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Kelin Emmett

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Chapter 7 Access to Health Care 7.2 Macroallocation: Is there a Right to Health Care? The Right to a Decent Minimum of Health Care by Buchanan The Assumption That There Is a Right to a Decent Minimum - Is there a more extensive right than right to decent minimum to health care? - What is included in the decent minimum? Preliminary Clarification of the Concept - Theory-dependent - Right to minimal level of health =/= right to everything b/c of resource constraints - Concept of right: o A is entitled to X o May be backed by sanctions o Infringing A’s right to maximize overall/A’s utility not sufficient reason o Universal applies to all o Enforceability for coercive policies for universal right The Attractions of the Idea of a Decent Minimum - Allows to adjust level of services provided as matter of right to relevant social conditions and possibility that as society becomes more affluent, decent minimum is raised - Avoids excess of strong equal access principle  everyone has equal right to best health care services available - Limited to basic services for tolerable life The Need for a Supporting Theory - Concept of right to decent minimum of health care inadequate as moral basis for coercive backed decent minimum policy without coherent and defensible theory of justice - ^would only imply that there is right to health care that is more limited than the right to strong equal access depending on resources - (author) Special rights, harm prevention, prudential arguments + two enforced charity with public goods = universal right to decent minimum Arguments from Special Rights - Universal right-claim: same right to all persons - Special right-claims: right to certain individuals/groups 1. Requirements of rectifying past/present institutional injustices a. Native Americans 2. Requirements of compensation to those who suffered unjust harms/unjustly exposed to health risks by assignable actions of private individuals/corporations 3. Undergone exceptional sacrifices for good of society a. Military Services Arguments from the Prevention of Harm - Right to decent minimum more extensive than traditional public health services, justified on grounds that they are required to protect citizens from harms arising from interactions of living together - Harm Prevention argument for traditional public health services can be argued for universal right to health care o Expending public resources on public health measures  obligation to achieve standard of equal protection?  Availability of public health services should not greatly vary across race, ethnicity, geography Prudential Arguments - Emphasize benefits rather than prevention of harm - Availability of basic health care makes labour force more productive - Does not assume that individuals have moral rights to services Two Arguments for Enforced Beneficence - Contribution to production of public goods o Individuals have incentives to withhold contribution  enforcement through penalties and assurance that others will contribute - Enforced justified by need to overcome individual incentive but also to ensure that efforts are coordinated - ^both depend on coordination and aspect of concept of public good o (libertarians) Basic moral obligation of charity/beneficence  Provision of resources  Efficacy of impulses o (leftists) Competitive acquisitive society  self-interest > beneficence First Argument - Need enforcement of principle requiring contributions to ensure decent minimum o Collective effort for decent minimum for all > independent charitable acts  People may think their contribution makes no difference collectively so give independently  Maximize the good they can give with the resources they have Second Argument - Believe that collective decent minimum > independent charitable act and will pay but only if assurance that enough others will contribute to achieve success - Both arguments agree that enforced decent minimum needed to achieve coordinated join effort - Second focuses on assurance problem while First does not - Second – only need assumption that rational beneficence requires assurance that enough others will contribute - First – individual’s reason for not contributing is not lack of assurance but better to not contribute whether others do or not - Neither assumes conflict between individual moral motivation of beneficence and self-interest - Paradoxes of rationality called public goods problem o Introduce coercive mechanism with penalties to non-contribution o Use same mechanism for health programs Managing Care the Canadian Way by Armstrong - Medicare – publicly administered, non-profit - Managed care: any method of health care designed to reduce unnecessary utilization of services, contain costs, measure performance, while providing accessible, quality, effective health care o Fixed payment to provider regardless of services supplied Sustaining Medicare: The Commission on the Future of Health Care in Canada by Romanow - Commission mandate to make recommendations to ensure long-term sustainability of universally accessible, publicly funded health system o Canadians want system to be sustainable and to also to change What is Sustainability? - Based on c
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