Health Care Right or Privilege
Health Care Right Privilege
Whether health care is a right or a privilege is one of the most intensely debated social questions of the modern era, but phrasing it in this binary way of one or the other masks a deeper problem that is far more complex. The specific issue at hand is the rationing of scarce medical resources. If there were unlimited resources where everyone could achieve the maximum health all the time, we would not have to ask the question, but this is clearly not the case. Glannon argues this requires a theory of "distributive justice" (2005, p. 144), and outlines the four main theories that have emerged from the modern discussion, which are Utilitarian / consequentialist, Libertarian, Communitarian and Egalitarian.
Utilitarian, consequentialist theory is often invoked toward a solution of who deserves health care when there is not enough for everyone, and tries to maximize the social good possible from the given resource endowment. In order to achieve the widest possible public health, we must first recognize that not all needs are the same, which is masked by asking if the resource is a right or a privilege. Either way, some people are in better health than others already, and so do not actually need any more health care than anyone else. Glannon (2005) relates John Rawls' egalitarian theory of distributive justice as the state where "no changes in the expectations of those who are better off can improve the situation of those who are worse off" (145). This parallels an idea from economics called "Pareto optimality," where getting the most out of limited resources means obtaining all good up to the point where no more gain can be achieved without costing one of the parties (Brownstein, 1980, p. 94). What this boils down to is that more good can be achieved by allocating health care resources to those who are in the direst need.
This requires we rank medical conditions and outcomes against each other. Rawls' egalitarianism argues that "inequalities in the distribution of social goods are admissable only if they benefit the least advantaged members of society" (qtd. In Glannon, 2005, p. 145), which Glannon traces back to the original Utilitarianism of Bentham and Mill (145-146). Thus this theory includes the question of whether health care is a right or privilege, and indicates who should get the most even when the answer is "both." If health care is a right, and the claimant is a member of the group with rights, then the member with the most privilege, is the one with the greatest need, rather than the one who can best afford to pay for it. The answer from this point-of-view becomes "yes" to an either-or question.
The problem is more complex because both answers contain more ethical nuance than all of one and none of the other. If health care is a right, not all claims are the same. If health care is a privilege, ability to pay does not necessarily measure need or the greatest good an organization of scarce resources can achieve. If we use a Utilitarian schema to answer the question, and ask what is the greatest good a particular package of health care resources can achieve, we find that the largest benefit may not come about by sharing it all exactly equally across right-holders, or assigning the most to those who can pay if it is a privilege. Those with the highest ability to pay may not have the greatest need, and those in greatest need may very well not be able to earn the same as those who have no need of care because they enjoy perfect health.
The levels of complexity continue to expand. What if two patients claim the same right to treatment when one is far older than the other? Likewise, Glannon asks (2005, p. 151-2), how should we prioritize resources between prevention, treatment and research, especially if withholding medical care actually causes greater need in the future? These considerations can be analyzed using a number of 'net present value' accounting methods but the difficult question of the value of life to different parties at different states of age and well-being remain no matter how we discount the cost of scarce human and medical resources. Nor does such right-or-privilege reductionism answer questions of perceived value of contribution between individuals, as in the case of organ rationing (Glannon, 2005, p. 158). How do we assign value between the potential social contribution of a talented brain surgeon compared to...
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