I want to bring a somewhat different perspective to the discussion of recent U.S. health reform from the focus of this Symposium. My field is in justice and health policy. I’m not a lawyer, and I’m not going to try to pretend to be. And, although I chair an ethics concentration for the Health Policy Ph.D. at Harvard, my work in policy is not quantitative. Primarily, I want to discuss the ethics of health reform.
One of the foci of concern has to do with the number of people in the U.S. who are uninsured. I want to take up the question: “Why should we care about who is missing coverage?”—which was the focus of the Affordable Care Act. I want to emphasize that we are talking about roughly fifty-one million people who are uninsured, and this is a number that has increased by fifty percent since the Clinton efforts at reform in the early 1990s. This population of fifty-one million people is larger than the nation of South Korea, a middle income country that instituted universal coverage years ago. The second issue I want to discuss is the efficiency of the American system and the high cost of health care in the United States. I will address why we should think about efficiency as an ethical issue and not simply as an economic concern. Finally, even with our very significant spending on health care, we still cannot meet all of our nation’s health needs. This is a general problem across the world. Every country struggles with how best to utilize resources that are insufficient to cover all of its health care needs.