Module 6: Two-tier health care
Explain and evaluate the
libertarian argument for a right
to private health care.
If I have justly acquired some wealth, then I have the right to spend my wealth in any
manner that I choose, provided that doing so does not violate anyone else’s rights.
1. If a person freely consents to an action and the action does not violate the rights of
others, then the government is not morally permitted to interfere.
2. If a person does not engage in force or fraud, then the person does not violate the
rights of others.
3. Sanders freely consents to getting a private MRI without engaging in any force or
fraud.
-4. Therefore, the government is not morally permitted to interfere with Sanders’s
getting that private MRI.
Premise 1 could be considered false because redistributive taxation may well be
permissible.
Premise 2 may be objected using the complicity objection. If private procedures lead
to a worsening of the public system – say, because lots of doctors and MRI technicians
abandon the public system in favour of the more lucrative private sector – then, the
government would be justified in opposing these private medical procedures.
Explain and evaluate the
libertarian argument against
publicly funded health care.
Premise 2 may also be objected using the compassion objection. The gov’t is not
compassionate if it puts the distribution of basic goods entirely in the hands of a free
market. However, an objection to this objection would be that “ought does not imply
can” and also, the gov’t should be compassionate towards those who can afford to
pay for private MRI.
Forcing people to pay for a public system violates people’s rights.
Suppose there is a system considered by libertarian’s opponents. Wilt Chamberlain
signs a contract that allows him to get 25 cents for each ticket sold. He gets $250,000
in a year, but the government taxes his income in order to give to people in need, or
to fund health care, etc. The gov’t is basically taking something that properly belongs
to Wilt, and treating him as a means to some other end.
This argument is based on intuition. However, we can have another argument for the
opposite, also based on intuition. Suppose Mary gets a tumour, but cannot support
herself because it is too expensive and she cannot work either since she has to be at
the hospital. The bank will not loan her money, nor will the hospital defer her
payment because she is at a high risk of dying. Mary realizes she will die and that
there is nothing she can do.
In this example, a charity could step in and help her by paying. Libertarians would say
Mary has no right to the assistance of others, though the situation is unfortunate. But
there could be a public system that taxes Wilt and others who could afford to pay
taxes, and this money could then be used to fund a public medical system that could
help save lives of those like Mary.
Also, people take jobs knowing they will be taxed. Wilt would have known that he
Explain the egalitarian
arguments against two-tiered
health care.
would end up with say, 18 cents instead of 25 cents per ticket when he signed his
contract, and he would still have agreed, so he was not treated as a means.
To award some better or faster medical care merely because they can afford it, and to
deliver inferior medical care to others merely because they cannot afford it, is deeply
offensive to many.
But what if the best way to get health care for everyone was by allowing some private
MRIs? If that were the case, and no serious harms were done outside of health care,
then people in the original position might choose private MRI. To opt for an
egalitarian system that is best for no one would not be virtuous.
It is unfair that some get better health care because they are richer, and for this
reason there is a strong prima facie reason to oppose two-tier MRI. But if we can
improve the situation of everyone by allowing private MRIs, and if there is no fairer
way to provide these benefits, then perhaps it is the greater moral good of harm
reduction that outweighs the unfairness.
Another example for the objection would be public and private education. People can
pay for private, arguably better, education but this is not unfair because the public
education system is good and private education does not harm the public education
system or harm the public in other important ways.
Explain the conditions under
which two-tiered health care is
just, according to Warren and
Patrick.
Explain Warren, Patrick and
Doran's views on the
permissibility of using private
health care, when it is
administered in a way that is
unjust.
We agree that both the libertarian argument for private MRI and the egalitarian
argument against private MRI fail. We rejected the libertarian argument in part
because it implies that private MRI is justified even if it harms those in the public
health care system. And we rejected the egalitarian argument because it implies that
private MRI would be wrong even if it brought benefits to everyone in both the
private and public system.
Private MRI is permissible provided that it does not harm those in the public system
and that it doesn’t harm the public provision of other important goods.
Warren believes most people in the original position would say: We should bias our
decisions about allowing differences so as to provide a robust advantage to the least
advantaged. People in the OP would rule out private MRI if it threatened this robust
advantage for the least advantaged, an excellent safety net in wealthy societies like
our own.
Patrick says private MRI is permissible if it benefits those in the public system, or at
least does not make them worse off. Gov’t has an obligation to ensure that citizens
have a reasonable basic level of primary social goods like food, shelter, education, etc.
If everyone has a reasonable basic level of primary goods, then the gov’t should allow
private MRI, provided that this does not make those in the public system worse off in
terms of access to the primary goods, than they would be in a purely public system.
But for Patrick’s view: what is the gov’t is not meeting its obligation to provide basic
primary social goods – would private MRI then be wrong? Private MRIs would still be
permissible only if allowing it improves the situation of the general public. The gov’t
could impose a tax on private MRIs and use the money to improve everyone’s lot. Or
the private sector could provide subsidies for those who cannot afford the fee. This is
the virtuous thing to do.
Further, Warren thinks that people do not do wrong when they seek private MRI for
serious medical reasons. It is the politicians who do wrong by putting people in the
position of having to seek private MRI.
It would be callous and irresponsible if Sanders’ father made his son suffer and wait
for an MRI when he has the means to get him one right away. The moral failing,
again, lies with the Canadian gov’t.
Doran agrees that two-tier MRI can be justified if a robust social safety net is in place,
provided that it does not harm that net. And it can be justified if a robust social safety
net is not in place, if it improves the condition of the worst off.
In summary, everyone thinks two-tier MRI can be justified under certain
circumstances. And under the assumption that two-tier MRI is unjust in Canada,
Patrick and Warren agree that it would still be permissible for a patient to use private
MRI (because it is the gov’t’s fault).