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January 24, 2011

Health Care Reform: Values and Beliefs vs Economics

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Udow Phillips2014

Marianne Udow-Phillips

Director
Center for Healthcare Research & Transformation

Ever since Bill Clinton took a turn at health care reform, the issue has often been discussed as an economic one. Bill Clinton first framed the health reform issue in 1992 before he took office. He had famously kept as a center piece of his campaign the idea that “it’s the economy, stupid” and health care became part of that dialog. He heard from the CEOs of many businesses, including the three Detroit automakers, that they were having a hard time competing in the global economy because they had to bear the cost of health insurance whereas their foreign competitors did not. So, when President Clinton convened his economic summit in Arkansas after he was elected but before he took office, health care was front and center.

Ever since that time, politicians advocating for some form of universal coverage have tried to give some urgency to health care reform based on the idea of making American businesses more competitive, workers more productive, hospitals more solvent, or all of the above. In other words, the emphasis has been on the economics of health care. This context of the health care discussion was quite evident in the debate about health reform last year and was also what President Obama generally led with in his calls for sweeping change to the health care financing system. And, many of the comments in the House repeal discussions occurring over the past week echoed this view from another perspective with their “job killing” (or in the kinder, gentler Congress, “job destroying”) rhetoric.

I believe this is fundamentally the wrong framing of the issue. While there are clearly economics involved, basing the need for health reform on these issues perpetuates the debate about what actually works to change the financial trajectory we have experienced with health care in this country. It allows the opponents of government provided or enabled universal coverage to mask their beliefs in the technical details of the program. In fact, the question of whether or not we should have universal health care coverage in America is essentially an issue of philosophy and beliefs. How one answers this question is truly more about one’s views of what constitutes the proper role of government and a civil society than it is about how to “bend the health care cost curve” (or not).

Every developed country in the world other than the U.S. has come to the conclusion that health care should be part of the social compact with citizens. That is: that is a fundamental right – as much as education is a fundamental right. Even with the passage of the Affordable Care Act, the U.S. has not come to a clear view on this issue. President Obama has spoken to it when he talks about his uninsured mother and I believe his emphasis on the moral imperative to cover the uninsured last January was a powerful message that helped propel the final passage of health reform.

But, this message is more often than not buried in the discussion of health care in America.

It wasn’t always this way. In fact, over the past 100 years, most of the serious efforts to change health care financing in America have embodied a philosophical statement at their core. One of the ones I find most fascinating is what was said by President Nixon in 1974 when he introduced his plan called CHIP (Comprehensive Health Insurance Plan). He said:

“Without adequate health care, no one can make full use of his or her talents and opportunities. It is thus just as important that economic, racial and social barriers not stand in the way of good health care as it is to eliminate these barriers to a good education and a good job.”

This is an extraordinary statement – especially from a Republican leader whose rhetoric was generally considered to be conservative. Whether or not you believe, as President Nixon did, that government-enabled universal health care coverage is essential to provide equal opportunity for all citizens, isn’t it time to discuss that question? Theatrics of repeal votes aside, what is it we truly believe and want for America? We need to get back to the basics and really consider: When it comes to health care, what are our core values?

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