November 5, 1997

Wanted: A Clearly Articulated Social Ethic for American Health Care

Author Affiliations

From Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, NJ.

JAMA. 1997;278(17):1446-1447. doi:10.1001/jama.1997.03550170076036

Throughout the past 3 decades, Americans have been locked in a tenacious ideological debate whose essence can be distilled into the following pointed question: As a matter of national policy, and to the extent that a nation's health system can make it possible, should the child of a poor American family have the same chance of avoiding preventable illness or of being cured from a given illness as does the child of a rich American family?

The "yeas" in all other industrialized nations had won that debate hands down decades ago, and these nations have worked hard to put in place health insurance and health care systems to match that predominant sentiment. In the United States, on the other hand, the "nays" so far have carried the day. As a matter of conscious national policy, the United States always has and still does openly countenance the practice of rationing health

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