Values and politics

Our push to make health care fair, to make coverage and access universal, is based on shared American values. Health care is not simply as a set of complex technical issues that can be fixed by elected representatives alone. Fairness in health care, as well as other social areas, define our national identity and clarify our values. Active citizen engagement that moves us beyond “politics as usual” is necessary for success.

How do shared American values relate to health care?

Liberty. Life is shortened and the pursuit of happiness is hindered when someone is ill. Our current health care system limits freedom of choice for many, including, but not limited to, choice of clinician, facility, and therapeutic options. Financial barriers too often result in avoidable or undertreated sickness, a profound limitation of liberty. Justice. Usually, when we talk of justice, we mean criminal justice. But other forms of justice are just as important: social justice, political justice, and economic justice. Economic justice is essentially everyone getting their “fair share.” A glaring example of the injustice in our health care system is that a few profit a great deal, while most who seek health care pay too much and get too little.
Equality. The Declaration of Independence boldly proclaims that “All men [people] are created equal,” meaning that we deserve equal opportunities to achieve our goals and to live healthy and fulfilling lives. As our nation has matured, we have recognized that equality should apply both to individuals and to groups. And in health care, there are wide disparities in how groups are treated – based on wealth, where we happen to live, race and ethnicity, sexual orientation, and gender identity. We all deserve equal treatment, equal protection, under the laws.

What are the main ingredients of “politics as usual” in health care?

  • Kick the can down the road – Congress often avoids dealing with a variety of issues in health care, For example, for more than a dozen years, Congress annually passed a “ doc fix” to prevent huge drops in Medicare fees because of problems with the “sustainable growth rate” model of cost containment.
  • Take small steps - Politicians define the problems in small, narrow, technical ways and create big debates on proposals with more symbolism than substance.
  • Avoid risky situations - Politicians avoid angering wealthy and powerful interest groups that might fund opposition to them in their next election. In health care this has especially included the lobbies of organized medicine, insurance companies and drug companies. One way politicians do this is by refusing to bring controversial proposals up in Committee for discussion or a vote.
  • Pass legislation more in line with special interest desires and economic elites than the needs of the general public. - As a study of key variables for policy issues demonstrated, the average citizen, unless there is a unusually strong political pressure, generally has minimal influence on the way Congress votes.

How do we move beyond politics as usual in health care?

Only twice since the founding of our country have we enacted large changes in health care that moved towards making it more fair: the passage of Medicare and Medicaid in 1965 and the passage of the Affordable Care Act in 2010. In the current era of political hyperpolarization, to achieve another big change we will have to persuade many Americans, both in the general public and in elected office, to think differently about health care. This will necessitate:

  • Consistently talking about the shared American values and principles that inform the health care all Americans deserve
  • Addressing structural issues
  • Addressing the financial reality that we do not need to spend more money in health care, we just need to spend it more wisely.
Updated 6/1/2018