In the commentary "Class, Health and Justice"many different possible solutions to the inequalities in health care distribution are listed. It is a known fact that in most societies, there is a definite difference in the health care distribution which is the direct result of a difference in socioeconomic status. Simply put, money rules everything. It governs not only the opportunities available to us (with regards to things such as education) but also the treatments that we are able to receive (for example, health care).
Four possible solutions to resolving this inequality were listed:
1. Maximizing the total sum of health of a society
2. Equalizing levels of health between classes
3. Maximizing the health of the lowest socioeconomic class
4. Give priority to eliminating and treating the sickest individuals
Before reading this commentary, I will admit that I was 100% for universal health care. I didn't see any issues with equalizing the health care provided to all socioeconomic statuses until the point was brought up of how underlying egalitarianism would have to extend far beyond just issues of health. This would only result in a socialist society, which in theory seems morally just, but we know it just does not work.
After completing the commentary, my position had changed to my believing that the fourth solution would be the best. I however must mention that I could not ignore the consideration listed towards the end of the commentary: "any attempt to locate the source of injustice in class inequalities in health is the notion that people bear some responsibility for their own morbidity and mortality."I strongly agree with the statement that each individual is somewhat responsible for their health. I know there are definite exceptions, especially when considering genetic predispositions, but why should health care be equalized when we don't know for sure that everyone has the same goals and life plans? Many individuals may not care about their health and may engage in activities that deteriorate their health, so I do not believe that they should receive equal treatment as someone who chooses not to engage in such behaviors.
Even in agreeing with this statement, I think that the fourth option is still the best as it gives advantages to those who really need it. Not only this, but in attempting to help those that are the "worst-off", we are also eventually helping ourselves by directing our resources towards diseases that desperately need cures.
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The issue that worries me with the view of "equity as priority to the sickest" is that this view calls for "relative weight", weighing urgency of the sick against cost and efficiacy. How could we chose which illnesses were more urgent than cost and wouldn't this decision have to been done prior to individuals' illness? For Example, would there have to be a senate meeting where cancer is deemed more urgent than a gun shot wound or vice versa. If the decision was not completed in this matter, would an individual have to wait for care until it was decided that there needs were more urgent than cost or efficiacy? I agree that the sickest should take priority regardless of class but how do we objectively determine who the sickest are? If it is determined by the "normal opportunity range", as Daniels suggests in his article, another problem emerges. This view does not take into account all health care needs, just those that allow us the minimal range of opportunity, which sounds to me like the minimal quality of care and life.
ReplyDeleteAlthough contradictory, I agree with both cchristi and wasabi. All in all, the fourth option described by Marchand, Wikler, and Landesman makes the most sense, in principle. Those who are sickest should receive care before those who are not as sick. Somewhat akin to the idea of medical field work in a war situation. Those who are in a life-threatening situation due to their injuries are given priority over those whose injuries are not as serious.
ReplyDeleteThe comparison to socialism is probably the best realistic example considering how impossible it would be to putting these ideas into practice, which causes me to seriously consider if it would work. It is easy to consider this ideally as a thought experiment, but in actuality systems are never that ideal.
Consider the idea that one man’s life is worth more than another man’s. It is a given that all men are created equal, and I will not argue against that. However, just as another point to consider, if the president of the United States was sick or injured and we place his level of sickness/injury at a 7 on a scale from 1 to 10 (assume that this is impossible), would he or should he have priority over an average citizen who’s sickness/injury level is an 8? Both of their injuries/sicknesses are life threatening, however the average citizen’s are slightly worse. Is the president’s life “worth more”?
What if that average citizen was a convicted felon? Or what if it was a comparison between a 7 and a 7.5 or 7.1, the list goes on. And this is assuming we can accurately rank order sicknesses on a numerical scale.
Continuing the president example, on a daily basis his secret service lay their life on the line to protect his. They are, in effect, saying that their life is “worth less” than his.
We are all created equal, but does what one does with that life make him/her worth more or less than another person?
One point I wish the authors had not brushed over was in the opening few paragraphs. “Surely all but the very poorest countries can avoid exposing a sizable proportion of their populations to avoidable, material deprivation that denies them even a minimally decent standard of living.”
The authors do not consider these individuals throughout the rest of the article, but I wonder what percentage of the world’s population actually falls into this category. Considering more than 3 billion people (about half the world’s population) live on less than $2.50 a day, what percentage of people are the authors talking about and what percent are they ignoring?
While I read the first half or so of the aritcle, I was thinking: differences in health are often brought about due to individual risk-taking habits; how can a chain-smoker that gets cancer lay a moral claim with regards to his health, for his lung cancer is a consequence of his risk-taking behvaior? I had something akin to Nozick's theory of justice in mind: once some level of distributative social justice is achieved, whatever result that comes about through just means is itself just. The authors, of course, discusses this very issue at the end of the article. Yet, I'm not sure if they have fully addressed the worry.
ReplyDeleteNow, the problem that is posed in the article is that class inequality in health persists even when there is a just allocation of health care. If the authors see class inequality as a problem . then I would expect the solution to the problem to be a reduction of class inequality in health.
Strangely enough, the solution that the authors seemingly endorse ("Equity as Priority to the Sickest") is that "we should not give priority to the lowest socieconomic class, but to those with the most urgent needs, regardless of class." In other words, the authors are suggesting that class inequality in health has no bearing in the allocation of resources avaiable for medical treatment. If so, why should we see class inequality in health as a problem in the first place, once it is assumed that an adequate level of distributive justice as been achieved with regards to health care?
Furthermore, if there are class inequalities that remain after a just allocation of health care, shouldn't we think that the "just" allocation of health care is not socially just?
The inequality that persists after a just allocation of health care shouldn't be social inequality, but inequality in levels of health brought about by personal choice (such as risk-taking behavior).
My hunch is that once a just distribution of health care is achieved, the rest of the "inequalities" cease to be a problem of social justice, but of practical reasoning. Of course we ought to give priority to the sickest (that's why we have ER--because we don't want someone with a gunshot wound to wait two weeks for an appointment). Of course we ought to treat the worst-off--the point of medicine is to save lives and it seems to be a trivial thing to say that medical practitioners ought to give priority to those who are on the verge of dying over those who are not.
Yes, I think the fourth option is the most attractive one. But I also think that it's a quite trivial outcome.
I agree with most of what has been said. The fourth option is ideally the most attractive, but as wallace points out, it would be almost impossible in practice.
ReplyDeleteIn response to lebenswelt's question: "the authors are suggesting that class inequality in health has no bearing in the allocation of resources avaiable for medical treatment. If so, why should we see class inequality in health as a problem in the first place, once it is assumed that an adequate level of distributive justice as been achieved with regards to health care?" The authors touch on this, saying that "since urgent needs are much more prevalent among the lowest class, the real-world effect of such a policy would be to reduce those class inequalities." So, even in the fourth option, the authors are saying that class inequality in health does matter, and it will be partially fixed by this option.
I don't know how much I really buy that. Sure, some class inequalities will be reduced, but the gap will still remain. This option might be the best, but it certainly takes the emphasis off the whole point of the paper: creating class equality in health.
I think the author is saying improve healthcare in itself. It makes sense to me, I mean if healthcare is universal but inefficient and discriminatory why spread it around? The solutions the author lists are quantitative so it would be easy to measure progress. My concern is concrete applications that will improve accomplish the goals. Goals are the easy part it seems. I think of the Surgeon General’s Health Initiative we were talking about in a different class. It lists goals for America like reduce drug use by 25%, reduce the number of smokers by 45% etc. The goals were to be met by 1990 (It was created in the eighties). Then they made it for 2000, recently it was changed to 2110. Am I way off? I just don’t think without strategic planning the author’s ideas are worth much. To improve healthcare by maximizing overall health, limiting gaps in health etc. would make universal application more welcome.
ReplyDeleteLastly, I do agree with the people in class that raised the issue of stress and overall poor health that is associated with minorities in this country. Health needs to be more concerned with overall wellness in order to raise the health of the sickest. People are healthier when they have security in their basic needs. It translates into physical symptoms but the issue can start developing when one is born into treacherous water.