Abstract
Over the past two years the debate has reemerged over whether or not the US ought to replace its current patchwork system for financing access to health care with some system of national health insurance.1 This debate last occurred in the mid-1970s, but it was effectively squelched by a worsening economy and escalating health care costs that made national health insurance seem unaffordable. Growth of more than 25% in the ranks of those without any health insurance during the decade of the eighties has renewed this debate. Currently, there are about 37 million Americans without any health insurance. Most are poor, but employed—70% of them are employed more than twenty hours per week. But these are generally low-paying service sector jobs for small employers who cannot afford to provide health benefits.
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Notes and References
See David Himmelstein and Steffie Woolhandler, et al. (1989) “A National Health Program for the United States: A Physician’s Proposal,” The New England Journal of Medicine, 320, 102–108.
Robert Evans. (1986) “Finding the Levers, Finding the Courage: Lessons from Cost Containment in North America,” Journal of Health Politics, Policy and Law, 11 585–615, at 588–589.
Robert Veatch. (1986) The Foundations of Justice: Why the Retarded and the Rest of Us Have Claims to Eauality (Oxford University Press, Oxford, UK).
H. Tristram Engelhardt. (1986) The Foundations of Bioethics (Oxford University Press, Osford, UK), especially chapter eight.
Norman Daniels. (1985) Just Health Care (Cambridge University Press, Cambridge, UK).
See James Todd, President of the AMA. (1989) “It is Time for Universal Access, Not Universal Insurance,” The New England Journal of Medicine, 321 46–47.
See Shortell and NcNerney, op. cit., 463–467.
John Rawls, op. cit., 279.
/bid., 279.
For full details describing the framework of nonideal justice, the reader may see my earlier article (1987) “DRGs: Justice and the Invisible Rationing of Health Care Resources,” Journal of Medicine and Philosophy, 12 165–176.
For a more complete description of the problem of those without health insurance, see Donald Cohodes. (1986) “America: The Home of the Free, the Land of the Uninsured,” Inquiry,23 227–35;
’Norman Daniels, Just Health Care, op. cit.,226.
Paul Starr. (1982) The Social Transformation of American Medicine (Basic Books, New York, NY), chapter three.
Norman Daniels, Just Health Care, op. cit., Chapters 2 and 3.
DThe President’s Commission for the Study of Ethical Problems in Medicinc and Biomedical and Behavioral Research. (1983) Securing Access to Health Care, Vol. I (Government Printing Office, Washington, DC), 17.
Ibid., 4.
Leonard M. Fleck. (1989) “Just Health Care (I): Is Beneficence Enough” Theoretical Medicine, 10 167–182.
David Himmelstein and Steffie Woolhandler. (1986) “Cost Without Benefit: Administrative Waste in U.S. Health Care,” The New England Journal of Medicine, 314 441–445.
Deborah Pinkney (1989), “ACS Report: Poor Caught in Cancer Trap,” American Medical News (July 28, 1989), 1, 38–39.
The Chicago Tribune (August 6, 1989), 7.
Martin Feldstein (1983), Health Care Economics, 2nd Ed. (John Wiley and Sons, New York, NY), 480–557.
Ronald Bayer, Daniel Callahan, et al. (1988) “Toward Justice in Health Care,” American Journal of Public Health, 78 583–588, at 583.
Paul Volberding, et al. (1990) “Zidovudine in Asymptomatic Human Immunodeficiency Virus Infection: A Controlled Trial in Persons with Fewer than 500 CD-4 Positive Cells Per Cubic Millimeter,” The New England Journal of Medicine, 322, 941–948.
John Moskop, “The Moral Limits to Federal Funding for Kidney Discase,” The Hastings Center Report, 17 11–15.
Enthoven-Kronick, op. cit. and Himmelstein-Woolhandler, “A National Health Program for the United States,” op. cit.
Enthoven-Kronick, op. cit., 29.
/bid., 31–35.
Himmelstein-Woolhandler, op. cit., 103–106.
Loren Lomasky. (1981) “Medical Progress and National Health Care,” Philosophy and Public Affairs, 10 65–88.
Paul Menzel. (1983) Medical Costs, Moral Choices: A Philosophy of Health Care Economics in America (Yale University Press, New Haven, CT); and Strong Medicine: The Ethical Rationing of Health Care (Oxford University Press, Oxford, UK, 1990).
Baruch Brody. (1988) “The Macro-Allocation of Health Care Resources,” in Health Care Systems, Hans-Martin Sass and Robert Massey, eds. (Kluwer Academic Publishers, Dordrecht), 213–236; and “Wholehearted and Halfhearted Care: National Policies vs. Individual Choice,” in Ethical Dimensions of Geriatric Care: Value Conflicts for the 21st Century, Stuart Spicker, et al., eds. (Kluwer Academic Publishers, Dordrecht), 79–94.
Enthoven-Kronick, op. cit., 32.
/bid., 35.
Lomasky, op. cit., 69–70.
The most recent advances in genetic engineering and gene therapy are discussed by Ron Kotulak and Peter Gorner in a series of seven articles that appeared in The Chicago Tribune from April 8–15, 1990. Each article started on the front page of the paper.
See Marcia Angell. (1985) “Cost Containment and the Physician,” Journal of the American Medical Association, 254,1203–1207.
The EC/ IC Study Group. (1985) “Failure of Extracranial-Intracranial Arterial Bypass to Reduce the Risk of Ischemic Stroke,” The New England Journal of Medicine, 313 1191.
Daniel Callahan. (1990) What Kind of Life: The Limits of Medical Progress (Simon and Schuster, New York, NY), 53.
/bid., 34.
Menzel offers the most philosophically interesting discussion of what should count as costworthy health care, which he ties in with the “willingness to pay” of individuals. See his Medical Costs, Moral Choices,op. cit., chapter one.
Lomasky, op. cit., 75–77.
Ibid., 77.
1bid., 78.
/d., 79.
/bid.,79–80.
For a good discussion of the issues raised by voluntary health needs, see Daniel Wikler. (1987) “Personal Responsibility for Illness,” in Health Care Ethics: An Introduction, Donald Vandeveer and Tom Regan, eds. (Temple University Press, Philadelphia, PA), 326–358.
Arthur Caplan was one of the first to raise the problems posed by experimental medicine for a national health insurance program. See his (1981) “Kidneys, Ethics, and Politics: Policy Lessons of the ESRD Experience,” Journal of Health Politics, Policy, and Law, 6, 488–503 at 499–500.
For an excellent and timely discussion of all these issues, see Haavi Morreim. (1990) “The New Economics of Medicine: Special Challenges for Psychiatry,” Journal of Medicine and Philosophy, 15 97–119.
John Rawls. (1980) “Kantian Constructivism in Moral Theory,” The Journal of Philosophy, 72, 515–572, at 539.
See also Gerald Winslow. (1986) “Rationing and Publicity,” in The Price of Health,George Agich and Charles Begley, eds. (Reidel Publishing, Dordrecht), 199–216.
See my paper (1990) “DRGs: Justice and the Invisible Rationing of Health Care Resources,” op. cit.; and “Justice, HMOs, and the Invisible Rationing of Health Care Resources,” Bioethics, 4 97–120.
Guido Calabresi and Phillip Bobbitt. (1978), Tragic Choices (W.W. Norton, New York, NY).
Baruch Brody, “The Macro-Allocation of Health Care Resources,” op. cit., 217.
/bid., 217–223.
Ibid., 225–226.
Ibid., 227.
See Tristram Engelhardt, The Foundations of Bioethics, op. cit., 40–43.
Baruch Brody, op. cit., 228–229.
For a moral justification of the imposition of such controls, see Daniel Callahan. (1989) “Rationing Health Care: Will It be Necessary? Can It Be Done Without Age or Disability Discrimination?” Issues in Law and Medicine, 5, 353–366.
This ad appeared in The Detroit Free Press (Sept. 14, 1985), their emphasis in the text.
NormanDaniels. (1988)AmlMyParents’ Keeper: An Essay on Justice Between the Young and the Old (Oxford University Press, Oxford, UK).
Daniel Callahan. (1987), Setting Limits: Medical Goals in an Aging Society (Simon and Schuster, New York, NY).
Enthoven-Kronick, op. cit.,94.
Baruch Brody, “The Macro-Allocation of Health Care Resources,” op. cit., 213.
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Fleck, L.M. (1991). How Just Must We Be?. In: Humber, J.M., Almeder, R.F. (eds) Biomedical Ethics Reviews · 1990. Biomedical Ethics Reviews. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-4612-0471-8_6
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