The philosophy of health care reform

A couple of years ago, I was reading a biography of Albert Einstein.  I was struck by how much he, and scientists like him, we versed in philosophy.  I realized it was one of the areas in which my education was deficient.

This seemed like a big hole, especially given the rhetoric being flung around about health care reform.  People cited the values of our founders, those of America, and how they would feel about reform.  I realized I knew shockingly little about this.  I did what I usually do in that situation – I took a whole pile of books and spent many summer evenings reading in my backyard with a glass of scotch.  My wife is still making fun of me.

I read Hobbes.  I read Locke.  I read Rousseau.  I learned a lot, and even wrote a paper on how we could reframe reform as a reopening of the social contract that I’ll get published someday.  But it wasn’t until I got to John Rawls that things took off for me.  There was distributive justice.  There was the veil of ignorance.  And – most importantly – fair equality of opportunity:

Equality of fair opportunity (EFO) is satisfied in a society just in case any individuals who have the same native talent and the same ambition will have the same prospects of success in competitions that determine who gets positions that generate superior benefits for their occupants. In other words, if Smith and Jones have the same native talent, and Smith is born of wealthy, educated parents of a socially favored ethnicity and Jones is born of poor, uneducated parents of a socially disfavored ethnicity, then if they develop the same ambition to become scientists or Wall Street lawyers, they will have the same prospects of becoming scientists or Wall Street lawyers if EFO prevails. (It should be noted that the specification of EFO just given departs from the specification in Rawls 2001. There Rawls defines EFO so it requires only that the socio-economic status into which one is born has no impact on one’s competitive prospects.)

Is there any better description of America? We don’t declare that everything will be the same for everyone.  We don’t say that outcomes for everyone will be exactly equal.  But we believe in the equality of opportunity – that each of us should have the same chance of succeeding given equal innate ability and drive.  It’s the American dream.

I was wishing that someone would take Rawls and apply him specifically to health care, when someone pointed me to Norman Daniels.  He did just that.  I can’t do his work justice, but I will say that he goes where others won’t.  He tries to answer questions like what is the special moral importance of health? When are health inequalities unjust? And, most importantly, how can we meet health needs fairly when we cannot meet them all?

I bring this up because I was lucky enough to have lunch with Norman Daniels today.  He even signed my copy of his book.  He didn’t disappoint.

I’m willing to bet most of you haven’t heard of him.  Or John Rawls.  You can fix that:

Update: If you’ve read these before, there is no need to take offense. Many people haven’t. I hadn’t until relatively recently.

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