Ethics in the American Counseling Association

Ethical Perspectives

The Affordable Care Act was enacted to address a number of issues in the American health care system. Some of the more prominent objectives of the Act are to increase the number of Americans who have health coverage and to the reduce the overall cost of health care in the United States. A two-pronged approach was used to address the latter. The government will use its bargaining power to drive down costs of many services government pays for, and the use of health care exchanges will increase consumer bargaining power in health insurance, which again should over time reduce the cost of health care (HHS, 2014). It was believed that there was urgency with respect to the timing of the ACA's passage. There was political urgency to be certain since the Democrats held a supermajority and could only reliably hold that for two years, but there was also ethical urgency because of the 40 million Americans who didn't have health insurance. If those people's needs were not addressed, it might be another twenty years or more before another similar opportunity came about.

In order to make the structure of the law work, the ACA features a controversial element known as the individual mandate. This states that all Americans need to have health insurance, either through their employer, through a government plan like Medicare or Medicaid, or buy purchasing insurance on the open market. The individual mandate is rooted in economics, not ethics, in that by widening the pool of people paying for health care, many profitable (i.e. young and healthy) individuals are compelled to purchase health insurance (or pay a fine) in order that insurance companies can remain profitable while taking on many new, unprofitable customers such as those with pre-existing conditions. Because it was not designed with ethics in mind, the individual mandate runs into some questionable ethical ground, while at the same time it exists as a tradeoff for the greatly expanded coverage and reduced bargaining power of insurance companies. This paper will examine the ethics of the ACA in the context of these two major issues, using the frameworks provided by Kant and Locke.

Kant

Kant's standard of morality revolves around the categorical imperative, and an immoral act is one that violates this imperative. The definition of the categorical imperative is therefore important to the application of Kantian morality to the features of the Affordable Care Act. The categorical imperative can be ill-defined, but as a society we set out laws and it is thus our duty to obey them. Such rationale should probably only apply to democracies where the law reflects the will of the people, and even then only when the laws do not result in direct harm. Further under Kantian morality, we cannot forfeit our own moral goodness in order to obtain some desirable object (Johnson, 2008). Individuals have free will, according to Kant, but are bound by duty in how that will is exercised.

When Kant's moral philosophy is applied to the ACA, it supports the key tenets of the law. First, Kant's moral philosophy fairly clearly applies to the idea of expanding health care coverage, and the idea of lowering its cost. When we enact laws that have the effect of limiting the access to health care of tens of millions of Americans, we benefit from such laws in that many businesses within the health care industry are profitable. Large parts of the U.S. medical system in general, with a for-profit model, deliberately exclude these uninsured, and bring unto them tremendous harm. They often die and suffer where such death and suffering could have been prevented. . The profit motive, under Kantian philosophy, is insufficient to justify bringing so much suffering to so many people. The ACA does not by any means fully resolve this, but it makes strides towards addressing this critical issue of morality. The individual mandate is similar -- where the profit of one individual leads to the suffering of another, the suffering takes precedence -- the money is not as important. Not doing harm to others is the more important imperative, so the sacrifice for the greater good in this case would be the moral course of action according to Kant.

Locke

Locke's moral philosophy comprises two parts. The first is natural law, in that there are divine laws, they are obligatory and humans can understand these. The second is more hedonistic, that pleasures and pains serve to "provide morality with its normative force" (Sheridan, 2011). That these two views seem to contrast is well-established and indeed they lead to different interpretations of the key tenets of the Affordable Care Act. The natural law would hold that one should ensure, if possible, that all people have access to health care. As far a divine law is specified, you are supposed to love thy neighbor, and in wealthy nations it is entirely possible to provide this without undue hardship -- and the individual mandate might certainly reduce the wealth of some but it is unlikely to induce genuine hardship. Thus, the ACA is ethical within the bounds of natural law.