Social Justice: Bringing Light to Our Darkness
Ron Manderscheid, PhD
Executive Director, NACBHDD
As our nights lengthen into fall, darkness has also descended upon our country’s dialogue on National Health Reform. Positions have hardened, and the gulf has widened among our points of view. In this period of uncertainty, it is useful to revisit the underlying values that originally led us to undertake the long health reform journey, and to explore their implications. Our values are guideposts to action; they can also serve as points of reference to generate dialogue and consensus-building.
These values derive from several important sources. Specifically, they can be identified from our Constitution and its Amendments, from statements made by previous Presidents of the United States, from texts that describe the history of our country, and from our sense of fair play taught to every child in our schools. Hence, these values are pervasive in our culture, and they are very important in how we address our societal problems.
Applied to health reform, these values can be stated as follows:
Health is a human right. This is the primary foundational value that led us to undertake national health reform. It means that everyone ought to have a right to seek and to achieve the highest level of health possible for them. In that sense, it is like the right to pursue happiness. Happiness means different things to different people. So does good health. Our democratic Government has an obligation to assure and to defend our basic human rights, including our right to good health.
People are valued equally. This is a foundational value closely related to the first one. American society, itself, is based on this value. From this, we derive the principle of equal protection under the law, which is enshrined in the Constitution and its Amendments. Health disparities among groups due to different degrees of access to good quality care represent departures from this value, in which one group is valued more highly than another. These disparities can be based upon race, gender, income, religion, diagnosis, or any other social or health factor.
Social justice is necessary. This third foundational value is essential for maintenance of an egalitarian society. It is this value that led us to eliminate state religion and slavery from American society, since they represent gross departures from social justice. It is the value that prompts us to insist on national health reform.
Together, these values lead to the imperative that equitable access to good health care should be available to all Americans. In other words, if good health is a human right, and all people are valued equally, then social justice demands that, as a Nation, we pursue health reform.
Now, let’s take this framework and apply it to some of the arguments one is likely to encounter out in the street. Several come immediately to mind.
Insurance should not be mandated. This issue can be argued in the abstract, i.e. Federal vs. States’ rights. At that level, the Federal Government clearly has the right over States to mandate participation in the military; similarly, under the equal protection clause of our Constitution, it has an obligation to assure equal access to good health.
But more important for our purpose, this question should also be considered at the human level. For those Americans to whom the mandate applies, I believe virtually all would agree with the three values delineated above: Who amongst them would not want to enjoy the right to good health? Rather, the real question for them is: How can I afford to pay for needed health insurance? There is an answer: National Healthy Reform includes a broad range of subsidies, including total subsidies through Medicaid for those Americans at 133 per cent of poverty or below. It also includes partial subsidies through the State Health Insurance Exchanges for those up to 400 percent of the Federal poverty level.
Also hidden under this issue is another view, much less frequently stated. This logic is as follows: I am young (and healthy) and don’t need insurance this year, and I resent paying for health insurance that will benefit others. Another variant of this argument is: I (and my family) have good health insurance; I don’t want to pay more taxes (or higher insurance premiums) to subsidize the newly insured. Clearly, both of these positions run counter to the American values enunciated above. They also ignore the economic logic of good care: With adequate health insurance and good care, those who are currently uninsured will cost less, not more, over time. Hence, an investment for others is also an investment in our own future well-being.
Reform will unduly burden American businesses. This argument is a variant of the first one. Hence the dialogue should be similar. There is an answer: Small businesses that lack resources for employee health insurance will be subsidized through tax credits already initiated in 2010. Further, improving the quality of care to currently uninsured Americans will reduce taxes (and insurance premiums) paid for the costs of health care over the longer term.
A related logic can be added here as well: A healthy workforce is necessary for a productive America, and a healthy workforce will be beneficial to businesses. Some large businesses already recognize this, and they have begun health promotion programs for their employees and their families. They understand both the productivity gains that can be made and the insurance cost savings that can accrue through fostering a healthier workforce. As noted earlier, this very same logic applies to the currently uninsured.
The United States cannot afford health reform. The immediate response is that the United States cannot afford not to undertake National Health Reform. Clearly, the current national financial trajectory of health care is unsustainable, as is the trajectory of the Federal financial contribution to it. In that sense, National Health Reform is not optional, but rather, mandatory. Recognition of this simple fact is growing with each passing day.
This economic argument is critical, but it is not the only one. In today’s complex world of wars and terrorism, the United States also cannot afford not to be a paragon of social justice, in which all people are equally valued, and human rights are protected.
I predict that our concern for others will prevail over selfishness, our concern for global competitiveness will prevail over short-term gain, and our concern over the future well-being of the United States will prevail over an unsustainable financial and value trajectory. Together, these do reflect our long-held values, and they can serve as a very solid basis for our future. They can bring light and warmth to the national darkness we are currently experiencing.
© Ron [email protected]