The headlines marking a health care crisis continue to appear with regularity: “Study Ties Bankruptcy to Medical Bills,” “Cost of Insuring Workers’ Health Increases 11.2%,” “Retirees Are Paying More for Health Benefits, Study Says.” As the headlines suggest, matters are getting worse, not better, and no relief is on the horizon. No economic relief is in sight, no systematic political or legislative process is underway, and yet sound moral analysis should provoke us to do something. It is these three systematically related dimensions of discussion— moral, political, and economic—that concern this present volume.
The problems that led to the Clinton health care initiative have not disappeared, but have gotten worse as we have failed to come to grips with them in any sustained manner. More and more citizens are being priced out of the health care system. Health care coverage is being skewed more and more to exclude those most in need—children and the poor. The biases in coverage are only getting worse. A larger percentage of Hispanics, African Americans, and middle-class single women lack coverage than they did a decade ago. Nor are we permitted the luxury of thinking that moral analysis alone can suffice. If divorced from organizational understanding, procedural sensitivity, and institutional context, such analysis will have little force.
These problems, however, are usually cast only in economic or in political terms, in terms, that is, that attempt to preserve the economic and political arrangements that presently prevail. The question “How are we to pay for increased health care costs?” usually presupposes maintaining the arrangements—of profit, distribution, and basic cost—that make the question particularly impervious to a thoroughgoing moral analysis. Thus, the problem is political as well: “How can we create a consensus that will marshal the nation's resources to solve the health care problem?” When no politician wants to be seen as advocating alternative arrangements that might challenge present interests, the political problem of initiating and leading change seems acute.
It is a mistake, however, to treat these problems as purely economic or political. They have moral dimensions, and the principles that ought to drive a resolution are moral principles.