Foreword

Summary

Recently, I heard the distinguished physician and political leader, Doctor John Kitzhaber, former governor of Oregon, describe the principles one would need to follow in order to design the health care system we Americans live under. It was a ruefully hilarious exercise. It would take a singularly perverse and insane genius to create the American health care system from scratch. A system that leaves, at this writing, more than 45 million of our fellow citizens uninsured while those with the best policies can call on astonishingly expensive technologies to eke out an extra few days or hours of encumbered existence seems to have an odd set of priorities. That the health and longevity of the American people are middling, at best, compared to citizens in other developed nations seems a disappointment—until you realize that we manage to achieve these mediocre results at a far greater cost than anywhere else, at which point the proper response is astonishment and, perhaps, anger.

The distinguished editors and authors of this anthology have channeled their outrage in the most constructive directions. It is all too easy to succumb to despair at the political and economic obstacles to meaningful health care reform. These intellectual leaders have chosen a different course: Mindful always of the powerful interests and the accretion of institutional habits that stand in the way of change, these writers plunge courageously beneath the surface turmoil to the moral foundations of health, health care, and society.

What are our deepest ethical commitments as they touch on health care? What is the most fruitful relationship between a system that should be delivering care to all who stand in need of care and the larger society's commitment to a market economy? How have other nations struggled with the same challenges, and can we learn anything from their successes and their failures? Should health care be available to all who need it? How are we to discern the boundaries of a just health care system given medicine's seemingly limitless capacity to absorb our finite resources? The thinkers whose words make up this volume take on these questions and more. They have all thought long, hard, and fruitfully about these matters; their reflections are well worth attending to.