In 2002, in the U.S. there were over 45 million people uninsured, this is 16-17% of the population. (NCHC, CDC) 7 million of these are children. (CDC) In 2002, 30.4% of those living in poverty lack health insurance (10.5 million). (CDC) The U.S. spends over a trillion dollars on health care, ($1.7 trillion in 2003). (NCHC) That represents 15.3% of the country's gross domestic product (total amount of revenue produced in the country in a year). (NCHC) Even though this country spends more per capita on health care than any other country in the world, it ranks 33rd in infant mortality, which is considered to be the best gauge of the health of a nation’s populace. (Pop. Ref. Bur.) These statistics indicate that spending more money may not solve the country's current health care problems. As a matter of fact, the amount of money we spend on health care is one of the major problems with the U.S. system.
When we discuss health care reform, we need to identify the goals we wish to achieve and the means we think are justifiable to use in order to achieve these goals. This involves attempting to achieve a balance between competing social and individual goals, and is thus, in part, a question of justice. Below, four basic theories for achieving such a balance are described.
When reading this ask yourself the following:
• Is there a right to health care?
• If so, what is it based on (e.g. human need, social membership, fairness,
utility, etc.)?
• What is one entitled to under a right to health care?
• Who or what is obligated to provide the entitlement?
UTILITARIAN - We should enact policies and practices that produce the greatest amount of happiness and least amount of unhappiness over time, for all concerned. Individual rights should be respected and protected as long as doing so continues to maximize the net social utility in the circumstances over time. In the distribution of health care, justice involves trade-offs and difficult comparisons between the benefits and burdens of various health care distribution strategies. The two main problems with this approach are, that rights and obligations are tenuous since their weight varies with the current estimation of their social utility and that this theory does not recognize that sometimes the individual's concerns should override those of social utility.
LIBERTARIAN - Libertarians stress fairness of procedure, not fairness of outcome. "The just society protects rights of property and liberty, allowing persons to improve their circumstances on their own initiative." (Beauchamp & Childress, p. 336.) Under this theory, health care is only a negative right. We should all have fair opportunity to get health care. We as individuals might decide to donate some of our resources to provide health care services to those who cannot afford them. But, we would not be morally wrong if we did not do so.
COMMUNITARIAN - Communitarians stress the responsibility of the individual to the community and vice versa. Each community has community-derived standards which determine what is due individuals and groups. The right to health care may be determined by the collective obligation of the community to take care of its citizens. Individual responsibility towards health is considered in light of one's obligation to the well being of the community.
EGALITARIAN - Under this type of theory, persons should be
provided an equal distribution of certain goods such as health care. These theories
recognize that society cannot require all social benefits and burdens to be
distributed equally. However, "when structuring social arrangements, qualified
egalitarianism requires only some basic equalities under individuals, and permits
inequalities that redound to the benefit of the least advantaged." (Ibid,
p. 339.)
Resources:
Beauchamp, T. L. & Childress, J. F. Principles of Biomedical Ethics, fourth
edition (Oxford University Press: 1994).
Center for Disease Control, “Health, United States 2004,” http://www.cdc.gov/nchs/hus.htm,
07/07/05.
National Coalition on Health Care, “Facts About Health Care,”
http://www.nchc.org/facts/cost.shtml, 07/07/05.
Population Reference Bureau. “2000 World Population Reference Sheet,”
http://www.prb.org/pubs/wpds2000/.