Wanted: A Clearly Articulated Social Ethic for American Health Care

Classic Uwe Reinhardt piece: "Wanted: A Clearly Articulated Social Ethic for American Health Care."

From JAMA. 1997;278:1446-1447

Throughout the past 3 decades, Americans have been locked in a tenacious ideological debate whose essence can be distilled into the following pointed question: As a matter of national policy, and to the extent that a nation's health system can make it possible, should the child of a poor American family have the same chance of avoiding preventable illness or of being cured from a given illness as does the child of a rich American family?

The 'yeas' in all other industrialized nations had won that debate hands down decades ago, and these nations have worked hard to put in place health insurance and health care systems to match that predominant sentiment. In the United States, on the other hand, the 'nays' so far have carried the day. As a matter of conscious national policy, the United States always has and still does openly countenance the practice of rationing health care for millions of American children by their parents' ability to procure health insurance for the family or, if the family is uninsured, by their parents' willingness and ability to pay for health care out of their own pocket or, if the family is unable to pay, by the parents' willingness and ability to procure charity care in their role as health care beggars.

I think this is a great piece and I can't add anything to it and it is well worth the read. The responses in the letters section that followed are, sadly, very revealing about the debate then and now.

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