Field Notes

Freedom's not just another word.

"Freedom's just another word for nothing left to lose," crooned Janis Joplin in her raspy rendition of "Me and Bobby McGee." Would that it were so simple. Because freedom—arguably a bedrock American value—is hardly "just another word." Despite the 450 days that remain until the 2008 presidential election, the values slug-fest is already in full swing, and "freedom" is one of the favored punching bags. One side claims it justifies a largely unfettered free market, while the other claims greater government investment will ensure it for all citizens. And both sides blame the other for curtailing it.

Health care reform is one of the most important arenas in which this debate is playing out. The majority of the public wants some sort of universal coverage, but few agree on how to pay for it. The dreaded "s" word—socialism, that antithesis of freedom—has been thrown about in response to such seeming moral imperatives as insurance coverage for all children.

For what it's worth, the socialist charge is specious: German Chancellor Otto von Bismarck introduced universal health care in the late nineteenth century to thwart a growing socialist movement, and even Margaret Thatcher—not known as a bleeding heart liberal—did not privatize Britain's National Health Service. Nor, as Dan Callahan points out, is letting the government run various services—the military, the sewage system, public education—cause to debate socialism. When it comes to flushing and fighting, we're solidarity itself, happy to all be in this together. Why not when faced with the scourge of the uninsured?

I travel to Washington often to work on the Center's new initiative, Bioethics and the Public Interest, which aims to inform debates such as this. On health care reform, the nonpartisan Center does not seek to be yet another stakeholder offering yet another remedy—tax credits, single-payer coverage, mandates, health savings accounts, or Medicare-for-all. In this crowded field, the details are driving the debate. Yet without clarity on the values that underlie health care reform, it risks collapse—as happened with the last reform effort in 1993. Drew Altman, president and CEO of the Kaiser Family Foundation, framed this danger recently, warning that he is "concerned that we will get lost in the trees, instead of looking at the bigger picture . . . that we'll obsess over plans and not the fundamental issues."

Through Bioethics and the Public Interest, the Center intends to bring its strength in fostering nuanced discussion of such issues to our national debate. One of our first efforts will be to establish a working group charged with "Connecting American Values with American Health Care Reform." We're going to look at freedom—as well as solidarity, efficiency, justice, dignity, and personal responsibility—and emphasize how all have a stake in these values, even if different persons interpret them differently. As Hastings associate Josie Johnston, who hails from New Zealand, put it at our lunch table recently, "There's nothing free about being stuck in a job you hate because you can't risk losing your health insurance." There's a lot to lose if that message doesn't come across.