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commonly held sentiment that “we are all in this together,” that disease and death remain an unavoidable part of life for everyone, that all people deserve respect, and that
it is immoral to mark a group of people as unworthy of medical care because of their socioeconomic status.
My sense is that given the pitfalls, perils, and misadven- tures of the NHS throughout its history, there is widely held agreement that seeking to provide health services for all is correct moral thinking, and that the UK is well intentioned in pursuing this vision.
I recall earlier this year reading the first editorial of the year in the Journal of the American Medical Association by Dr. Harold Bauchner, “Health Care in the United States: A Right or a Privilege” (H Bauchner. JAMA 317 \[1\], 29. 2017 Jan 03). Dr. Bauchners’ opinion in this essay is that health care should be considered a right, and that such a view needs to be central in any form of health care planning which seeks to promote justice. As he states, “Is the United States a just and fair society if so many individuals lack health care coverage? The United States guarantees all citizens an education, access to fire and police services, a national postal service, protection by the military, a national park system, and many other federal- and state-funded services. But the country has not yet committed to ensuring that all of its citizens have health care coverage.”
Justice is a core value in the American experience and throughout our history. In “liberty and justice for all,” it becomes woven into the fabric of our lives early as children in the recitation of our Pledge of Allegiance. It is the bedrock of our culture and a driving force in our jurisprudence and public policy. And yet justice is far from the ultimate goal in our discussions of health care, where political debates center more on health care services as a market-based commodity and less as a social good. If the question in the US health care debate were, “How do we achieved a fair and just society in the delivery of health care to everyone?” it seems we would be having a different discussion at the legislative and executive level. We need to admit that our leadership is not passionate about the lives of all of our citizens in this debate, and we should be. It’s the right thing to do.
Trump remarked at the beginning of his presidency when opening the lid on the restructuring health care in the US, “Nobody knew health care could be so complicated ... I have to tell you it’s an unbelievably complex subject.” Well, yes, thank you; that’s something we can all agree on. But how we take this “unbelievably complex subject” and make it work for everyone should be the center of the debate. The vision. The goal. Unfortunately, it’s not. In this respect I think the UK has better intentions and a better vision, and achieves better outcomes where justice is concerned. We can do better here. And we should.
It’s time to land.
Volume 69 • Number 3 Washtenaw County Medical Society BULLETIN 7

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