Health care in the United States is the subject of endless discussion, and no little of it happens at Aspen Ideas: Health. Though each session brings us tales of promising new therapies, innovative new delivery approaches, and inspiring stories of improving health outcomes, the shadow of a broken US healthcare system seems to hang in the corner of every stage. For all the hope the future brings, the present is still full of stories of copays and preexisting conditions and Kickstarter kidney transplants.
This year, a current that had been flowing through the festival bubbled to the surface. We’d always talked about the fundamental unfairness of the current system, but there’s been a shift in language. Now, rather than throwing about “unfair” as a (very valid) criticism, big thinkers in health are identifying a goal — equity — and the boldest are declaring it a first principle of health in these United States.
In a live recording of KHN’s “What the Health” podcast, the panelists address the ethics behind healthcare arguments. Clearly, politics reflect a difference of opinion about how much we owe to our fellow citizens:
We will, of course, continue to argue claims of “healthcare as a human right” — a position with more than a few detractors — but there is much to be said for reframing the debate in terms of the long-established (if poorly practiced) doctrine of equality.
This is not a rhetorical trick; There is data to support this reframing. We know that racial injustice and inequality are more important health determinants than even the quality of clinical care — though that, too, is unevenly distributed. Detroit’s Devita Davison defines equity through the lens of freedom in this clip from the “Health from the Ground Up” session:
On the futuristic side, the ethics of cutting-edge techniques such as gene enhancement through CRISPR are often debated within the frame of equity:
Equity undergirds arguments about the rights of women:
It factors into discussions of income inequality and health outcomes:
And even in discussion of sexual harassment:
Ultimately, in the words of Dr. Sanjeev Arora, founder of Project ECHO, “At the heart of equity is empathy.” If we are secure in our dedication to the proposition that all men (sic) are created equal, then equity in healthcare is a necessary and laudable goal.
Why, then, is there a disconnect? Have we lost our capacity for empathy? Have we become a nation of people who no longer believe that we are all created equal, endowed with certain unalienable rights?
The answer, suggests one frequent Aspen Ideas participant, is depressingly simple. When we turn a moral obligation into a financial transaction, our rational, consumer selves overpower our moral, compassionate selves. Whether inequity is a byproduct of our free-market system or bad behavior couched in capitalism may be left as an exercise to the reader — but either way, it isn’t fair.