In regards to healthcare inequalities, Daniels writes, in his article “Justice, Health, and Healthcare”, that a society’s health is strongly affected by its social inequalities, such as unequal distribution of income; therefore, we, as a society, must bridge the gap between these social inequalities thereby eliminating health inequalities. He uses empirical evidence to support this argument, quoting studies that show the more unequal a society is in economic terms, the more unequal health is in that particular society. One strong suggestion he makes is that income inequality leads to educational inequality which leads to health inequality. Not only do these inequalities lead to poorer health but he states that it also “erodes social cohesion” within the society. Utilizing Rawl’s Theory of Justice, a supporter of Kantian Contractariansim, Daniels argues that since it is morally just to protect opportunity and distribution of goods, these social inequalities are unjust. Furthermore, since health inequalities are a result of these social inequalities and further limit opportunity, they too are unjust. Therefore, Universal Healthcare is necessary to promote equality.
Sreenivasan, criticizes Daniels argument in his article, “Opportunity is not the Key”, stating that Daniels has missed an important factor by assuming that health and healthcare are essentially the same thing. He argues that health is indeed special in terms of equality but “access to healthcare” is not the same moral right and therefore, is not unjust. Using Daniels own empirical evidence, he states that since health inequalities are a result of socioeconomic inequalities and the fact the universal healthcare has been shown not to work in terms of equalizing health, such as in the UK, then a just society has a duty not to provide universal healthcare access. Instead, it should utilize all its resources to equalize socioeconomic inequalities.
Although I have in the past been a strong proponent for Universal Healthcare, our discussions in class on the sheer complexity of what would be necessary to provide minimum healthcare to all and what exactly the definition of “ decent healthcare” would entail, I find myself agreeing with Seerivasan that the socioeconomic inequalities are the true culprit in an unequal society and that we must work on closing the gap between these inequalities first and foremost. Thinking of these inequalities, I found myself stuck on Daniels suggestion that income inequality leads to education inequalities which leads to health inequality. Is this the correct cause and effect order or do they blend together? I do see how income can lead to education inequalities through unequal distribution of state resources. However, I believe income inequalities ultimately stem from generations of individuals being lost in a poor education system. As a result, they do not have the same resources as others and cannot find a job with equal income. Both inequalities are so strongly tied together that how does a just society chose which inequality needs to be fixed first? Furthermore, I think it would take generations to fix these inequalities in any society. For example, fixing the education system now will not show economic results until those children enter the workforce. So, in the meantime, what do we, as a society, do while we wait for the inequalities to diminish. Can we stand by and let the current generation suffer so that in the long run future generations have greater opportunity?
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Wasabi, I had the same question regarding Daniels’ income-education-health cause and effect chain. It’s a chicken and an egg scenario, one that seems difficult, even impossible, to point at a certain link and claim this is the causative event. As you asked, “how does a just society chose which inequality needs to be fixed first?” Do we need more chickens or do we need more eggs?
ReplyDeleteDoes Sreenivasan commit the same error he accuses Daniels of making? By claiming that universal healthcare access doesn’t work without more equal socioeconomic conditions, he is saying societies need to fix socioeconomic conditions and health will follow. Sreenivasan appears to use the same evidence Daniels does, just reverse, to claim we need more chickens, as opposed to eggs.
Am I way off on Sreenivasan’s analysis of Daniels and/or vice versa? I think there is something there I am missing.
While I was reading the article with Daniels, I agreed with pretty much everything he was saying with regards to socioeconomic inequalities until the point where he discussed his "societal mechanisms". Although I will say it seemed rather clever to show a tie between the three inequalities, I found it to be quite a stretch to state that income inequality leads to educational inequality which then leads to health inequality. With social issues such as these, I feel it is impossible to have a direct "mechanism". This proposal is something that you would expect to find in a hard science textbook on a given reaction, not on social issues!
ReplyDeleteWallace, I agree with belief that Sreenivasan commits the same error as Daniels. Though he is attempting to refute Daniels societal mechanism, he is also agreeing with it by stating that "ameliorating the social determinants of health, rather than to healthcare, would thus move citizens closer to their 'fair share of health', however exactly this is defined". How can he be skeptical of the link that Daniels proposes and yet agree that these social inequalities must be repaired in order to have equal healthcare?
I personally feel that the commentary by Daniels was much more convincing and definitely stronger than that of Sreenivasan simply because Daniels seemed to hold true to his belief in the definite link between socioeconomic status and health care inequalities.
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ReplyDeleteWallace and cchristi // I am not too sure what you mean when you say that Sreenivasan has committed the same error as Daniels.
ReplyDeleteWhat Daniels argues is that reducing socio-economic gap would increase health. Daniels takes for granted the link between health and healthcare, as Sreenivasan correctly points out. Hence, his view is that considerations of Rawlsian contractarianism justifies equal distribution of health, and this, I take, is to serve as the justification for equal, or universal access to, health care.
Sreenivasan’s criticism of Daniels is that the very considerations (Rawlsian justice and empirical data) that Daniels takes into account leads not to the conclusion that there should be universal health care but to the conclusion that the society ought to invest its resources into flattening the socioeconomic gradient. The gist of Sreenivasan’s criticism is that Daniels’ data does not support investment in healthcare, but only the reduction of the socioeconomic gap itself.
cchristi, you cite Sreenivasan as saying that “devoting the entire healthcare budget to ameliorating the social determinants of health, rather than to healthcare, would thus move citizens closer to their “fair share of health,” however exactly this is defined” and contend that Sreenivasan has committed the “same error” as Daniels. Yet, the very next sentence goes: “If a fair share of opportunity was the key, this society would be required not to spend anything on healthcare and, a fortiori, not to provide universal access.” Of course, universal access to healthcare is what Daniels wants to argue for; Sreenivasan has shown that the considerations that Daniels uses in support of universal access to healthcare does not, surprisingly enough, support universal access to healthcare.
In this sense, Sreenivasan’s article is a robust criticism of Daniels’.
I'm just here cuz my post got no love....
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