RAND E. ROSENBLATT
Health care delivery and health law are characterized by three basic tensions as we move into the twenty-first century. These tensions provide a revealing view of American society and offer an exceptional opportunity to address important questions about the nature and role of law.
First, imbalances of knowledge and power are pervasive in health care and have a deeply ambiguous significance. On one hand, we want the physician to take us under his or her parental wing, heal us, and reconnect us with the rest of humanity. On the other hand, we fear our dependence on another fallible human being.
Second, even in a society as enamored with the economic market as the United States, health care continues to be perceived as different from other commodified goods and services. If a poor person cannot afford to own a car, that is merely life in a market society, where almost all of us face some sense of limited resources. But if a poor person cannot afford to pay a doctor's fee and therefore is refused admission to a hospital and gives birth to a child in a car in the hospital parking lot, that is shocking (but before 1986, not necessarily illegal).1 We can all imagine ourselves in that situation.
The impulse toward inclusion and solidarity is matched--in our time and place, overmatched--by the contrary impulse to exclude the poor, the immigrant, the person of color, the "other" from "our" schools, neighborhoods, suburbs, and health insurance groups so as to protect ourselves and those with whom we identify from the costs of the dispossession that our society inflicts on many of the "others."
In the 1991 and 1992 elections, large numbers of middle-income American voters were concerned about lack of health insurance due to unemployment, preexisting medical conditions, and eroding fringe benefits and favored health reform legislation that would assure access to quality care for all or most of the population. This impulse toward equal-