deficits + unfunded liabilities were absolutely staggering relative to the resources (GDP) required to finance them.  Further, tomorrow’s tax-paying citizens not only have so much financial capacity but also have limits as to how much pain and reduced economic opportunity they’ll be willing to tolerate, while today’s fixed income investors are not going to tolerate a decreasing risk/reward profile on their Treasury investments forever.

Which is why I’m convinced that adding a new and very large entitlement “on top of the pile” was an act of fiscal lunacy.  Only a madman would have added a new entitlement to a society that was already this overcommitted.  I’m sure that sounds rhetorical, but I’ve carefully chosen the words “lunatic” and “madman” as accurate qualitative descriptions given the underlying quantitative drivers.

Although the new HC entitlement is technically “paid for”, and technically “reduces the deficit”, it does so only by cutting spending and raising taxes that could have otherwise been used to help (partially help) reduce the unfunded liabilities that already existed prior to the new healthcare law.  It’s a fantasy to think that this new law improved the fiscal health of the county.

What I guess I’m trying to say here is that the existing context matters when considering any new potential commitment.  That’s true in your personal life as well as in your career; whether it’s a private enterprise or a government.  And as sure as Gawande’s footing likely is as he describes the high costs of the many uninsured, I seriously doubt he understands the fiscal & monetary context here.  How else to describe such a flippant response to it?

But I know the math.  And it ain’t pretty.

So whether it’s Barack Obama or Atul Gawande, the bottom-line for me is that I’ve lost interest in being condescended to as some sort of neanderthal for being both 1) fiscally literate and 2) morally concerned that people who are counting on the existing entitlements are set to receive way less than they’re currently expecting. Not to mention the reduced economic opportunity all of these commitments will mean for just about anyone under 60.  But hey, I guess those other moral considerations aren’t as “wicked” a problem as access to healthcare.
President Obama’s healthcare law is, at best, morally questionable.  Though in-truth I personally find it to be deeply immoral. How can promising things that can’t be delivered, building people’s expectations around a safety net that won’t be there, all while reducing economic opportunity possibly be ethical?