John Rawls, why not free health care system

[MaxManus]

Hey, I'm reading about rawls in Kymlicka Contemporary Political Philosophy: An Introduction and it says that Rawls did not favour a free health care system. Does anyone know why? It strikes me as odd that you would design a society such that economic inequality is only allowed if it favours the least well of and not at the same time not give at least some compensation to the sick people.

 

[russ_watters]

I don't kbow, but did it have anything to do with the fact that without slaves, healthcare can't be "free"?

 

[Ryan_m_b]

I don't kbow, but did it have anything to do with the fact that without slaves, healthcare can't be "free"?

I'm pretty sure he means universal/socialised healthcare where the state ensures that everyone has access to healthcare through either directly paying for it or heavy regulation/control of insurance.

As for why not it's something that always has baffled me coming from the UK where universal healthcare is a given. Reasons I've heard against such things include not wanting to pay for other people or wanting to encourage competition (both things that I don't agree with).

 

[Mech_Engineer]

There's no such thing as a free lunch. Either you pay for your healthcare directly, or you pay taxes (or insurance premiums) and those payments are used to pay for your healthcare.

In the case of paying insurance premiums (or taxes) your helathcare costs are basically averaged with everyone else's, so it's a good deal if you're above average in healthcare costs, but you get screwed if you're below average in costs. Insurance premiums do usually reflect your overall costs (some people pay more based on certain conditions).

One way or another the healthcare workers need to be paid, so when people demand "free healthcare for all" they usually haven't thought it through appropriately.

 

[russ_watters]

I'm pretty sure he means universal/socialised healthcare where the state ensures that everyone has access to healthcare through either directly paying for it or heavy regulation/control of insurance.

Yes, I'm sure. It just irritates me and I think is informative.

As for why not it's something that always has baffled me coming from the UK where universal healthcare is a given.

It baffles me that it would baffle you: surely you are aware that it is a relatively new idea? It also baffles me that a new and radical idea is often simply taken as self-evident; without theoretical development.

To the OP: a google suggests he never discussed healthcare. Did you misread? Do you have a reference?

 

[Ryan_m_b]

Yes, I'm sure. It just irritates me and I think is informative. It baffles me that it would baffle you: surely you are aware that it is a relatively new idea? It also baffles me that a new and radical idea is often simply taken as self-evident; without theoretical development.

Who said anything about self-evident? I am aware of the age of the NHS and the history of socialised healthcare. What baffles me is why anyone would be against the principle, I understand the counter arguments but one has never struck me as being particularly convincing.

 

[Greg Bernhardt]

What baffles me is why anyone would be against the principle.

I'm not sure people argue the principle, but rather the practicality.

 

[Ryan_m_b]

I'm not sure people argue the principle, but rather the practicality.

Most people may argue the practicality but I've met people who argue the principle as well, with rather sickening rationale.

 

[Greg Bernhardt]

Most people may argue the practicality but I've met people who argue the principle as well, with rather sickening rationale.

My first "not deep" thought is that if the US moves to a true socialized health care, I'd want tobacco, alcohol, cheeseburgers and tootsie pops banned. I'd want helmets mandatory for bikers. This would just be the start. I have absolutely zero problem paying towards a child needing a cancer treatment or any other reasonable medical scenario. There is a part of me however that pauses when asked to help pay for someone's very poor decision. I know it's an impossible line to draw, but there are really terrible decisions being made all the time and I'm not sure I want to pay for them. Does that make me a bad person, I don't know.

 

[Ryan_m_b]

My first "not deeply" thought is that if the US moves to a true socialized health care, I'd want tobacco, alcohol, cheeseburgers and tootsie pops banned. I'd want helmets mandatory for bikers. This would just be the start. I have absolutely zero problem paying towards a child needing a cancer treatment or any other reasonable medical scenario. There is a part of me however that pauses when asked to help pay for someone's very poor decision. I know it's an impossible line to draw, but there are really terrible decisions being made all the time and I'm not sure I want to pay for them. Does that make me a bad person, I don't know.

(Emphasis mine) Indeed it is a hard line to draw. One might argue that people partaking in extreme sports bring it on themselves when they have accidents or people who eat poorly because they can't afford good food might get caught in the system. If an insurance based universal system was implemented this could be tailored to the patient's needs/behaviours.

Personally I wouldn't advocate this however I like it how it is now in the UK where self-inflicted puts you at a low priority and bans you from certain procedures unless you change e.g. liver transplants for alcoholics.

 

[MaxManus]

Yes, I'm sure. It just irritates me and I think is informative. It baffles me that it would baffle you: surely you are aware that it is a relatively new idea? It also baffles me that a new and radical idea is often simply taken as self-evident; without theoretical development.

To the OP: a google suggests he never discussed healthcare. Did you misread? Do you have a reference?

My refference is Kymlicka p 70-72

 

[micromass]

Of course, health care is never free. People always pay for it in taxes. But socialized health care is not a bad idea at all.
I personally believe that each person has the right on cheap health care and cheap education. It makes sense that the people who are well off in society would pay for the people who are less lucky.

As for the practicality of it all. Socialized health care exists in many european countries and it works fine. So I don't see any real reason why it shouldn't work in the US.

 

[Greg Bernhardt]

If an insurance based universal system was implemented this could be tailored to the patient's needs/behaviours.

That sounds interesting, but I could see it being full of fraud.

well off in society would pay for the people who are less lucky.

Well off people are just lucky? :) Why should I pay for a meth dealer's heath insurance? Is he just unlucky?

As for the practicality of it all. Socialized health care exists in many european countries and it works fine. So I don't see any real reason why it shouldn't work in the US.

I think there are plenty of interesting debate points to be made. I am not smart enough to properly engage. However, one thing is we have more illegals than most european countries have citizens.

Everyone should have affordable heath insurance. Does that mean the only option is to socialize the industry? Are there no other options?

 

[micromass]

Well off people are just lucky? :) Why should I pay for a meth dealer's heath insurance? Is he just unlucky?

Not all of them are lucky, of course. But a lot depends on luck, sure.

Let's say you are born in a poor family with not many opportunities. Chances are larger that your education won't be good and that you will end up in poverty.
Poverty is a turning wheel, once you're in it, it's very hard to get out of it.

And yes, meth dealers can be considered unlucky. If you're raised in an environment where criminality is normal, then you won't have the norms and values we have. That doesn't excuse criminality, but it makes it more understandable.

I also don't think it's a wise idea to equate criminals with poor people. Most poor people are honest and hardworking people.

 

[Ryan_m_b]

Not all of them are lucky, of course. But a lot depends on luck, sure.

Let's say you are born in a poor family with not many opportunities. Chances are larger that your education won't be good and that you will end up in poverty.
Poverty is a turning wheel, once you're in it, it's very hard to get out of it.

Broadly one gets rich through a combination of accident of birth, profits from labour of other workers and hard work. No one of them is necessary: you could be born in the most poverty stricken area and work your way to 1% status, likewise you could be born into a rich land owning family and never work a day in your life. Social policies IMO are important to address the first two of the three. How this plays into state provided medicine is to ensure that there is a justifiable reason for spending taxes on health care for all.

 

[Greg Bernhardt]

Poverty is a turning wheel, once you're in it, it's very hard to get out of it.

I understand that very well. I think more money should go into parenting and education. That is where the wheel will be stopped, not health care.

I also don't think it's a wise idea to equate criminals with poor people. Most poor people are honest and hardworking people.

I never did. I simply said I hesitate to pay for people when they make very poor decisions. Income doesn't enter into the equation for me.

 

[Ryan_m_b]

Everyone should have affordable heath insurance. Does that mean the only option is to socialize the industry? Are there no other options?

Arguably I would say that if you have achieved that goal (actually I would replace affordable with cheap/negligible concern) you've probably instituted some pretty social policies anyway so you could argue you have an indirect social health care system

 

[Greg Bernhardt]

Arguably I would say that if you have achieved that goal (actually I would replace affordable with cheap/negligible concern) you've probably instituted some pretty social policies anyway so you could argue you have an indirect social health care system

The more I think, the more it all boils down to education. The more educated people are, the better decisions they will make on average. The key to health care, might be the education system. Of course that is a long term campaign and people won't have the patience for it.

 

[Ryan_m_b]

The more I think, the more it all boils down to education. The more educated people are, the better decisions they will make on average. The key to health care, might be the education system. Of course that is a long term campaign and people won't have the patience for it.

Possibly, I'm all for increasing education. Though there would still be the issue of how to provide for diseases/accidents that occur regardless of ones behaviour and education.

 

[micromass]

I never did. I simply said I hesitate to pay for people when they make very poor decisions. Income doesn't enter into the equation for me.

I understand and I agree. People who make poor decisions and who know what the consequences are, put themself at risk.

But I also think it is crucial to educate the people enough so that they don't make poor decisions. People often don't realize the result of their decisions, and this is something we should stop. A good education system is crucial in that. This is exactly why education should be very cheap or at least affordable.

 

[Greg Bernhardt]

Possibly, I'm all for increasing education. Though there would still be the issue of how to provide for diseases/accidents that occur regardless of ones behavior and education.

I wouldn't be opposed to chipping into help, in order to make it affordable. This of course is requires a utopian society.

I think we need a clear objective study on WHY health care is not currently affordable. From there you can start to problem solve.

 

[Ryan_m_b]

I wouldn't be opposed to chipping into help, in order to make it affordable. This of course is requires a utopian society.

I'm not sure it has to be utopian, as micro pointed out it works quite well in Europe as well as countries like Canada. It's not perfect but it works quite well and there's nothing to stop us continue to improve.

I think we need a clear objective study on WHY health care is not currently affordable. From there you can start to problem solve.

Emphasis mine. I totally agree but severely doubt it will happen. With an issue this divisive it would be difficult to even get people to agree whether or not something was objective.

 

[Greg Bernhardt]

But I also think it is crucial to educate the people enough so that they don't make poor decisions. People often don't realize the result of their decisions, and this is something we should stop. A good education system is crucial in that. This is exactly why education should be very cheap or at least affordable.

Agreed as I said a few posts earlier. I think everything follows education. But it will take time, because parents are the most important in development, but you can't directly change parents. You can only slowly change children through education. With proper education you can slowly wind down the delinquents over generations.

 

[russ_watters]

My refference is Kymlicka p 70-72

Could you provide a short quote please.

 

[MaxManus]

Could you provide a short quote please.

There are difficulties in trying to compensate natural inequalities, as we will see in section 5. It may be impossible to do what our intuitions tells us is most fair. But Rawls does not even regognize the desirability of trying to compensate such inequalities.

p 72

 

[russ_watters]

That quote doesn't mention healthcare...

There should be a concise quote that supports your thread's premise.

 

[MaxManus]

That quote doesn't mention healthcare...

I should have mentiond that Rawls calls health a natural good and natural inequalities are differences in our health.

 

[Vanadium 50]

This is getting off track.

Hey, I'm reading about rawls in Kymlicka Contemporary Political Philosophy: An Introduction and it says that Rawls did not favour a free health care system. Does anyone know why?

If you want to know what Rawls thought, it's best to read Rawls, not about Rawls. (Although, truth be told, he's not an easy read.

not give at least some compensation to the sick people.

Note that "free health care for all" and "at least some compensation to the sick people" are two different things. If you are going to study philosophy, it's vitally important that you be clear in your thinking and writing. Mixing up two somewhat related things will not help in the least.

 

[MaxManus]

This is getting off track.



If you want to know what Rawls thought, it's best to read Rawls, not about Rawls. (Although, truth be told, he's not an easy read.



Note that "free health care for all" and "at least some compensation to the sick people" are two different things. If you are going to study philosophy, it's vitally important that you be clear in your thinking and writing. Mixing up two somewhat related things will not help in the least.

1) Yes I should read rawls, but I'm not sure if he gives an answer to my question in his famous works.


2) Yes I see my opening post was unclear. According to Kymlicka Rawls doesn't want to compensate sick people at all.

But don't agree that it is strange that Rawls not to want to compensate the sick? For what he tries to do is see how we would like our society to be if we did not know who in the society we would be and Rawls himself thinks that we only would allow inequality if it benefitted the least advantaged.

But he excludes health status from the calculation of who is least advantaged.

 

[Gokul43201]

Reasons I've heard against such things include not wanting to pay for other people or wanting to encourage competition (both things that I don't agree with).

What is your argument against them?

One way that the US is organically different from the countries in Europe is that there is a philosophy (born of the Declaration of Indep) here that is deeply cherished, along the lines that it is government's job and responsibility to provide people with the opportunity to extricate themselves from the cycle of poverty. An unspoken corollary is that it is not really acceptable for government to try to make things comfortable for those seemingly trapped in that cycle. It's a philosophy that's based on the premise that it is always prossible to break free, given the opportunity. In contrast, the US might see the European philosophy as one of resignation and pessimism: it's impossible to break free from a cycle of poverty, so let's at least make things a little more comfortable for those that are stuck in it. In the US, we'd think of that as providing the wrong kind of feedback.

 

[Vanadium 50]

"Compensate the sick" is yet a third idea you are bringing into the mix.

What you are writing is very un-Rawlsian. It's true that healthcare is not considered on Rawls list of "primary goods". So are many other things we regard as important: such as the ability to enter into a contract - a legally binding agreement between individuals. Indeed, in Justice and Fairness, he specifically argues that the high cost of healthcare in the US leads to injustice.

This thread represents the worst of PF's discussions on philosophy. It's a bunch of people who have never read Rawls arguing about what he might have said or could have said or should have said - and not what he actually said.

 

[Ryan_m_b]

What is your argument against them?

One way that the US is organically different from the countries in Europe is that there is a philosophy (born of the Declaration of Indep) here that is deeply cherished, along the lines that it is government's job and responsibility to provide people with the opportunity to extricate themselves from the cycle of poverty. An unspoken corollary is that it is not really acceptable for government to try to make things comfortable for those seemingly trapped in that cycle. It's a philosophy that's based on the premise that it is always prossible to break free, given the opportunity. In contrast, the US might see the European philosophy as one of resignation and pessimism: it's impossible to break free from a cycle of poverty, so let's at least make things a little more comfortable for those that are stuck in it. In the US, we'd think of that as providing the wrong kind of feedback.

Sorry but that's totally wrong. The "European philosophy" is best characterised as recognising that ensuring that everyone gets healthcare is more practical and ethical than expecting people to somehow come up with the money themselves. Not being poor is not a case of rolling your sleeves up and getting stuck in, people can work their fingers to the bone and still be poorer than most who work the standard 40hpw. Your statement seems to imply that it would be easier to break the poverty cycle if people had to work for more in life which is not the case. I agree that if you are "poor" but sitting on a mountain of benefit payments then you will probably stay that way but that's a different issue.

Socialised healthcare doesn't increase poverty simply because people don't have to work, being poor still sucks. Secondly having to work for your health clearly does not help break the poverty cycle, instead people just stay poor and sick (the latter of which increases their chances of staying poor. Thirdly not everyone who is poor is so because they do not work for their money, many people work far, far harder than those at the other end of the economic spectrum but get paid orders of magnitude less, in addition many people are poor because of circumstances outside of their control such as economic crises. Fourthly socialised healthcare can help break the poverty cycle by ensuring that illness is not a factor in keeping someone poor, in addition to this you can still work on breaking the poverty cycle whilst possessing a socialised medical system.

Other practical advantages include enabling a monosomy healthcare system whereby one massive provider get's to throw it's weight around to get cheaper supplies and a country where the gross happiness index is higher overall, I judge the latter to be increasingly important these days.

 

[Gokul43201]

Sorry but that's totally wrong.

What is totally wrong?

 

[Ryan_m_b]

What is totally wrong?

The idea that policies ensuing that everyone has free/cheap access to healthcare via tax payments or state/regulated insurance increases poverty or makes it harder to break the poverty cycle.

 

[JDoolin]

To the original question, "why not a free health care system," we should acknowledge that doctors and nurses and pharmacists, and drug manufacturers and researchers do valuable work, and deserve to be paid! And we should acknowledge that there are hospitals that do provide charitable service, and actually do subscribe to that philosophy that health care should be free.

But don't tell anybody. Matthew 6:2 "But when you give to the needy, do not let your left hand know what your right hand is doing,"

I would also make the case that insurers do valuable work, so long as their goal is to make health-care affordable for everyone. But in an environment of rampant and legal price-fixing, is it possible for such an altruistic health-insurance company to survive?

Some statistics to check out: (Source "Griftopia" by Matt Taibbi.)

"Americans spend an average of about $7200 a year on health care, compared with the roughtly 2900 average for the other market economies that make up the OECD (Organization for Economic Cooperation and Development), and for that greatly increased outlay we get higher infant mortality, higher obesity rates, lower longevity, fewer doctors per 1000 people (just 2.4 per 1000 in the US compared with 3.1 in OECD states), and fewer acute care hospital beds (2.7 per 1000, compared to 3.8 per 1000 in the OECD countries)."

"Moreover, private insurance provides almost nothing in the way of financial protection for those who have it. A full 50 percent of all bancruptcies in America are related to health care costs, and of those, three-fourths involve people who actually HAVE health insurance."

Taibbi goes on to suggest that perhaps a major contributor to that extremely high cost of health insurance is that insurers are legally allowed to do Price Fixing, unlike any other industry, due to a law called the McCarran-Ferguson Act.