The Logic of the Health Care Debate

Introduction

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.

This analysis presents something new and important: a distinction among three modes of thought — progressive, conservative, and neoliberal. What's new here is a deeper understanding of neoliberal thought, as it affects the discourse on health care. Briefly, it accepts the progressive ethic of care, insisting on maximizing coverage. Meanwhile, neoliberal thought accepts a conservative version of market principles that guarantees profits to insurance and drug companies. Often, this is done in the name of political pragmatism, as a way to mute expected conservative opposition. This creates an inherent tension between the moral mission of government to provide for the protection — in this case the health security — of all of its people and the profit-maximizing insurance marketplace, which works only by denying care.

The neoliberal mode of thought is at the center of the health care debate. It can also be found in issues across the board.

In the health care debate, positions based on the progressive values of empathy and responsibility for oneself and others are focused on the well-being of human beings. The current health care system¹ is focused on insurance company profits, which insurance companies maximize through denying health care to millions of Americans. Neoliberal plans that sincerely seek market solutions or simply appease conservative opposition and protect insurance profits are unlikely to remedy our current health care tragedy. We conclude that progressives who adopt a neoliberal mode of thought, or align themselves with others who do, could inadvertently undermine progressive values and policy goals, surrendering them in advance — anticipating conservative resistance even before negotiations occur — and before the public has a chance to even consider such values.

References

1. According to Thomas L. Greaney, Professor of Law and Co-Director of the Center for Health Law Studies at Saint Louis University, calling ours a health care "system" is overstated. "It is hard to imagine anyone creating a health care apparatus — the word 'system' is totally inaccurate — such as the United States has today. Fragmentation, inequity, and inefficiency abound." Knowledge, Winter 2007, p. 13. Retrieved September 27, 2007, from http://www.slu.edu/Documents/university/KnowledgeWinter07.pdf.