In Bioethics Forum, Daniel Callahan took issue with Amitai Etzioni's article in Dissent, "A Moral Assessment of the Attack on Social Safety Nets."
"Amitai Etzioni, a prominent social scientist and leader of a communitarian movement, published an article in Dissent in February arguing that it would be “immoral” to cut Medicare or Social Security benefits unless we first eliminate a range of pathologies in our health care system. “If we must make cuts,” he wrote, “we ought first to cut those budget items that in effect pay for harmful activities and then those without discernible social benefits.” He had in mind such long-time villains as excessive administrative overhead, waste and fraud, direct-to-consumer advertising, unnecessary treatments, and medical error.
"He was right to identify those failings, all of which reflect a bad health care system. And as a fellow communitarian, I welcome his support for a solid and equitable social safety net. But are those on the other side of the aisle “immoral”? At what point does a political issue or position pass from simply being unfair, wrong-headed, or dangerous in some way or other, to being immoral?"
Read the rest of Callahan's comments here.
Amitai Etzioni responded:
Daniel Callahan’s commentary about my article in Dissent shows that even a bioethics giant, and a fellow communitarian, can make a mistake, and not a trivial one. Sadly he is not alone in adopting a culturally relativistic definition of what is moral. (The co-editor of Dissent, Michael Walzer, also holds that the community is the ultimate arbiter of that which is right.) And hence, of course, when there is no consensus, there are no moral standards and we are told there is nothing on which to base our moral judgments.
As I see it, there is a limited set of universal moral truths—human rights, for instance. Life and health over death and illness in all but exceptional circumstances, for example. These truths are, as the founding fathers put it so well, self evident. (As a deontologist would put it, these are moral causes that speak to us directly.) In the subject at hand, I need no community to approve a standard that will inform me that if one has a choice between saving money by cutting reimbursement for beneficial procedures, say kidney dialysis, or cutting the funds that pay doctors who run two CTs on the same patient on the same day or blowing money because insurers refuse to use the same claim form—which is the moral direction to go. It may not be politically practical, but there is no question what is right. (And the fact that one may find some very limited conditions under which the suggested statement will not hold just shows that some philosophers are sharp, not that we lack foundations for moral judgments).
Callahan correctly points out that I use normative arguments for a political purpose. All political acts and decisions have a moral dimension and if we do not judge, it will not stop others from laying moral claims, just mute our side. Moreover, it is this bad? I am trying to shame and lose votes for those who pass immoral laws that provide obscene profits to health insurers and exorbitant salaries for their executives while cutting funds for health care for poor children and many more such policies. I stand content to be judged accordingly.
Callahan truly crosses a line when he jumps from my position that some people make immoral choices —to argue that they must be bad people (his non sequitur), and therefore accuses me of ad hominem attacks. As I see it there are some bad people, those who have no moral conscience, the psychopaths. Most people struggle between their debased and nobler sides, and I am out to give whatever support I can to their better angels.
For more discussion, see Amitai Etzioni, “On Communitarian and Global Sources of Legitimacy,” The Review of Politics, 73 (2011): 105-122.