Introduction to Political Philosophy

The Issue of Health Care

As you read the material for the next class, keep the questions below in mind. To answer these questions you will have to reflect critically on what you have read and possibly re-read important passages. Keep in mind that there are two basic kinds of information that you need to look for in the readings.

  1. What are the main points or conclusions that an author accepts with respect to a particular issue?
  2. What are the reasons or important considerations that lead the author to accept that conclusion?

For our purposes, it is information of the latter sort (2) that will be our primary concern since our most basic task is to evaluate the reasons that are offered to support accepting one possible conclusion about an issue, rather than another. Although I strongly suggest that you write out brief answers to these questions, you do not have to turn in written responses. You do, however, need to be prepared to speak intelligently to these issues in the next class meeting.

Reading:

  • Ronald Dworkin, Sovereign Virtue, “Justice and the High Cost of Health”, pp. 307-19 (handout).
  • Malcolm Gladwell, “The Moral Hazard Myth: The bad idea behind our failed health-care system” (handout).
  • Ezekiel Emanuel and Victor Fuchs, “Getting Covered: Choose a plan everyone can agree on” (handout).

Questions:

  1. According to Dworkin, what is the rescue principle? Why is it “almost wholly useless”? What is Dworkin’s “prudent insurance” ideal? How does it employ “individual prudence” to answer the questions at the beginning of the paper? Why is this ideal different from and preferable to the rescue principle?
  2. In the prudent insurance scheme, why can’t we know our health status? What moral idea does this ignorance express? Should health insurance be based on individual situation and risk, or should there be some form of sharing of risks?
  3. What is Gladwell’s distinction between social and actuarial insurance? How does this distinction relate to Dworkin's insurance model?
  4. What is moral hazard? How is it related to personal responsibility and how has it shaped approaches to health insurance in the United States? What is Gladwell’s argument that it is not really a serious problem? Is his argument convincing and does it apply to Dworkin’s insurance model?
  5. Why, according to Emanuel and Fuchs, is a voucher system more in accord with Americans’ commitments to equality and liberty than a single-payer system?

 

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