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.