John J Conley Lecture on Ethics and Philosophy. Health care reform: ethical foundations, policy, and law.

t Health care system reform has enormous implications for the future of American society and economic life. Since the early days of the republic, 2 world views have vied for determination of this country’s political system: the view of the individual as sovereign vs government as sovereign. As they developed the foundations of our nation’s governance, the founders were heavily influenced by the Enlightenment philosophy of the late 17 and 18 centuries—the US Constitution sharply limited the power of central government to specific narrowly defined functions, and the economic system was largely laissez faire, that is, economic exchange was mostly free of government regulation and securing individual liberty was a high priority. This situation has slowly reversed—the federal government originally was narrowly limited, but now it dominates states and individuals. The economic system has followed, lagging by several decades, so although it still retains some features of laissez faire capitalism, federal and state regulation have produced a decidedly mixed economy. Among economic sectors, health care has led the shift toward government domination for decades. The shift is propelled by the idea that there is a right to health care, a concept that was first articulated by Franklin Delano Roosevelt in his address to Congress in 1944, in which he spoke of a new set of basic rights, including “the right to adequate medical care and the opportunity to achieve and enjoy good health.” The debate over whether such a right exists has been ongoing for decades, some claiming it does exist, others that it does not. Although a right to health care has never been explicitly recognized in US law, the closest approach is in the new health care reform law with its amendments, the Patient Protection and Affordable Care Act (ACA). Various ethical arguments have been