MARY ANN BAILY
Most people agree that health care is a good of unusual importance. For individuals, health care plays a vital role in preventing pain and suffering, preserving the ability to live a normal life, providing information, and relieving worry. For society, health care can avert social costs associated with disease and disability, and contribute to the achievement of social goals. Finally, health care's importance in individual lives makes access to health care of deep symbolic significance, reflecting the concern members of society feel for one another.
For these reasons, there is broad support for a public role in ensuring access to health care. In justifying this role, some focus on the individual's claim on society, framing the issue in terms of a right to health care. Others focus on society's duty to the individual, framing the issue as one of social responsibility. Still others emphasize the pragmatic benefits to society from a healthy population and an enhanced sense of community.
Whatever the justification for a public role in ensuring access, a central question is: Access to what? The benefits of health care vary in importance, from the preservation of life to the elimination of minor inconvenience, and some highly beneficial care is extremely costly. Society's resources are limited. To guarantee universal access to all care of any benefit would be prohibitively expensive, compromising the ability to spend resources on other important social goods which might even have more impact on health through, for example, better nutrition or safer transportation. It seems reasonable to conclude that society must guarantee access only to a limited level of care. This level is variously referred to as a "decent minimum," "basic care," or "an adequate level," with the content determined in reference to the reasons for considering health care to be "special." 1
In the United States, all parties to the current debate on health care reform seem to accept this approach to ensuring access. Neverthe