Other Points of View

Values, Health Care Reform, and Universal Participation

Mary Crowley, B.A.

N Engl J Med 2009; 361:e103September 3, 2009

Article

In his Perspective article in the July 30, 2009, issue of the Journal, 1 Brett was critical of an overreliance on one American value — choice — and argued that equity was at least as important. We at the Hastings Center (a nonpartisan bioethics research institute) believe that a sophisticated and nuanced account of values can and should be the beating heart of health care reform. To date, however, the nuts and bolts of reform have been front and center, while the underlying values have received scant attention or, worse, been used as cudgels to batter opponents. We need to engage in a deeper and more productive discussion about values so that reform is built on a solid foundation.

The relevant values range from justice to liberty to responsibility to stewardship. These values must be placed in historical and philosophical context before we can determine the policy implications for health care reform of taking each value seriously. For example, liberty can be freedom from being forced into a particular health plan or using a particular physician, but it can also be freedom to pursue a new career unhindered by fears that preexisting conditions will lead to “job lock” because of the need to retain employer-sponsored health insurance.

In an effort to explore these values and their ramifications, we recently published a collection of 11 essays, entitled Connecting American Values with Health Reform. The collection reinforces our belief that values can help us to balance coverage for all with individual responsibility. As Thomas Murray, president of the Hastings Center, writes in his introduction, “The concept [of] universal participation may be one whose time has finally come. The core idea is simple enough: Everyone should be responsible for participating in whatever way is appropriate; when anyone needs health care that is reasonably effective and not financially ruinous, the care will be there for them.”

Mary Crowley, B.A.
Hastings Center, Garrison, NY

This article (10.1056/NEJMopv0907334) was published on August 19, 2009, at NEJM.org.

References

References

1. 1

   Brett AS. “American values” -- a smoke screen in the debate on health care reform. N Engl J Med 2009;361:440-441
   Full Text | Web of Science | Medline