As our nights lengthen into fall, darkness has also descended upon our country’s dialogue on National Health Reform. Positions have hardened, and the gulf has widened among our points of view. In this period of uncertainty, it is useful to revisit the underlying values that originally led us to undertake the long health reform journey, and to explore their implications. Our values are guideposts to action; they can also serve as points of reference to generate dialogue and consensus-building.
These values derive from several important sources. Specifically, they can be identified from our Constitution and its Amendments, from statements made by previous Presidents of the United States, from texts that describe the history of our country, and from our sense of fair play taught to every child in our schools. Hence, these values are pervasive in our culture, and they are very important in how we address our societal problems.
Applied to health reform, these values can be stated as follows:
Health is a human right. This is the primary foundational value that led us to undertake national health reform. It means that everyone ought to have a right to seek and to achieve the highest level of health possible for them. In that sense, it is like the right to pursue happiness. Happiness means different things to different people. So does good health. Our democratic Government has an obligation to assure and to defend our basic human rights, including our right to good health.
People are valued equally. This is a foundational value closely related to the first one. American society, itself, is based on this value. From this, we derive the principle of equal protection under the law, which is enshrined in the Constitution and its Amendments. Health disparities among groups due to different degrees of access to good quality care represent departures from this value, in which one group is valued more highly than another. These disparities can be based upon race, gender, income, religion, diagnosis, or any other social or health factor.
Social justice is necessary. This third foundational value is essential for maintenance of an egalitarian society. It is this value that led us to eliminate state religion and slavery from American society, since they represent gross departures from social justice. It is the value that prompts us to insist on national health reform.
Together, these values lead to the imperative that equitable access to good health care should be available to all Americans. In other words, if good health is a human right, and all people are valued equally, then social justice demands that, as a Nation, we pursue health reform.
Now, let’s take this framework and apply it to some of the arguments one is likely to encounter out in the street. Several come immediately to mind.
Insurance should not be mandated. This issue can be argued in the abstract, i.e. Federal vs. States’ rights. At that level, the Federal Government clearly has the right over States to mandate participation in the military; similarly, under the equal protection clause of our Constitution, it has an obligation to assure equal access to good health.