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BIOETHICS

Supporting Health Care Reform Is the Right Thing to Do

Why We Must Fix an Unfair System

doctor listening to child's chest with stethoscope SOURCE: AP/LUCAS FLORY In supporting health care reform, we can be good citizens and morally responsible neighbors, and still do right by those we love.

New polls suggest that Americans’ support for health care reform is wavering. Attacks by opponents of reform appear to be succeeding in increasing fears that health care reform is bad for those of us who already have insurance—that is to say, bad for most of us. The critics claim that government will get between ourselves and our doctors, we will get less care and have fewer choices.

That none of this is true seems almost beside the point. Americans are getting nervous and that is not good news for health care reform. Supporters of reform are now working overtime to reassure us that health care reform will not make us worse off, that it will instead improve the quality of the care we get, and that if we like what we have, we can keep it. Health care reform will not change, in any way that matters to us, the self-interested world we each inhabit.

At the risk of sounding like a Pollyanna, we want to try a different tack. Each of us should support health care reform because it is the right thing to do.

We should say at the outset that although we do ethics for a living, we are neither impartial nor indifferent to the needs of those we love. When someone in our families is ill, we do every thing in our power to get them every medical intervention whose benefits outweigh the harms. We desperately want them to have the best. And because we have excellent employer-sponsored insurance, and have the resources to pay for whatever out of pocket costs there might be, we usually succeed.

But we are always painfully aware that what we can do for our families, many other people cannot. And we are also aware that there is no morally defensible reason why we are in this position and they are not. Our system is just unfair.

Most of us who have insurance—whether through our employers or through Medicare—do so because the government pays a big chunk of the bill. Most of us who don’t have insurance don’t qualify for the tax breaks that go along with employer-sponsored health insurance and are just too young for Medicare.

Not that insurance insulates a family from the staggering financial burdens of a serious illness. If you are happy with your health insurance it may be because no one in your family has ever had advanced cancer, serious arthritis, a debilitating brain accident, or any number of illnesses or injuries where the cost of care can exceed by tens of thousands of dollars a year your insurance benefits. Putting aside the contentious issue of whether those wealthy enough to absorb such costs deserve to be that much better off, surely in a country as rich as ours no family should have to be in the awful position of being unable to secure critical medical care because they cannot afford it.

So what does this have to do with a personal moral responsibility to support health care reform? We each have a duty to take care of our loved ones and that extends, of course, to making sure that what is good and valuable about the health care they now have is preserved. But don’t be misled into thinking you are being asked to trade away your family’s interests. The next time you hear how health care reform is going to get between you and your doctor or deny you needed care, press for specifics. Despite the hype, the proposals currently being debated in Congress impose minimal or no burdens on most of us. Indeed, we will be more secure with health care reform than we are now. After all, while we may be healthy or have good insurance today, that may not be the case tomorrow.

But even if, in the near term, some of us may be slightly worse off than we are today, there is a line between appropriate self interest and simple selfishness. Opposing health care reform crosses that line.

This is a case where we can have our moral cake and eat it too. In supporting health care reform, we can be good citizens and morally responsible neighbors, and still do right by those we love. We want a country in which all families, not just ours, have affordable, high quality health care. Don’t you?

Ruth R. Faden is the Wagley Professor of Biomedical Ethics and Director of the Johns Hopkins Berman Institute of Bioethics. Jonathan D. Moreno is the Silfen University Professor of Medical Ethics at the University of Pennsylvania and a Senior Fellow at the Center for American Progress.

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