Health care reform offers the possibility for advances in social justice of a magnitude not seen since the civil rights era. But health "reform" could just as easily institutionalize many of the worst features of the present system, perpetuating for generations the race, class, and gender discrimination that now taint American health care.
With the moral stakes so high, one might expect a grassroots ferment for reform among people of conscience. However, most Americans, trained as "good patients" to defer to health professionals, remain passive. For many people, the technical jargon of health reform either obscures the moral issues or makes them feel inadequate to address those issues actively. As a result, the policy debate is left by default to "experts," many of whom have a vested interest in the present system.
It need not be so. Ordinary citizens can grasp the health policy choices facing our democracy. To advocate for a more just health system requires no special credentials. All that is required is a basic appreciation of the flaws of the current system, an understanding of the politics of reform, and clarity about the moral choices that face us.
Most Americans are dissatisfied with their current health care system. They recognize that in many ways it is inefficient, inequitable, and inhumane. And the problem is getting worse. Health costs continue their decades-long spiral at inflationary rates twice that of national economic growth. More and more of the country's most vulnerable citizens are pushed to the margin of the health care system, even as the incomes of health care entrepreneurs continue to rise.