For the past 40+ years I have been a chaplain at varying times in a city hospital, a community mental health center, an academic medical center, a community not for profit hospital setting. I have seen patients from all places on the economic spectrum, gender, disease modalities, injuries, emotional difficulties and reactions and more. I have seen the staffs that work with these people – some of whom are bright, curious, well educated and highly motivated; and some who are simply putting in their hours of the job, dull in mind and spirit, and uncaring.

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…