AS the United States moves toward reform of its health-care system, key constitutional values must be kept clearly in view.
Some of these values, like respect for privacy, affect every American. Privacy is critical in health-care matters, where decisions about treatment and details of medical histories are intensely personal. Universal health insurance will entail a monumental amount of electronic record keeping, and the potential for abuse of personal information has to be minimized.
Individuals should have control over any release of health records, and limits on access to the records should be built into law. While the Clinton administration's reform plan endorses confidentiality in principle, it doesn't include a means of enforcing that standard. The final legislation should spell out the rules for privacy and how they will be enforced.
The use of a national health-security card, as envisioned in the president's Health Security Act, raises further privacy concerns. It may not be intended as a national identity card, but it will inevitably spark concerns about its potential to function as one. While tight restrictions could be put on the use of the card - which would serve as a key to gain access to personal health records - alternatives to a card system should be explored.
Another set of concerns revolves around ``equal protection'' questions - especially how the system will operate for different segments of American society. Chief among these concerns is the availability of health care regardless of the income or ethnic background of recipients. Critics of American health care point to the relegation of poorer Americans to poorer quality care. A basic tenet of reform is access to care for all Americans. But will the reformed system simply erect a new structure of tiered care, with poor and minority citizens still on the bottom?
Equally important are the rights of Americans who choose a healing method outside of the medical mainstream. Christian healing through prayer is one such option. A national health plan should include nothing that would restrict the rights of individuals to let conscience and conviction guide their health-care decisions.
Some form of wide-ranging health-care reform is likely to pass before the year ends. To most Americans, universal health coverage is a matter of justice. But justice will truly be served only if the emerging legislation is true to the constitutional values that underlie this society.