“American Values” — A Smoke Screen in the Debate on Health Care Reform

By Allan S. Brett, M.D.
The New England Journal of Medicine
July 29, 2009

Amid all the rhetoric about health care reform, one claim has emerged as a trump card designed to preserve the current patchwork of private and public insurance and to stop discussion of a government-sponsored single-payer system in its tracks: the claim that single-payer health care — a Canadian-style Medicare-for-all system — is antithetical to “American values.” The idea that American values dictate a particular approach to health care reform is often stated explicitly, and it is implicit in the generalization that “Americans want” a particular system. The underlying premise is that an identifiable set of American values point incontrovertibly to a health care system anchored by the private insurance industry. Remarkably, this premise has received very little scrutiny.

Americans have been misled by the rhetoric about choice. In contrast with the single-payer option, a system with multiple private insurers would continue to restrict one dimension of choice (selection of physicians) and perpetuate a choice most people would consider irrational (wasteful spending on administrative overhead).

A closely related rhetorical device — the idea that Americans or American values are “unique” — also deserves attention… What is relevant is whether a solution works, not whether it is unique. Indeed, the aspect of the current U.S. system that is truly unique among developed countries is its failure to cover everyone — hardly something to brag about.

Policymakers debating health care reform should stop hiding behind the smoke screen of “American values.” Discussions dominated by references to uniquely American individualism, uniquely American solutions, or narrowly defined conceptions of choice tell us more about the political and economic interests of the discussants than about the interests of the Americans they claim to represent. In an increasingly diverse country that has a widening gap between rich and poor, a more promising approach is to start with the questions that matter to everyone: Will the system care for us when we’re sick and help prevent illness when we’re well? Will we have access to medical care throughout our lives without risking financial ruin? Will we be able to navigate the system easily, without jumping through unnecessary hoops or encountering excessive red tape? Will health care spending be managed wisely? Health care reformers owe Americans a system that best addresses these questions — not one that merely pays lip service to ill-defined “American values.”

http://healthcarereform.nejm.org/?p=1245

Click on the link above now. At the bottom of this article you will find another link to the full PDF version (2 pages). Download it now. It will be a very important resource during the August recess when tens of millions of dollars will be spent to keep our thought processes suppressed by the poisonous rhetoric of carefully-crafted nice words – a process that has permeated our national dialogue on health reform. It is ideas, not words, that count.