During the current health reform debate, both Democrats and Republicans have often made their case in terms of values such as liberty, justice, and equality. One example has been the Republican opposition to the “individual mandate” – requiring everyone to purchase health insurance if “affordable” coverage is available – which Senator John Kyl of Arizona called “a stunning assault on liberty.”
Is the individual mandate consistent with American values? In an essay in the Hastings Center Publication “Connecting American Values With Health Reform,” philosopher Paul Menzel answers yes. Without an individual mandate, it would be unjust to require hospitals to provide acute care to all comers, he writes. It would also be unjust to bar insurers from excluding people with pre-existing conditions, as most proposals to achieve universal coverage would do, argues Menzel, a professor at Pacific Lutheran University.
Menzel acknowledges that, while “mandating insurance may be just and fair,” it “certainly appears to limit liberty.” However, he argues that this apparent conflict between justice and liberty can be addressed by considering liberty “in its fullest context, bound up with responsibility – where both are connected to fairness and justice.”
Each of the essays in “Connecting American Values” begins with a particular value and its connection to the health reform debate, but an interconnected view of values is one of the themes that runs through the publication. For example, in his introductory essay, Hastings Center president Thomas Murray argues that:
simplistic understandings of values are deceptive and harmful to private insight and public discourse. Liberty, properly understood, is not the opposite of equality; justice, not the opposite of liberty; and responsibility, both personal and social, is crucial to the full realization of liberty and justice. Efficiency, an instrumental value rather than an end in itself, is intimately related to quality, solidarity, stewardship, and justice. Core American values, rather than existing in ineluctable tension with one another, form a sturdy, mutually reinforcing foundation for health reform.
With the support of Health Affairs as a media sponsor, Hastings is seeking to broaden the discussion regarding the intersection of American values and health reform. Next week, the Center is launching a Web site that will feature new blog posts on values and health reform. Contributors are invited to respond to one or more essays in “Connecting American Values,” to each other, or to strike out on their own. Some contributions will be co-posted on the Health Affairs Blog. Stop by the site and join in the discussion.