Reframing the Health Care Debate

As health care reform lurches forward uncertainly, with the special election of Massachusetts Senator Scott Brown giving Republicans enough votes to block the passage of the reform bill in its current form, The New England Journal of Medicine has published a very thoughtful Perspective called "American Values and Health Care Reform."

The term "values" has been a battering ram for both political parties for so long, each side claiming that their values are better than the other's, that the word itself makes me a little nauseous. But Thomas H. Murray, Ph.D., the author of the Perspective, offers a different interpretation of the word. He argues that the values that Americans like to think they hold, such as liberty, fairness, and responsibility, are not applied evenly throughout the health care system. This inconsistency is an ethical, moral and financial loss for all Americans.

Do we really value liberty, Murray asks, when so many people are shackled to jobs they dislike because they need access to employer-sponsored health insurance? For example,

Under our current system, a young entrepreneur with a brilliant idea for a new business, a creative vision that can create jobs and wealth, can't necessarily follow that vision: if this person has a job at a large firm that provides good health insurance and has a child or a spouse with a chronic illness, the aspiring entrepreneur's freedom to pursue his or her dream is severely limited by the "job lock" imposed by our current patchwork of health insurance. The catch-22 of insurance underwriting for preexisting conditions is likely to make insurance unaffordable or unattainable for such a family on its own.

Similarly, Congress passed the 1986 Emergency Medical Treatment and Labor Act so that anyone in need can get emergency medical care, whether or not they have insurance, demonstrating that Americans feel responsible for others in dire circumstances. "Yet our achievements do not always live up to our values," Murray writes. "Consider the 20,000 people each year who, according to the Institute of Medicine, die for want of health insurance."

Americans need to see health care as a common good that benefits us all, not an individual choice. Murray writes that we need to pitch in to finance health care for everyone, and work together to make health care more efficient and effective.

Maybe calmer heads will prevail if we reframe health care reform as a reflection of our best instincts as Americans, rather than a political fight or a battle between individual and community rights.