Health Care Reform

Health Care Reform

Ethics and Politics

Edited by Timothy H. Engström, Wade L. Robison


University of Rochester Press



An examination of the moral principles and institutional arrangements that will be needed to drive any new health care reform inititive.
Health care reform has been stalled since the Clinton health care initiative, but the political difficulties internal to that initiative and the ethical problems that provoked it -- of cost, coverage, and overall fairness, for example -- have only gotten worse. This collection examines the moral principles that must underlie any new reform initiative and the processes of democratic decision-making essential to successful reform.
This volume provides careful analyses that will allow the reader to short-circuit the mythmaking, polemics, and distortions that have too often characterized public discussion of health care reform. Its aim is to provide the moral foundations and institutional arrangements needed to drive any new health care initiative and so to stimulate a reasoned discussion before the next inevitable round of reform efforts.

Foreword by Thomas H. Murray.
Contributors: Howard Brody, Norman Daniels, Theodore Marmor, Tobie H. Olsan, Uwe E. Reinhardt, Gerd Richter, Rory B. Weiner, Lawrence W. White

Wade L. Robison is the Ezra A. Hale Professor in Applied Ethics at the Rochester Institute of Technology and recipient of the Nelson A. Rockefeller Prize for Social Science and Public Policy for his book Decisions in Doubt: The Environment and Public Policy.
Timothy H. Engström is Professor of Philosophy at the Rochester Institute of Technology and recipient of the Eisenhart Award for Outstanding Teaching.


September 2006
301 pages
9x6 in
ISBN: 9781580462266
Format: Hardback
Library eBook
University of Rochester Press
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Table of Contents

Foreword by Thomas H. Murray
Introduction: The Problems of Health Care Reform - Timothy Engstrom and Wade L. Robison
The Moral Crisis in Health Care - Wade L. Robison
Ethics, Justice, and Health Reform - Howard Brody
A Social Contract for Twenty-First Century Health Care: Three-Tier Health Care with Bounty Hunting - Uwe E. Reinhardt
Corporatization of Health Care - Lawrence W. White
"We Can't Be Nurses Anymore": The Loss of Community Health Nurses' Personhood in Market-Driven Health Care - Tobie H. Olsan
Politics of Medical Care Reform in Mature Welfare States: What Are America's Prospects Now? - Theodore Marmor
Citizens and Customers: Establishing the Ethical Foundations of the German and U.S. Health Care Systems - Timothy Engstrom
Citizens and Customers: Establishing the Ethical Foundations of the German and U.S. Health Care Systems - Gerd Richter
Preparing for the Next Health Care Reform: Notes for an Interim Ethic - Larry R. Churchill
A Cooperative Beneficence Approach to Health Care Reform - Rory B. Weiner
Fairness and National Health Care Reform - Norman Daniels
Conclusion: Prospects for Reform - Timothy Engstrom and Wade L. Robison


U.S. health policy often appears to amount to little more than the search for technical solutions to what ails the health system. Yet Health Care Reform argues compellingly that the crisis in health care is, at root, a moral crisis that requires us to grapple with the ethical implications of our health care policies and practices in both the public and private sectors. This valuable collection provides diverse perspectives -- ranging from philosophy and economics to political analysis -- that highlight serious problems in the health care system while also offering provocative solutions. --Jonathan Oberlander, Associate Professor of Social Medicine, University of North Carolina, Chapel Hill and author of The Political Life of Medicare

This book comes at the perfect moment. The health care "system" is increasingly dysfunctional, presenting enormous burdens of cost and access insecurity for many Americans -- so much so that many corporate leaders are stepping forward as strong advocates of reform. This book reminds us about the moral and ethical underpinnings of having an equitable, good quality system of care in the U.S. As such, it is a most appropriate way to kick-start the new national debate which, if we're very fortunate, will end with a real solution that makes sense on every level. --Irwin Redlener, MD, Associate Dean, Columbia University Mailman School of Public Health, and President, the Children's Health Fund

This exceptional set of essays recognizes that health care reform must start with a vision of what we want the system to achieve. Proposals to change the US health care system often simply rearrange the deck chairs on the proverbial Titanic. Rather than tinkering with financial incentives, these authors make a bold case for comprehensive reform based on moral grounds. Such concerns support rather than contradict the strong economic case for change. --Leif Wellington Haase, Senior Program Officer and Healthcare Fellow, The Century Foundation