By Shawn Kennedy, MA, RN, AJN editor-in-chief

“ ‘The moral test of government is how it treats those who are in the dawn of life, the children; those who are in the twilight of life, the aged; and those in the shadows of life, the sick, the needy and the handicapped.’—Hubert Humphrey

These are the words that physician Donald Berwick saw as he went to work in the building that bears Humphrey’s name and houses the U.S. Department of Health and Human Services in Washington, DC. They reminded Berwick, the former administrator of the Centers for Medicare & Medicaid Services (CMS), of his most important mission: “to help the people who need our help the most.” And they are at the heart of an important topic of debate during this election season: what is the proper role of government in our lives?”

AJN Oct. cover, detail

So begins a blog post on the JAMA Forum by Diana Mason, PhD, RN, Rudin Professor of Nursing and codirector of the Center for Health, Media, and Policy at Hunter College, City University of New York, as well as president-elect of the American Academy of Nursing (and, for the sake of transparency, former editor-in-chief of AJN).

Her question is a critical one and one that has been a fundamental issue, tug-of-war even, for Americans. Our citizens take a great deal of pride in being independent, self-made, and self-reliant—yet it’s obvious that most of us also believe in a sense of obligation to community, in helping our neighbors. Witness the many community organizations like Meals-on-Wheels and food pantries manned by volunteers; the millions of dollars in donations to the American Red Cross and the United Fund; the hours of volunteer labor donated to building houses for Habitat for Humanity.

And we feel it’s important to imbue future generations with this sentiment as well—many schools have implemented student service projects as part of the graduation requirement.

Yet, it appears that many feel that our government should not have a role in providing basic health care and social services to those who are in need. Shouldn’t the government embody the values of its people?

The discussion reminds me of how disheartened I felt when I watched Sicko, Michael Moore’s film about America’s health care system. One scene showed the infamous film clip of a Carol Ann Reyes, a hospital patient being “dumped” on Los Angeles’ skid row, in what apparently was a common practice by several hospitals to be rid of patients who were homeless and had nowhere to go. As I watched the film of the disoriented woman getting out of a taxi and wandering the street in a hospital gown and no shoes, the voice-over asked, “Is this how we treat our sick and vulnerable? Is this what we have become as a nation?”

If the government isn’t going to provide for and protect people like Carol Reyes, who will? Does a sense of community refer only to people like ourselves or those in our own neighborhoods? And if many Americans feel that way, what does that say about our values and our identity as a nation?

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(Related article: “The 2012 Republican and Democratic Health Care Platforms,” AJN, October issue.)