IP-49: Guide for a Public Issues Gathering: Rethinking Our Choices on Health Care Reform

Most of us agree on what’s wrong with our health care system: spiraling costs, millions without insurance or millions more with inadequate coverage, a growing fear that the health care system will not be there when we need it, and the realization that despite the highest expenditures in the world and leading-edge medical technologies we still rank below most other industrialized nations on many leading indicators of health. Despite this agreement, there is considerable debate over how to fix our health care system. Each time a proposal for health care reform is presented, the arguments begin: who will pay, how much, and for what level of care? The technical questions of how to re-organize health care and how to pay for it are interesting, but they will only lead to a tinkering with the system. What we need is to ask questions that reveal our underlying assumptions and expectations about health care. What questions do we need to ask? The most important one is: What do we really expect from our health care system? Do we expect our health care system to keep us healthy or to help us restore our health if we become ill or injured? Should our health care system prolong life as long as possible and/or ease our dying? Should everyone be guaranteed at least some level of health care even if this means that some people will not receive all the care possible? Our basic values and beliefs about health, life, death, and dying are reflected in how we answer these questions. And our values, beliefs, and answers to these questions influence which proposal for health care reform we prefer. We will choose the reform proposal that comes closest to meeting what we expect our health care system to do and the one that most reflects our values and beliefs. What follows are three possible alternatives for health care reform. These choices reflect the diverse reform proposals that have been offered by states, members of Congress, and the President. Each of the three choices provides a different answer to what we expect from our health care system. A fourth choice may emerge from the discussion. Our purpose is to try to find the common ground that will be the basis for health care reform.