Wednesday, October 14, 2009

Healthcare and distributive justice

It's been a while since I updated this blog, but it's about time I get it going again. So, as a first comment, something about an issue that is crucial to much of the current healthcare debate, but is unfortunately rarely made explicit.

About a month ago, the College Republicans at UGA invited two doctors to speak on healthcare. These physicians claimed to offer "an evidence-based approach" to opposing health care reform. Most of this evidence is recapitulated on their blog (whose sub-title suggests that they do not know the difference between "ills" and "ails": not a good sign!).

Their argument against reform appears to be that 1) any statistics which indicate the U.S. healthcare system performs poorly are wrong, while statistics that indicate it performs well are correct; 2) access to healthcare is not a problem (there is always the ER), and 3) the Massachusetts healthcare reform has worked very poorly, so U.S.-wide reform will fail. Although they claim to base their arguments on evidence, their reading of this evidence is highly selective and obviously geared to support their predetermined conclusion.

More disturbing is their take-away message, as reported in UGA's student newspaper, the Red & Black: they consider it "common sense" that "If we are going to bring 47 million people into the system without increasing the number of doctors out there" this will "give you less access".

And there's the rub: Theirs is an argument of "haves" versus "have-nots". At its heart, this is not an argument about efficiency or cost, nor even about access. Of course, one can debate whether or not healthcare reform might bring new doctors into the system (though they do not address this question), whether physicians are the limiting factor in access to healthcare (also not addressed), and whether "less access" implies worse care (also not addressed).

But abstracting away from those questions, these two doctors apparently consider it "common sense" that those who benefit from the current system (doctors and well-insured patients alike), a system which is heavily subsidized by the government (about half of all healthcare spending in the U.S. is public spending), ought to oppose extending similar government-subsidized benefits to those who are currently excluded. This is a question of distributive justice.

It is about the justice of maintaining an institutional structure which excludes certain people from receiving benefits (subsidized by the government) in a way that is manifestly inequitable (see Nicholas Kristof's column in the New York Times last week; more systematic detail is in this academic study); an exclusion that, among others, results in an estimated 45,000 unnecessary deaths per year.

Even if it were true that the "you" the doctors addressed in their talk can expect to encounter "less access" under a reformed healthcare system, which is highly debatable, is it too much to hope that many of them would be willing to offer up a little access in exchange for saving the lives of up to 45,000 fellow-citizens per year?

P.S. Interestingly, the Red & Black recently reported that quite a few UGA undergraduates are without health insurance. Of course, it is possible that those without health insurance are less likely to attend an event organized by the College Republicans, and thus were not part of the "you" the doctors were addressing.


  1. Sadly, the two doctors who came to UGA recently are not alone. I was having a friendly debate with a local small business owner recently, a very smart and moderately wealthy man. After proudly proclaiming America's healthcare system to be the best in the world, he spelled out his opposition to current efforts at healthcare reform. His argument centered around a single "problem": if we were to extend healthcare coverage to the millions of currently uninsured, he said, every doctor's office in the country would be inundated with new patients. "We" would not be able to see a doctor for months because of this. If that were true, I countered, wouldn't that be evidence that lots of people currently need healthcare that they cannot afford? The gentleman apparently did not grasp the irony of his own argument- how can America have the best healthcare system in the world if we have millions of people who can't afford to participate in that system? I have heard variations on this argument everywhere lately. Coincidentally (or not), they usually seem to come from people who have no problem affording good health insurance. Rich people never fail to amaze me.

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