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 The Equity Principle

      Following their establishment of an ethical need for a “veil of ignorance,” Gostin and Veatch delve deeper as they begin to establish their arguments for equity in health care. Gostin builds his objection to the current assumption that health care is equitable by establishing that health care is a fundamental need and deserves special government treatment.  He asserts that health care “provides a necessary condition for the fulfillment of human opportunity” (75).  Gostin then follows by disclaiming equality health care and instead urges for greater equity in health care.  His definition of equity is reducing the amount of disparities and providing fairer access in the health systems. Strengthening his argument, Gostin then provides concrete examples and data portraying the disparities present among the different populations in health care. After a barrage of numbers and facts, Gostin concludes that the poor suffer from higher rates of morbidity, mortality and infant death rates due to health disparities.

      Veatch takes an alternate approach from Gostin’s after establishing the need for a “veil of ignorance” and a moral community.  Instead of providing one example of an “equity principle” as Gostin has done, Veatch introduces the Maximin theory and the Egalitarian theory before reaching his conclusion. The Maximin theory assumes that the principle of justice does not create an aggregate benefit, but rather improves the conditions for the least advantaged individuals (54).  Opposite to the Maximin theory, the principle of egalitarian justice is that everyone receives and equal amount of net welfare over their lifetime. Veatch chooses to support this view of fairness and justice by asserting that “this principle is a basic social practice or policy that contributes to the same extent to greater equality of outcome” (55). He then reiterates his concept of a moral community and asserts that the equality of net welfare is more important among its members.  It must be noted, however, that equality and equity of welfare are the points where Gostin and Veatch most differ.

      As stated, Gostin has built the case that all individuals are entitled to fundamental needs under Rawlsian theory.  He then asserts that health care is a fundamental need and therefore it can be concluded that there is an ethical basis for the individual guarantee for health care in terms of equity.  My first objection to Gostin arises in this portion of his argument. He provides copious amounts of data and facts concerning health disparities, yet he fails to mention the misuse of health care resources.  Veatch touches on this fairness of equity in health care when he states that it “would require forcing those in need of great emouants of care to go without or those in good fortune to be healthy to consume uselessly” (57). In other words, Gostin offers no solution for the misuse of insurance coverage nor does he even address it.  It is not fair to require a responsible, healthy individual to pay for the misuse of funds when there is an universal access to medical care. Because Veatch takes into consideration the misuse of medical coverage in his justification for universal health care, it leads me to believe this objection is justified regarding argument presented by Gostin.

This Economics & Policy article was written by Colby Almond on 5/11/2010

Colby Almond was a 2008 graduate from the University of North Carolina at Chapel Hill with degrees in Public Policy and Economics. He is currently the Director of Social Media for Virante INC