Who really wants health care justice?

U.S. health care is at a crossroads. It faces many challenges--the most evident being unsustainable cost increases and diminishing access. For decades, attempts at reform have been unsuccessful. One reason our traditional approaches have not worked is that we who serve the ministry have not brought to those efforts sufficient reflection concerning the deeper, values-level attitudes concerning reform. Instead, the reform movement has concentrated on promoting particular policy solutions. Ultimately, of course, we must agree on a delivery and financing system if we are to redress the situation. But first we must recognize that U.S. health care's fundamental challenge is moral and social in nature. Stakeholders will not let go of the status quo until a critical mass of people becomes convinced that there is a serious moral and social imperative to do so. Social change of this magnitude is not simply a matter of comprehensive new policy. To be effective, it must be accompanied by sustained individual and public conscience work that grounds a significant social movement comprising a critical mass of each of those stakeholders. Several principles from the Catholic tradition--the common good, solidarity, and stewardship--are particularly relevant to the individual and public conscience work necessary in the health care reform movement. Health care professionals and organizations are simultaneously part of the solution and part of the problem. By keeping this interior dialogue alive, in ourselves and in our work communities, we are much more likely to get at the root causes of our unjust health system and to contribute to the larger social movement that brings about more health care justice. This article contains a "conscience work exercise" that will help individuals and organizations examine and identify the values, attitudes, and dispositions that contribute to health care justice and those that keep us mired in the status quo.