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August 3, 1994

Ethical Foundations of Health System Reform

Author Affiliations

Baylor College of Medicine Houston, Tex

JAMA. 1994;272(5):353-354. doi:10.1001/jama.1994.03520050031018

To the Editor.  —Drs Brock and Daniels1 provide an interesting account of the ethical foundations of President Clinton's proposed health care system. They claim: "Important, widely shared ethical principles and values are involved in both the design of and the debates over the Clinton health care system reform proposal." Is this the case?None of their references are to empirical literature about the values that Americans actually have about health care, the right to health care in particular. This is an old idea, having been articulated by the French revolutionaries in the late 18th century as a right to "prompt, free, guaranteed, and total care."2 The ideas promulgated during the French Revolution were well known in the then new United States, but this one was not adopted here. Indeed, attention to our history shows that we have never adopted the value of health care as a universal right.