In Search of Equity: Health Needs and the Health Care System

I Several years ago, when the Carter administration announced that it would support congressional action to end the public fund- ing of abortions, the President was asked at a press conference whether he thought that such a policy was unfair; he responded, "Life is unfair." His remarks provoked a storm of controversy. For other than those who, for principled reasons, opposed abor- tion on any grounds, it seemed that the President's comments were cruel, violating what was thought to be an American com- mitment to providing equal access to health services to all citi- zens, regardless of their capacity to pay. Those sentiments had, in fact, been reflected in public opinion polls that had, for at least three decades, indicated that Americans supported the propo- sition that the government should guarantee health care to all. Ultimately, those beliefs had been translated into the oft-ex- 1 pressed political demand for a one-class system of health care. This commitment to equality is rather remarkable. American society evidences a striking willingness to tolerate vast inequal- ities with regard to income and wealth. While it guarantees ed- ucation to all children, there is not even a pretense that the children of the wealthy and the children of the poor ought to get precisely the same kind of schooling. While some commitment 'Hazel Erskine. "The Polls: Health Insurance," Public Opinion Quarterly, XXXIX (Spring, 1975), 128-143.