But unfairness in financing is only a part of what is morally wrong with our health care system. There are more immediate and egregious forms of unfairness at stake, and these concerns are at the heart of Mr. Obama's plan.
What Mr. Obama sees as most unfair about the system are the profound disadvantages that people without access to adequate health care experience, not only with regard to health but across multiple dimensions of well-being, including peace of mind, personal and economic security and the self-respect that comes from being able to plan for and meet the needs of one's family. As a consequence, the central feature of the Obama health plan is a commitment to the goal of (near) universal health insurance, with decent coverage for all. Instead of eliminating tax breaks for workplace insurance, employers would be required or subsidized (depending on their size) to assist with health care costs. Americans without workplace insurance would have expanded options to secure health insurance through a variety of private group plans and a new public plan. Although health insurance would be required only for children, the aim is to get as many people possible insured.
Mr. Obama's plans would not fix the unfairness in financing and the tax code that Mr. McCain correctly identifies. However, by preserving the workplace system, unfair though it is, Mr. Obama is taking fewer risks with what is, for many of us, more important: making sure that all Americans have access to decent health care.
Some things can and should wait till the economy improves; health care reform is not one of them. Perhaps nowhere more than in health care, we face a real choice in November. The choice is not merely between two different health plans, but even more so between two very different understandings of what is unfair about our current system, and two very different understandings of what matters most about health care. We can spend the remaining days of this campaign trying to make sense of the soft numbers and contested projections being used to describe the Obama and McCain health plans, or we can just remember that when it comes to fairness, Mr. McCain gets it half right, but Mr. Obama gets it more right.
Ruth R. Faden, director of the Johns Hopkins Berman Institute of Bioethics, and Madison Powersdirector of the Kennedy Institute of Ethics at Georgetown University, are the authors of "Social Justice: The Moral Foundations of Public Health and Health Policy."
