Logic of the Health Reform Debate

by | Feb 19, 2008 | Learn |

George Lakoff, Eric Haas, Glenn W. Smith and Scott Parkinson of the Rockridge Institute published a white paper in the second half of 2007 about how to frame the health care debate. Here’s their approach:

Most health care reports advocate a policy, describe it, and argue for it. We take a different approach. In this paper, we describe the logic of the overall debate over the U.S. health care system —the assumptions, the arguments, who makes them, and why. We do come out of this process with recommendations, but not of the usual sort.

Their approach can be the starting point for an interesting discussion about health care and values. They stop short of really talking about health, limiting themselves to talking about health care. However, their “progressive requirements for a health care system” come quite close to our principles. Here’s how they would have folks think about health care:

The Progressive Mode of Thought

The progressive mode of thought begins with progressive morality — the morality of empathy and responsibility, for oneself and others. Others, because life is interdependent; “no man is an island.” Translated into policy, that moral view defines two roles for government: protection and empowerment. Protection includes not only military, police, and fire protection, but also disaster assistance, public health, food safety, social security, and so on. The empowerment function of government makes business possible. It also makes it possible for individuals to pursue fulfilling lives. Government empowerment includes the development and maintenance of public roads and bridges, the internet and satellite communications, public education, the banking system, the stock market, and the courts. No business can thrive without government contributions in these areas.1

Progressive views on health care flow from this understanding of the moral mission of government. Empathy requires taking the viewpoint of the person cared for, the health care recipient as well as their family and community. From a policy perspective, health care is a matter primarily of protection, but also of empowerment. Putting these together, we get progressive requirements for a health care system:

  • Everyone should have access to comprehensive, quality health care (follows from empathy).
  • No one should be denied care for the sake of private profit (follows from empathy and protection).
  • You can choose your own doctor (follows from empathy).
  • Promotion of health and well-being, focusing on preventive care (follows from individual responsibility).
  • Costs should be progressive, that is, readily affordable to everyone, with higher costs borne by those better able to pay (follows from empathy).
  • Access should be extremely easy, with no specific roadblocks (follows from responsibility).
  • Administration should be simple and cheap (follows from empathy and responsibility).
  • Interactions should be minimally bureaucratic and maximally human (follows from empathy and responsibility).
  • Payments should be adequate for doctors, nurses, and other health care workers. Conditions of their employment should be reasonable (follows from empathy).
  • When people are harmed by either the unsafe practices or negligence of health care providers, the redress should be left to the courts — with no arbitrary caps on compensatory payments (follows from protection).2

You can read the entire paper (with footnotes) here.