‘The Good Place’ and What We Owe to Each Other in Health Care: Brainstorm Health

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Hello and happy Friday, readers!

The fourth and final season of The Good Place premiered on NBC last night. The show, one of my recent favorites, has a not-so-classical sitcom premise. (It behooves me to say right now—SPOILERS AHEAD, so run away if you plan to watch the show unencumbered by the knowledge of what goes down, and you can catch the first three seasons on Netflix while keeping up with the latest one on Hulu and other services.)

OK, with that warning out of the way… Here’s the gist: A motley crew of individuals including a self-professed Arizona trash bag (Eleanor, played by Kristen Bell), a philosophy professor whose intellectual hangups prevent him from taking any meaningful action in his relationships (Chidi, played by William Jackson Harper), a kind-yet-dumb Florida man who can’t seem to avoid comically unfortunate capers (Jason, played by Manny Jacinto), and a talented-but-elitist narcissist with a serious inferiority complex about her parents and sister (Tahani, played by Jameela Jamil), wind up together in the afterlife. Initially, they all believe they’re in the “Good Place,” an iteration of Heaven inhabited by those who have rung up enough morality points to justify their membership.

The twist, revealed at the end of the first season (again, SPOILERS!), is that our “heroes” aren’t in Heaven at all. They’re actually in the “Bad Place,” and they’ve been locked in with one another because an ageless demon named Michael who runs the joint (played impeccably by Ted Danson) thinks this would be the ultimate form of torture—forcing a group of completely incompatible people to deal with each other for eternity (as Sartre wrote, Hell is other people).

This would be a hilarious and fascinating premise unto itself. But what makes The Good Place so interesting is what comes next. At its heart, the show is about moral philosophy and the ethics of living in a society with one another. Chidi, the professor and philosophy nerd, winds up trying to teach his co-habitants—and himself, and even the reforming demon played by Danson—on how to be a good person who can actually make it to the Good Place despite their past sins.

It’s heady stuff for a network comedy. Philosophers ranging from Kant to Hobbes, and explications of their philosophies, are central to the series. But the real question driving the show is: What do we owe to each other?

It’s a query based, in large part, on one of the tomes on moral philosophy, by former Harvard professor T.M. Scanlon—aptly dubbed, “What We Owe to Each Other.” (This was literally the title of one of the show’s seminal episodes.) And, with this wonderful program heading for the exits, I can’t help but wonder… How do we answer that question when it comes to health care?

This is a business publication, and we strive to leave the politics to the politicians. But the fact is that there’s an election underway and leaders from across the political spectrum are offering up their views on which policies they believe are just and fair when reforming the medical industry. (The question of whether or not American health care needs reforming appears to have a resounding, bipartisan answer: Yes.)

So how might their proposals play in to the ethical debates of The Good Place?

Scanlon is largely associated with the concept of “contractualism,” which he presents as a unified theory of social morality (a concept that, interestingly enough, he holds distinct from plain old “morality” itself—for instance, what we owe to a friend or family member may differ from what we owe to society at large).

His book is thought provoking, if dense, delving into fundamental philosophical questions like, What makes an action right rather than wrong? How do we come to an agreement on such issues on both a personal and societal basis? How can you justify one course of action over another to your fellow human beings?

These questions are integral to how we shape a philosophy of health policy. For instance: Is access to health care a fundamental right that we owe to each other? And, if so, how far do our responsibilities go? (A related sidenote: The fact that Scanlon’s book is entitled “What We Owe to Each Other,” rather than “Do We Owe Something to Each Other?” is telling.)

Advocates of full-on Medicare for All and single payer proposals, the most extreme versions of which would ensure free medical services for everyone in exchange for collective tax payments by society, would likely answer that we should approach societal health care policy in the same way we approach the issue for our own families. Would you make benevolent payments in order to save your parents from medical bankruptcy, or to make sure they could access a basic level of care comparable to those of greater means?

On the flip side, there’s the issue of personal responsibility. Is a complete stranger’s illness truly my concern if I did nothing to cause it? Or is that notion far more complicated—for instance, does my participation in a system which may breed environmental catastrophe that makes people sick or favor the rich over the poor a responsibility I should assume? Are capitalistic incentives—such as work requirements for Medicaid beneficiaries, or wellness goals in corporate health programs—a reasonable ask of our fellow human beings?

Scanlon might answer that what we truly owe to each other is whatever cannot be reasonably rejected by others in society. He’s neither a socialist nor a libertarian by nature; instead, he tries to present a unified theory of moral action that preserves a baseline of equality without asking everyone to be a saint.

Shaping that into a theory of health care policy is as complicated as the work of distinguishing right from wrong itself. Clearly, I don’t have the answers. But I’m glad that a show like The Good Place is asking these kinds of questions, even if not specifically about the industry I cover.

I’d love to hear your thoughts on this. Read on for the day’s news, and I hope you have a wonderful weekend.

Sy Mukherjee, @the_sy_guy, sayak.mukherjee@fortune.com


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