American Values and Health Care Reform

With the national debate over health care reform careening between tired, well-rehearsed talking points, on the one hand, and deep-in-the-weeds debates over technical details, initiatives, and financing mechanisms, on the other, many people find themselves feeling frustrated and left out of the conversation. Yet most thoughtful Americans would have something meaningful to say about the values we should choose for the foundation of our system of health care.1 And by focusing on these fundamental considerations, perhaps we can deepen and broaden the discussion of values and public policy.
There is a broad range of values that we want our health care system to embody and pursue — not just liberty but also justice and fairness, responsibility, medical progress, privacy, and physician integrity, among others. These values have concrete, practical implications for our health care system. Two key implications concern money: Should every American be required to participate in health insurance? What are our obligations to ensure that the resources devoted to health care will be used wisely? The values of fairness and responsibility point to the need for a system of universal participation. Serious concern for the values of quality, efficiency, and health underscore the need to ensure good stewardship of our health care dollars.

Thomas H. Murray, Ph.D.  Posted by NEJM • December 23rd, 2009