Ross is right to come down on Ezra for reckless and irresponsible hyperventilating on health care. But let me dot the i here.

Ezra Klein kicked up a hornet’s nest of controversy by accusing Lieberman of being “willing to cause the deaths of hundreds of thousands of people in order to settle an old electoral score.” That “hundreds of thousands” refers to the number of Americans who die every decade because they don’t have health insurance — or rather, it refers to one study’s estimate of that number. Other studies , cited by Michael Cannon and John Goodman , suggest that the number is considerably closer to zero — or else that the link between health insurance and mortality might be too murky too penetrate. But of course there are still other studies that tend to confirm Ezra’s numbers . . .

Anyway, without trying to adjudicate these competing claims, I’ll just say that I would be very surprised if extending health insurance coverage didn’t have some positive effect on life expectancy for the newly-insured. And what’s more, I think liberals are absolutely right to be laying their emphasis on this point: It’s the best argument (and, indeed, increasingly the only argument ) in favor of the current legislation. But I think Ezra’s missing the point when he acts puzzled that anyone who accepts his statistics would object to the way he went after Lieberman.

[ . . . ]

In this regard, the claim that “health care reform will save lives” is very, very different from the statement that “opponents of health care legislation are willing to let hundreds of thousands of Americans die.” The two may be factually similar, but only the latter waves the bloody shirt. And the bloody shirt is the enemy of both reasonable debate and good lawmaking. It’s a conversation-killer, and a policy destroyer.


Ross is too kind in allowing Ezra’s original language — Lieberman will cause people to die — to translate freely with the more accurate language of letting people die. This isn’t simply a matter of grammar or style. Ezra did not attack Lieberman for supporting a bill which would merely get out of the way while some significant number of Americans happened to die. He attacked him for seeming “willing to cause the deaths of hundreds of thousands of people in order to settle an old electoral score.” Anyone who doesn’t support the right bill, you see, is killing Americans. And since this is obvious, you see, anyone who doesn’t support the right bill wants to kill those Americans, and wants them to die.

This is more than moral grandstanding or shirt-waving. It’s an intentional distortion of an ethical precept at the very foundation of our philosophy of law. It’s a lie mobilized to discredit one’s political opponents, not just politically but morally. In truth, of course, to kill a bill that would prevent people from dying is not to kill those people — just as refraining from saving a person in mortal peril is not causing them to die. Any law student who didn’t sleep through torts can tell you this distinction is essential. Though it rankles morally, the fundamental legal and philosophical distinction between letting somebody die and causing their death avoids the systemic injustice involved in forcing individuals to be Good Samaritans. Two key points emerge. We must be free not to act morally in order to act morally. And the sort of discernment that enables individuals to decide whether or not to act in a specific moral instance cannot be properly cultivated without that freedom. I suppose there’s a third point: we ought to continue to live in a world in which individuals can and do cultivate that kind of moral discernment.

All this can’t be bulldozed away in the name of any piece of legislation, or in the name of preventing any kind of present or future suffering. That’s not to suggest that Republicans or conservatives or whomever should pretend that Democratic health care reform wouldn’t actually lessen or eliminate the suffering of some number of Americans or save some statistically significant number of lives. The problem is that knowing this doesn’t settle the issue of whether it’s the right reform. Where Ross sees a conversation-stopper in the claim that opposing the current bill means being willing to let people die, I see the start of a crucial conversation. After all, as Ross notes, “Every side of every debate [ . . . ] can plausibly accuse its opponents of being ‘objectively pro-death.’” Nobody really requires that every policy and every law be structured above all to maximize the prevention of suffering and death, because, ultimately, the minimization of suffering and death is not the purpose of politics or even the definition of justice.

None of which is to say, to be sure, that we have no moral interest in mitigating suffering or decreasing our number of untimely deaths. We have a profound and inescapable moral interest, of course; one which conflicts in likewise inescapable fashion with our interest in political liberty and prudent governance. Ultimately, the stewardship of those goods has a moral character of its own. To speak and act as if there is no moral tension at the heart of the politics of health care is to give in to the temptation to deny that we ourselves, as citizens and human beings, have to suffer that tension.

Articles by James Poulos

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