Ethics: Theory of Justice & Health Care in the US

Out-of Control Costs

-A major issue about health care is that increasing access and services entails increases in costs. Fiscal conservatives say that our experience with Medicare has taught us an important lesson: the system cannot expand the number of patients covered or the range of services offered and simultaneously decrease costs. -In 2006, the trustees of Medicare and Social Security announced that, without higher taxes, Medicare will go bankrupt in 2018. -The more health care is seen as a right, the more of life becomes medicalized, that is people tend to seek medical care in more and more circumstances. -Reformers often want to increase services. Each increase in service provided to all Americans costs more money. -Libertarians fear that government will limit freedoms and require higher taxes.

3. Medicaid another branch

-A third arm of American health care is Medicaid, which began in 1965 as part of the Great Society legislation. It is run somewhat differently by each state but federal matching funds aid each state's efforts and enforce national guidelines. -Eligibility for Medicaid in all states depends on low income, so it is meant to cover medical expenses only for poor people. Among the people covered are people on public assistance, children of poor parents, poor seniors, people with disabilities, and adults with mental illness. -Eligibility for Medicaid varies with each state and what Medicaid covers varies from state to state. -One misconception about Medicare is that it covers nursing homes and long-term care. It does not. Only Medicaid does so, and in order to qualify, a senior citizen must exhaust all personal wealth, including the sale of a personal home. Also funded SCHIP. -Importantly, Medicaid pays for drugs since 2006. -An especially controversial aspect of American medical finance has been coverage for illegal immigrant workers. The Deficit Reduction Act of 2005 forbids Medicaid from covering services to noncitizens.

Greater Efficiency

-AmeriCare could eliminate the overhead and waste of multiple private insurers. About 4-12% of health care cost represent fees and profits of private insurance plans. -Money now spent for overhead and profits in private companies can be used to cover services for those who presently lack medical coverage. American health insurers made $100 billion in 2005, and that money would pay for a lot of health care for many Americans. -Medicare is a great American success story. We can extend Medicare to all Americans. -From physicians' viewpoint, AmeriCare would eliminate hiring personnel simply to deal with the vast array of private insurers. -Medicare is a system already in place. We could be gradually expanded.

Health Care Is Not a Right Health Care Is Not a Right

-AmeriCare would make access to health care a right of all American citizens. Problems at the margins would be difficult: who is a citizen and entitled to national care? A baby born here? An immigrant? How long must one live here before becoming eligible? -Supporters of AmeriCare claim that citizens have a right to minimal or basic health care. The problem here is conceptual: no one can agree on what is merely basis care. One person's minimal care is another's luxury. -As medicine improves, what is minimal becomes normal, just as what was once extraordinary becomes ordinary. What this means is that there is no logical point to stop providing health care, before which coverage is a right, after which, it is not.

what is the veil of ignorance

-At the hypothetical starting point-the original position- a group of normal, self-interested, rational individuals come together to choose the principles that will determine their basic rights and duties and their share of society's benefits and burdens.-But to ensure that their decisions are as fair and impartial as possible, they must meet behind a metaphorical "veil of ignorance". -Behind the veil, no one knows his own social or economic status, class, race, sex, abilities, talents, level of intelligence, or psychological makeup. If you disregard this you can come up with a fair principle. -Since the participants are rational and self-interested but ignorant of their situation in society, they will not agree to principles that will put an particular group at a disadvantage because they might very well be members of that group.

-Contractarianism

-Contractarianism refers to moral theories based on the idea of a social contract, or agreement, among individuals for mutual advantage.

Socialized Medicine Reduces Liberties

-Democracies try to balance two competing values: equality and liberty. -The more we move to perfect equality, the more individual liberty vanishes. For example, for many decades America had no income tax: citizens kept all the money they made. The programs of the Great Society resulted from transfers via income tax from the working to the needy. Liberty of some to keep all their money was reduced to increase financial and medical equality for all. -For universal coverage to work, patients cannot be allowed to opt out of the system. This is like having a situation of perfect equality and then allowing unequal trades. Physicians would not be allowed to sell their services privately. -Universal health care means more taxes and all taxation is involuntary.

Rawls: The first principle: The Equal Liberty Principle

-Everyone is entitled to the most freedom possible in exercising basic rights and duties (for examples, the right to vote and hold office and freedom of speech, assembly, and thought). -Each person should get a maximum degree of basic liberties but no more than anyone else. -This principle takes precedence over all other considerations (including the second principle) so that basic liberties cannot be reduced or canceled just to improve economic well-being.

Illegal Immigrants

-In the fall of 2006, America's population reached 300 million people, a growth of 100 million people since 1967. About 53 percent of the new Americans were recent immigrants, both legal and illegal, and their children. -The majority of these immigrants are illegal workers. Covering them for medical care will break the bank. Moreover, if they are covered, workers with expensive diseases and disabilities will flock to America to get coverage for their conditions. This is what is known in the insurance industry as adverse selection. -If children are born in America, such births are reimbursed by Medicaid and then the child is an American citizen, with K-12 public schooling available to him or her. -America cannot afford to open its borders and to give away medical coverage and jobs to everyone who wants to enter. This would be a tragedy of the commons.

Merits of Rawls's Theory of justice

-Less need of interpersonal comparison than utilitarianism. An interpersonal comparison of welfare is used only when identifying the least advantaged. There is no more need of comparing and aggregating the interests of different persons. Rawls theory you don't want to sacrafice a group of ppl b/c you might be in it (you don't know) -Assurance that the interests of the disadvantaged minority will not be ignored for the sake of the advantaged majority

Libertarian Theory

-Libertarians assert that people may be equal in many morally significant respects, but justice does not demand the collection and redistribution of economic resources that are required to fund government-distributed or international programs of health-related goods and services. -For a libertarian, just distributions flow from free-market procedures of acquiring property and legitimately transferring that property. A libertarians therefore prefers a free-market system in which health care insurance is privately and voluntarily purchased by individual or group initiative as a consumer good. In fact, libertarians believe it to be injustice when economic resources are redistributed through government programs. -Libertarians favor government for defense and for limited public works. -They disfavor government programs such as Medicare, Medicaid, disability insurance, food stamps, and welfare. -Libertarians oppose forced taxation by the government. Libertarian philosophers see forced taxation as equivalent to forced labor, that is, to slavery. -Accordingly, libertarians oppose mandatory FICA (Federal Insurance Corporation of America) taxes on workers' pay and taxes for the Medicare. -Even though federal programs such as Medicare have made American physicians rich, libertarian physicians would rather have no government control over their business. In a libertarian society, physicians would be reimbursed only in cash.

Intergenerational Injustice

-Many elderly citizens mistakenly believe that Medicare recipients have already paid for their benefits through FICA taxes. -In fact, the Medicare benefits going to today's elderly people are paid for by the FICA taxes of today's workers. For the first few years on Medicare, most beneficiaries receive benefits amounting to what they paid in, plus all interest; thereafter, young current workers pay for their benefits. -The expansion of Medicare must be done by increasing taxation on present Americans. If that is politically impossible, and if financing it is only done by long-term borrowing that future Americans must pay off, it would be unjust to young Americans to crate AmeriCare. If AmeriCare is created, the Medicare payroll tax will increase from 2.9% to 10%.

4. CHAMPUS/Tricare and The Veterans Administration Hospital System

-Military personnel, their families, and veterans are covered under a different medical system than other Americans. While on active duty, they receive health care through CHAMPUS/Tricare and must go to physicians and nurses employed by the Armed Services. Veterans may utilize a natioanl system of hospitals and clinics run by the Veterans Health Administration (VHA). -The second-largest department of the federal government with a budget of more than $60 billion, the VHA is one of the largest employers of physicians and nurses in the country. -The VHA covers veterans not only for surgery, drugs, and visits to physicians, but also for mental illness and long-term care in nursing homes. The Armed Services and VHA also run their own medical schools.

1. Emplyment-based coverage and private medical plans

-Most Americans, 54%, get medical coverage though employment. -Employers provide medical coverage as a benefit to employees (but The employers pay the bills making it a sticky situation because small businesses cannot afford it so they will not hire ppl full time or w/ enough responsibilites to give benefits. Founding fathers believe in capatalism though. Contradiction.)-Employers with large numbers of employees can negotiate lower rates than employers few employees because numbers spread the costs of illness among more people. An increasing number of small businesses cannot obtain cheap coverage and no longer offer medical coverage. -The number of private insurance plans is over 300, each with its own rules, qualifications, reimbursement rates, and forms to be filled out by patients and physicians. An average physician hires two full-time personnel just to deal with billing and insurance.

What principles have been proposed as a valid, general material principle of distributive justice?

-One or more of the following principles have been proposed as a valid, general material principle of distributive justice: 1)To each person an equal share 2)To each person according to need 3)To each person according to effort 4)To each person according to contribution 5)To each person according to merit 6)To each person according to free-market exchanges. -No obvious barrier prevents acceptance of more than one of these principles. -Most societies invoke several of these material principles in framing public policies, appealing to different principles in different contexts.

5. Health Care in Emergency Rooms

-Part of America's system of health care is the Emergency Medical Treatment and Active Labor Act (EMTALA) of 1986, which forbids emergency rooms from turning away anyone who is medically unstable. -All patients must be treated and stabilized before they are released. -This federal requirement means that emergency rooms serve as a national safety net for all kinds of medical problems of the uninsured and for illegal immigrants.

arguments for universal health care in US: illegal immigrants

-Some myths abound illegal workers. Most Americans do not believe that such workers pay FICA and income taxes, but taxes are deducted from their paychecks. So workers from Central and South America who work as janitors or cut up meat in factories subsidize Social Security checks and hospital care for senior Americans. -Anti-immigration advocates claim that illegal workers burden American's hospitals and drain resources from traditional Americans. Starting in 1996, reforms to welfare disqualified illegal immigrants form receiving welfare, food stamps, subsidized housing, Medicaid, and Medicare. -In 1996, the IRS began issuing identification numbers to illegal workers to take their taxes. Each year, half of the 7 million illegal workers use such ID numbers to file federal and state returns and pay the same taxes as traditional Americans. Do pay taxes directly from their paychecks. And they do file federal taxes Sometimes think they don't pay for anything but there are 7 mill workers that pay tax like us.

AmeriCare Is Not "Socialized Medicine"

-Some people would call AmeriCare "socialized medicine." "Socialized" could mean simply "publicly owned." If so, that is not necessary a bad thing, or even an unusual thing. Americans are used to public ownership: highways and waterways, public schools, state colleges and universities (UCLA vs USC, public vs private) all these are gov run. Why not medicare. Quality of care cause some things bad some things are better (kidney stones) -If universal coverage is not necessarily socialized medicine, what could it be? First, it could be a single-payer system in which the federal government would tax all Americans and reimburse physicians on a fee-for service basis. Second, it could be an American medical service in which all medical professionals work for the federal government. Third, it could be an employer-mandated system where the government requires every employer to buy basic medical coverage for every employee and establishes a separate government-financed system for unemployed people. Fourth, it could be a voucher system, where all Americans receive government-funded vouchers to buy health care directly from hospitals or insurers.

Rawls: The second Principle of Justice

-The second principle concerns social and economic goods such as income, wealth, opportunities and positions of authority. -Part (b) (equal opportunity principle) says that everyone is entitled to an equal chance to try to acquire these basic goods. No one is guaranteed an equal share of them, but opportunities to obtain these benefits must be open to all. -Rawls knows that social and economic inequalities will naturally arise in society. But as he assert in part (a) (difference principle) they are not unjust if they work to everyone's benefit, especially to the benefit of the least well off in society. -The requirements of part (b) must be met before those of part (a). -In any just distribution of benefits and burdens, the first priority is to ensure equal basic liberties for all concerned, then equality of opportunity, the the arrangement of any inequalities to the benefit of the least advantaged.

Universal Medical Coverage

-Universal medical coverage is a medical system that covers basic health care for all citizens in a nation.-Almost always a s-America differs from other developed countries in having high consumption and great wealth, as well as high expenditures per capita on health care, yet not providing coverage for a large percentage of its citizens (46 million total). The Institute of Medicine estimates that lack of medical insurance leads to the unnecessary deaths each year of 18,000 Americans.ingle-payer system administered by one and only one organization, usually a government agency. -It is often funded by taxes. -Most European countries provide universal medical coverage, inclu-America differs from other developed countries in having high consumption and great wealth, as well as high expenditures per capita on health care, yet not providing coverage for a large percentage of its citizens (46 million total). The Institute of Medicine estimates that lack of medical insurance leads to the unnecessary deaths each year of 18,000 Americans.ding Austria, Belgium, Denmark, Finland, France, Germany, the Netherlands, Norway, Portugal, Spain, Sweden, and the United Kingdom. So do Australia, Canada, Cuba, Japan, New Zealand, South Africa, and Taiwan.

Justice and Fairness for universal health care

-Universal medical coverage may be required as a matter of justice. -An essential part of Rawls's concept of justice is the recognition that the world is naturally unfair. Government can either worsen such inequalities or lessen them. For Rawls, governments that sharpen inequality are unjust; governments that reduce it are just. -Rawls's veil of ignorance can be seen as a device for ensuring that the golden rule will become part of decisions about the structure of society. -According to Rawls's difference principle, an unequal medical structure would be just only if the poor were better off under it that under an egalitarian system; and in the present, unequal American medical system, that is obviously not the case.

2. Medicare second branch of health care

-When Americans reach age 65, Medicare covers 80% or more of their medical expenses. Medicare in 2005 covered 30 million Americans. Medicare is a single-payer system and thus contrasts sharply with the bewildering array of private medical plans in America. -In creating Medicare in the early 1960s, Congress took a giant step toward creating universal medical coverage. -Medicare gave the elderly a medical security they had never known before. -Medicare also contains a special addition to cover people with disabilities under age 65. -Administered by the federal government, Medicare is financed from mandatory payroll taxes-FICA (Federal Insurance Corporation of America). Medicare in 2005 cost $265 billion a year. Really expensive and the money comes from payroll taxes. Which is why ppl are against this - support is that young generation has to pay for the older generation -Medicare stem from a moral belief that healthy, young people should pay for the medical care of sick and elderly citizens. A related idea lay behind the creation of the Great Society legislation of the 1960s

Not Another Federal Bureaucracy

-Why not expand Medicare to all Americans? Just call such an expanded Medicare system, "AmeriCare". -AmeriCare would create a bloated, unresponsive federal bureaucracy. The federal government simply cannot do certain things well, and especially not health care. -An expanded Medicare system would become another dead-end program with runaway costs. -What is the proper role of the federal government with regard to health care? Not providing health care. American government is being asked to do too many things for too many people. -With one-seventh of the American economy at stake in health care, and one-sixth of new jobs, do we want to take the chance of a federally administered system?

Rawls two principles of justice

1. (Equal Liberty Principle) Each person is to have an equal right to the most extensive total system of equal basic liberties compatible with a similar system of liberty for all. 2. (Principle of Justice) Social and economic inequalities are to be arranged so that they are both: (a) (difference principle) to the greatest benefit of the least advantaged...and (b) (equal opportunity principle) attached to offices and positions open to all under conditions of fair equality of opportunity.

Criticisms of Rawls's Theory of Justice

1. An arbitrary donning of a veil of ignorance. What kinds of facts to be concealed are predetermined by Rawls's assumption that we should support the equal liberty principle, the difference principle, and the equal opportunity principles. 2. Is it possible for us to ignore the facts that we belong to a certain generation and that we occupy a certain social status? 3. Would everyone really choose Rawls's two principles of justice in the original position? 4. Is it always correct to adopt the equal distribution principle or to observe the difference principle? What about social rules for triage in disaster? 5. What are the convincing reasons for those who are better off, and will be better off for the rest of their lives, to accept these two principles of justice in this actual world? How will rich and happy people persuade themselves to consider the interests of the disadvantaged?

SCHIP

3. Medicaid -Starting in 1997, the federal government allotted over 40 billion dollars of federal matching funds in 1997 toward the State Children's Health Insurance Program (SCHIP). It is designed for the working poor who earn too much money to qualify for Medicaid yet are unable to insure their children through employment or private insurance companies. SCHIP usually works with Medicaid in each state. -Under SCHIP, children of those parents with low-income jobs can obtain free regular check-ups, prescriptions, dental and eye care, as well as hospital and physician services.

there is a moral right to government funded health care: an argument from collective social protection

An argument from collective social protection: Threats to health are relevantly similar to threats presented by crime, fire, and pollution. Collective actions and resources have conventionally been used to resist such threats.

there is a moral right to government funded health care: An argument from fair opportunity

An argument from fair opportunity: The justice of social institutions should be judged by their tendency to counteract lack of opportunity caused by unpredictable misfortune over which the person has no meaningful control.

Does Canada have a better health care system than the US?

Canada has a universal health care system. Depends on how you look at it, some people in US have really good health care and a lot of time people do not have it. In Canada, all have it but they do not have the best health care (long waits, average treatments). Quantity (Canada) vs quality (US) and depends on the disease. In different health care systems, doctors do their practices differently. US spend a lot of money per capita on health care but people still do not have health care. In US, because of specialization, certain diseases can be treated faster. Also our technology is a lot better.

Should illegal immigrants get access to our health care system?

Define established because some say they would have to be a vital members of society to obtain this title of established. You may have children or you have been working in a job that requires your set of skills. Need to separate the two issues. Everyone should have medical care, and immigrants are humans too.

Is access to health care to every US citizen a right?

Depends on how you define access (how much access). US is all about eliminating discrimination, this is still another form of it involving equal access to heath care. But if we fund universal health care, it comes from taxes implemented on citizens. Also hard to define basic access. Might not be realistic, especially when considering illegal immigrants. Some people even go to prison wanting to get the health care provided to the inmates. In places like France, they always consider what is best for the patient instead of how much it will cost. If we have a universal health care, someone has to pay for it and will it be run by GOV? Medication, what would happen to the companies that come up with drugs and pharmaceuticals. Here, primary care doctors are not that great because they are not as well paid compared to specialized doctors and so most people do not want to be primary care doctors. However, these primary care doctors are necessary to treat most people.

Distributive justice

Distributive justice refers to fair, equitable, and appropriate distribution determined by justified norms that structure the terms of social cooperation.

What are the two theories for thinking of medical care?

Egalitarian Thoery and Libertarian Theory

Market Solutions Won't Work

It is sometimes argued that health care could be provided and costs controlled by letting medicine operate as a true market, subject to the laws of supply and demand. Markets regulate other goods and services without bloated bureaucracies and wasteful costs. Why not medicine, too? -Such a true market would lower costs, but a market in medicine also has burdens, especially for sick and elderly patients. -A real market in medicine would be a harsh, cruel system where patients and professionals no longer worked together to overcome illness but where each bargained with the other for maximal financial gain. -It is also true that if health care were provided as other commercial commodities are-rather subsidized as it now is-many people who could afford care would not make wise decisions. When you go out to buy insurance, if you have a prexisting condition, they deny you. If you do get it it costs a lot of money. Not fair for sick and elderly patients. Or those with a genetic history.

Is equality required for a just society?

Need to define equality. We should have equal opportunities, but there are some other things that should not be equal (house, cars). Define a JUST society: some ppl think about justice,it may also require aspects of being morally correct, or maybe its that everyone is equally accountability for everything.

Arguments against universal health care in the united states

Not Another Federal Bureaucracy; Health Care Is Not a Right Out-of Control Costs Intergenerational Injustice Socialized Medicine Reduces Liberties Illegal Immigrants

Egalitarian Theory

Started by J. Rawl when began arguing that a social arrangement is a communal effort to advance the good of all in the society. -Because inequalities of birth, historical circumstance, and natural endowment are undeserved, persons in a cooperative society should aim to make the unequal situation of naturally disadvantaged members more equal. Evening out disadvantage in this way is a fundamental part of our shared conception of justice. -His recognition of a positive societal obligation to eliminate or reduce barriers that prevent fair opportunity and that correct or compensate for various disadvantages has clear implications for discussions of justice in health care. -Rawls's principles of justice are those that people would agree to under hypothetical conditions that ensure fair and unbiased choices. He believes that if the starting point for the social contract is fair then the principles themselves will be just and will define the essential makeup of a just society. This lead to the invention of the veil of ignorance

-By what principles should a just society structure itself to ensure a fair distribution of rights, duties, and advantages of social cooperation? What are Rawls principles?

area up for debate. -Rawls's principles of justice are those that people would agree to under hypothetical conditions that ensure fair and unbiased choices. He believes that if the starting point for the social contract is fair then the principles themselves will be just and will define the essential makeup of a just society.

The following terms have been used to explicate justice: fairness, desert, and entitlement. What does fairness mean?

conformity with rules or standards

The following terms have been used to explicate justice: fairness, desert, and entitlement. What does entitlement mean?

right granted by law or contract (especially a right to benefits)

Does justice require socities to adopt an explicit distribution plan for health care.

there are many different view on this. It is very difficult to distribute health care in only one fashion

What are the arguments for universal health care in the US

there is a moral right to government funded health care (argued in a collective social protection and fair opportunity fashion); Justice and Fairness; Greater Efficiency; Market Solutions Won't Work; AmeriCare Is Not "Socialized Medicine"

The following terms have been used to explicate justice: fairness, desert, and entitlement. What does explicate mean?

to explain; make meaning clear

Starndards of justice are needed whenever what happens?

whenever persons are due benefits or burdens because of their particular properties or circumstances, such as being productive or having been harmed by another person's acts.