Tom Murray, president of The Hastings Center, discussed how and why health reform should reflect our values in an interview on NPR’s Science Friday.

In a previous post, I used Paul Menzel’s provocative contribution to the Hastings Center’s Values and Health Reform Connection as a touchstone for getting clearer on what implication the values of fairness and equality of opportunity might have for health care reform. Since that post was mostly critical in nature (I argued that they do not have the implication Menzel describes), I wanted to offer a constructive suggestion that, while not novel, might provide some reason to think that seemingly conflicting strands in contemporary political philosophy can provide mutually supportive grounds for a government guarantee of affordable access to adequate health insurance.

In “Justice and Fairness: Mandating Universal Participation,” Paul Menzel grounds his endorsement of government-assured universal access to basic health care in a ideal of “just sharing” between fellow citizens. At the same time, Menzel calls unfair the current arrangement that shifts the costs of unpaid emergency care provided to “those who cannot afford to pay” onto “patients who can pay, almost all of whom are insured.” According to the figures cited by Menzel, such cost-shifting raises average family premiums by roughly $1,000 per year, and amounts to “unfair free-riding.”

There is some dissonance between these two planks of Menzel’s overall view.

As Americans, we value a health care system where people are treated fairly. We expect that if we work hard and pay our taxes, we’ll have access to that most basic human right — getting care when we need it. But for millions of people in this country who work hard and pay their fair share of taxes, that’s not the reality…

Assume, for the moment, that you support the adoption of universal, single-payer coverage in the United States. Let us say that you believe that everyone has a right to a decent and equitable minimum of health care, and that we as a society have a moral duty to ensure that everyone has financial and other access to such services. Under these circumstances, to what extent, if at all, can you reasonably support the current major congressional efforts to reform health coverage, and at what point if at all – and why – ought one to withdraw support?