The Moral Ethos of U.S. Health Care

An excellent article by Gregg Bloche in the September 20th issue of the New England Journal of Medicine examines the current moral ethos of U.S. health care in a broad historical context. Bloche suggests that a society’s readiness to provide expansive social insurance (such as health care for all) is a reciprocal of the demand that its citizens be prepared to sacrifice themselves in war. Now that war is the province of a small volunteer military there is less readiness to treat health care as a right and more demand for individual responsibility.

Bloche predicts that “if the United States is to come close to universal coverage, personal responsibility will need to play a larger role than it did in the mid-20th century welfare state…The new compact is likely to start with an enhanced sense of individual obligation – to eat sensibly, exercise regularly, avoid smoking, and otherwise care for ourselves. It may include an obligation to buy insurance.”

Bloche is describing this perspective – not defending it. His aim is to offer a guardedly optimistic view of how health care for all might actually be achieved within the political culture he believes we are in.