In June, President Barack Obama said that providing Americans with affordable health insurance is “an economic imperative, but it’s also a moral imperative.”

Harris Sherline

Harris Sherline

Immanuel Kant defined moral imperative as a principle that compels that person to act, saying it’s a kind of categorical imperative. Later thinkers took the imperative to originate in conscience, as the divine voice speaking through the human spirit. The dictates of conscience are simply right and often resist further justification.

However, the idea that providing affordable health care is a moral imperative raises a number of questions: At what cost, or regardless of the cost? Are there other moral imperatives that are of equal importance to society, such as food, clothing, shelter (housing) or education?

After all, we can’t or shouldn’t allow people to go hungry or sleep on the streets, right? What about transportation? Should the society at large provide free transportation for everyone, with bus or subway fares, or should the government give a car to everyone who “needs” one, including the cost of maintenance and insurance?

At a Sept. 10 interfaith meeting in Tampa, Fla., spiritual leaders from a number of denominations, including Episcopal, Jewish, Islamic, Metropolitan Community Church, Unitarian Universalist and United Church of Christ, united to advocate for health-care reform as a moral imperative. The Rev. Leddy Hammock said, “If anyone is vulnerable to suffering, we are all vulnerable, we all suffer. For the sake of our common humanity, let us call upon our collective intelligence to create a health-care system that is inclusive, affordable, accessible and accountable.”

Unfortunately, the terms “affordable, accessible and accountable” are all subjective. They can mean almost anything to anyone at any point in time.

The meeting concluded with the following statement: “We, the undersigned, serve several religious and spiritual communities … Our faith traditions teach us that care and compassion for the sick and injured is a basic human responsibility rooted in the foundational principle of affirming human worth and dignity. We believe that the crisis of American health care is not merely an economic or social or political problem — it is a moral problem that confronts us all. As people of faith, we envision a society where each person is afforded human dignity, health and wholeness.”

However, columnist Thomas Sowell recently noted: “What sense does it make to ‘hurry up and wait’ on something that is literally a matter of life and death? If we do not believe that the president is stupid, then what do we believe? The only reasonable alternative seems to be that he wanted to get this massive government takeover of medical care passed into law before the public understood what was in it. Moreover, he wanted to get re-elected in 2012 before the public experienced what its actual consequences would be. Unfortunately, this way of doing things is all too typical of the way this administration.”

What else may be considered a moral imperative? Does fiscal responsibility qualify? What about honesty?

Should we provide health care for everyone even if it breaks the bank? What then? Would that be a case of two moral imperatives coming into conflict?

Proponents of the notion that providing health care for all is a “moral imperative” don’t seem to be bothered by the fact that it may be so costly that it can only be paid for by reducing services to others who have health insurance, such as seniors who are covered by Medicare, or by massive deficit spending, or both. And, if financial solvency is also a “moral imperative” because it affects the entire population, does health care trump when the two imperatives are in conflict? How about taxation?

Writing in the Washington Post on Sept. 14, economist Robert Samuelson said: “Americans generally want three things from their health-care system. First, they think that everyone has a moral right to needed care; that suggests universal insurance. Second, they want choice; they want to select their doctors — and want doctors to determine treatment. Finally, people want costs controlled; health care shouldn’t consume all private compensation or taxes.”

Note that Samuelson uses the expression “moral right” as opposed to “moral imperative,” which seems to be a difference without a distinction. Either way, when it comes to health care, we seem to be caught in a web of moral choices that simply can’t co-exist in the same political policy environment.

At least one “right” or “imperative” is bound to be violated in the process of resolving the nation’s health-care dilemma. What then?

— Harris R. Sherline is a retired CPA and former chairman and CEO of Santa Ynez Valley Hospital who has lived in Santa Barbara County for more than 30 years. He stays active writing opinion columns and his blog,