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Health care reform has been stalled since the Clinton health care initiative, but the political difficulties internal to that initiative and the ethical problems that provoked it -- of cost, coverage, and overall fairness, for example -- have only gotten worse. This collection examines the moral principles that must underlie any new reform initiative and the processes of democratic decision-making essential to successful reform. This volume provides careful analyses that will allow the reader to short-circuit the mythmaking, polemics, and distortions that have too often characterized public discussion of health care reform. Its aim is to provide the moral foundations and institutional arrangements needed to drive any new health care initiative and so to stimulate a reasoned discussion before the next inevitable round of reform efforts.
Foreword by Thomas H. Murray. Contributors: Howard Brody, Norman Daniels, Theodore Marmor, Tobie H. Olsan, Uwe E. Reinhardt, Gerd Richter, Rory B. Weiner, Lawrence W. White
Wade L. Robison is the Ezra A. Hale Professor in Applied Ethics at the Rochester Institute of Technology and recipient of the Nelson A. Rockefeller Prize for Social Science and Public Policy for his book Decisions in Doubt: The Environment and Public Policy. Timothy H. Engström is Professor of Philosophy at the Rochester Institute of Technology and recipient of the Eisenhart Award for Outstanding Teaching.
This volume began its life at the Conference on Ethics and Health Care Reform in 1995 at the Rochester Institute of Technology. Among those speaking was the late Senator Moynihan and many of the authors in this volume. The conference had been planned without knowing what would become of the Clinton health care initiative, but with the aim of helping us to investigate some of the moral and political issues that arise in any health care system and that need to be considered in any reform effort.
We could not have known that the initiative would have died by the time of the conference and that its death meant the end of any real attempt at reform of the health care system for the foreseeable future. We could not have known that the analyses being offered in this volume would remain as urgent as they now are.
A decade has passed since that conference, and, as we remark in our introductory essay on “The Problems of Health Care Reform,” things have only gotten worse with the health care system. Scholarly work has not ceased, but it operates in a political vacuum, the life of health care reform having been sucked dry by the failure of the Clinton initiative. It would be too much to expect that a scholarly work, dedicated to examining some of the moral principles that ought to animate health care reform, would suffice to breathe life back into the political system so that a new health care initiative would arise. We think the examination of moral principles and their relations to public policy issues important and helpful, but we are not cockeyed optimists. We can only hope that this work will encourage others to look again at our health care system and the systems of others, see the competing moral and political principles upon which they rely, and see that ours could be changed and improved. We hope this volume contributes to the reform of a health care system we can be proud of.
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