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The rising costs of healthcare in the United States has been a point of concern for many years. This concern has largely been focussed on the economic problem involved in these costs, when the living poor are unable to afford basic healthcare. The widely accepted solution is creating a system that fairly allocates the health care resources and permits equitable access for all social classes. Though this solution seems logical, there are many underlying ethical dilemmas involved in its implementation. Lawrence Gostin and Robert Veatch each develop arguments and solutions for universal health care by utilizing various ethical theories and approaches. In what follows, I will compare and contrast the arguments for universal health care and offer my objections and replies to the solutions they provide.
Rawlsian Theory as a Basis for the Necessity of Health Care
Gostin and Veatch base their arguments for universal healthcare under the premise of Rawlsian theory. This theory asserts that every individual should make decisions under a “veil of ignorance,” where everyone has no concept of what social class, status or economic position they will be born into. If everyone in the “original position” is to make a decision, Rawls assumes their decision will benefit the most people and produce the least harm in a society. Gostin and Veatch vary in their applications of Rawlsian theory to healthcare.
Gostin develops his argument for a universal healthcare system under the Rawlsian theory by stressing the value of health as a basic reason for equitable health care. He begins his essay with an array of facts and data stressing the value of health and why the government should intervene with universal coverage. He asserts “the prevention of disease [. . .] and promotion of health [. . .] provides the preeminent justification for the government to act for the welfare of society” (72). His assumption is backed by the argument that equitable access is warranted by the claim that health care is essential to the ability for one to pursue opportunities in life. Accordingly, Gostin maintains that if an individual is placed under the veil, he will choose a health policy that allows for equal access because it is the foundation for their future.
Differing from Gostin, Veatch utilizes the Rawlsian theory to argue his position of justice in universal health care under the premise of a moral community. Veatch defines a moral community as one that is generated under the principle that each person’s welfare counts equally. From this basic definition, Veatch then introduces the Rawlsian theory and concludes that members of a moral community respect each other on the basis of mutual trust and loyalty (53). The ways in which Gostin and Veatch utilize their interpretations of the Rawlsian theory have both their strengths and weaknesses.