Debates about the Affordable Care Act are usually related to the technicalities of its implementation, petty politics, and occasionally, more fundamental claims about the role of government. This latter claim usually centers on the constitutionality of the Affordable Care Act, or as been the case in recent divisive court cases, certain religious aspects of the legislation. Rarely, however, is this debate focused on the fundamental role of health in our society. Does health have moral importance? Is healthcare a good that the government should guarantee? If so, how should we view health in comparison to other goods like income? Is health intrinsically important or is it merely instrumental to goods such as opportunity? The answers to these questions seem as though they should hold a more principal role in the healthcare debate. However, few philosophers have even attempted to incorporate health into a coherent system of justice in a way that provides a compelling argument for a moral obligation to provide healthcare.
Norm Daniels, in his book Just Health, attempts to do just this. Daniels aims to incorporate the concept of health into the system of justice presented by John Rawls. Daniels’ claim focuses on Rawls’ concept of Fair Equality of Opportunity. Fair Equality of Opportunity, in a grossly simplified way, states that individuals should have an equal chance of succeeding as those born with similar talents and motivations, regardless of the socioeconomic status they were born into. Rawls uses this principle to advocate for the importance of education as a way of protecting equality of opportunity. In Just Health, Daniels argues that we should view healthcare in a similar manner as Rawls views education.
If Daniels can make an effective claim that the government should provide a base level of healthcare, as it does with education, there would be a very compelling for some level of universal healthcare. The problem, as several philosophy scholars pointed out, is that the concept of health is too large a concept to fit neatly into Rawls’ conception of Fair Equality of Opportunity. Namely, viewing healthcare through the lens of opportunity forces us to discount the importance of diseases and disabilities incurred at birth as well as care for the elderly and those with a terminal illness. Furthermore, if we view health as a good analogous to a good such as income, we are forced to accept certain tradeoffs and an overall level of inequality in health that may prove unattractive to many.
Though Daniels theory accurately expands Rawls conception of health to include the social determinants of health and therefore to expand Fair Equality of Opportunity to include health, it falls short of answering the fundamental questions about the importance of health. Understanding Daniels’ argument, and how it falls short, is hopefully an important step in finally conceiving of a compelling presentation for public healthcare as a claim of justice.