When the Clinton health care reform initiative died in 1994, the problems it promised to address didn't disappear with it; they grew worse.

More than a decade later, the United States' population has reached 300 million, a large percentage lacking adequate--or any--health care. Figures vary, but approximately 45 million Americans have no health insurance at all and another 20 to 30 million are underinsured, while many more are at risk of losing what little they have.

A new collection of essays, Health Care Reform: Ethics and Politics (University of Rochester Press), questions the ethics of having so many citizens without basic health care--the middle aged who have lost their jobs and benefits, children of uninsured parents--and proposes ways of moving beyond the standard ideological roadblocks.

The anthology, edited by Timothy Engstrom and Wade Robison, professors of philosophy at Rochester Institute of Technology, call for a renewed national dialogue committed to revamping the U.S. health care model guided by moral principles in balance with political and economical realities.

Health Care Reform grew from a conference held at RIT in 1995 and shows how little has improved since the failed Clinton initiative. Essayists include Howard Brody, a former consultant with the Clinton administration's Health Care Reform Task Force; Norman Daniels, from Harvard School of Public Health; and Uwe Reinhardt, who sat on the National Advisory Council for Health Care Policy, among others.

"The message throughout the book is that moral clarity comes first and that clear policies can and must follow," says Robison.

The escalating costs of health care force companies to cut benefits and transfer costs to employees to remain profitable or, paradoxically, to move abroad to countries with a national health care system--all decisions that compromise individuals' and the nation's economic health.

"What is ironic about outsourcing health care costs by moving whole industries abroad is that we are the only industrialized country that doesn't have some kind of national health care," Engstrom says. "We cling tenaciously to what doesn't work and ignore solutions that have been shown to work well in other countries. If we would learn from the countries to whom we send our industries, we would not have a health care system in crisis."

As more companies transfer costs to employees and more workers find themselves with increased costs, diminishing benefits, or no health care benefits at all, the crisis will only deepen, the editors say. Often overlooked is the cost of not meeting citizens' health needs, potentially laying the foundation for new strains of communicable diseases such as tuberculosis that could spread and infect the population indiscriminately and hurt the economy in unforeseen ways.

"We can let things proceed, letting individual companies solve their problems as best they can, or we can, provide examples of how clear moral argument and economic and political comparisons can foster consensus regarding the universal principles needed to reform health care," Engström says.

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About RIT: Rochester Institute of Technology is internationally recognized as a leader in computing, engineering, imaging technology, fine and applied arts, and education of the deaf. More than 15,500 full- and part-time students are enrolled in RIT's 340 career-oriented and professional programs, and its cooperative education program is one of the oldest and largest in the nation. For well over a decade, U.S. News and World Report has ranked RIT among the nation's leading comprehensive universities. The Princeton Review recognizes RIT as one of America's "Most Wired Campuses," and the university is also featured in The Fiske Guide to Colleges and Barron's Best Buys in Education.

Contact: Susan Gawlowicz
Rochester Institute of Technology