At one point or another, in your life, you will encounter the issue of Health Care and you will have to choose a side on the issue. In fact, the next US presidential elections are going to be riddled with the issues of Health Care as a main topic. To understand what we are talking about, let’s first define Health Care. According to HIPAA, Health care is “Care, services, or supplies furnished to an individual and related to the health of the individual.” Currently in the US, the market for the distribution of Health Care is broken with over 47 million people uninsured, increasing health care costs, increasing burdens on employers and worse health conditions.

So then the question that should be on our minds is, is there a moral obligation for society to provide adequate access to health care for all its citizens? In this paper, I will try to present many of the theories and philosophical arguments for and against a universal health care plan and then try to rationally assess each of them to come to the conclusion that, based on moral and ethical principles, we do have a moral responsibility to provide adequate access to Health Care for all citizens in our great nation.

There are many theories out there that argue for and against Health Care’s reform. Out of all of these theories, one thing is clear – Health Care is an important and concerning topic, hence the reasons for their theories. But to get a clearer picture of the issues at hand, we must look at how the US Health Care system stands up to other western nations. Currently, the US is the only industrialized westerns nation without Universal Health Insurance and we have over 47 million people uninsured, 9 million children without Health Care and 18,000 deaths because they are not insured. Not just the uninsured, but health care costs have also increased dramatically, a whooping 2 trillion dollars or 13.6% of our GDP is being spent on health care, and the costs are still increasing.

We are among the highest in the world (23rd) for infant mortality rates, even though we spend so much on Health Care and highest infant morality rates among western nations. We are ranked only 20th in women’s life expectancy, and 21st for men’s life expectancy. We are also ranked 67th of the availability of immunizations. Yet we remain the biggest spender on Health Care, while countries like Canada spends considerably less money on Universal Health Care and gets better results. So as you can see, something is clearly wrong here. Simply put, our health care system is broken, so we come back to our original question – is there a moral obligation for society to provide adequate access to health care for all its citizens?

Health care is a good of special importance. It is a commodity. It is a primary good because it is fundamental to the well-being of individuals, but more importantly, it broadens opportunity, enabling individuals to be productive members of society. Even the President’s Commission agrees that Health Care is a social product and that its need is unevenly distributed. It is a social product because everyone in society, in some way or form, contributes towards the cost and care aspect of Health Care. Since its need is unevenly distributed and highly unpredictable, the costs should be shared by all. The Commission goes on to say that Health care needs are largely undeserved and thus reflects current administration’s view on Health Care.

Health care is a need of great importance but it seems the cost and the implementation issues seem to be of concern to the Commission. Thus no real action is being taken to broaden the access of Health Care to all citizens because of a few “concerns” such as cost or the coverage of the program etc. But such costs can be distributed equally, just like we can distribute the benefits. However, if we look at the Moderate Principalism, it is not so unified in its opinion as the President’s Commission.

Moderate principalism tries to stay away from the notion that uses a “philosophical theory as the ultimate locus of moral certitude.” Thus we use our intuition and certain principles to judge if we are obligated to provide Health Care. According to the Beneficence factor of Moderate Principalism, we must care for the patients or the people in general and thus Beneficence says that the general welfare will be increased by giving everyone health care, the very reason for this country’s establishment as stated in the Preamble of the Constitution. But when we look at nonmaleficence or “do not harm” factor in Moderate Principalism, it takes a new approach on the issue.

It brings in the perspective of the rich and the more fortunate. Thus moderate principalism based on nonmaleficence says that we cannot harm people by taking away their money or their better “fortunes.” In the same way Autonomy can view the issue and say people have a choice in the matter, thus they can choose not to contribute to the health care cost burdens. But in regards to Autonomy, we can take a Kantian perspective and have autonomy say “Yes” to health care because we would be helping people be fully autonomous by helping them stay healthy.

And in addressing the issue raised by Autonomy and nonmaleficence, Justice can say that we can distribute benefits and the burdens of such a program equally with all involved, thus agreeing with the Rawlsian principles of distributed justice and equality of opportunity. But Robert Nozick raises the question, what gives us the right to take away people’s hard earned money? Thus raising the strongest objection to Health Care by raising the issue of justice against itself by saying it is simply unjust to take people’s earned money away for something they do not want to do. So to decide upon the right course of action, we will have to resort to using our moral intuitions. One good example is the drowning child scenario to see how intuition sees the problem.

In the scenario, if we walk by a child drowning in a shallow pond, most of the people will immediately take the time to save the child if they can. The intuition to reach out and help the child can be applied to the matter to Health Care. But then again, there will always be those people who do not help the child because they are too lazy or do not want to dirty their clothes. But intuition clearly says that we must help, if we will help that child, why not help the millions who have suffered with no health care? So we must use intuition to decide which principal of Moderate Principalism is more important and then apply them, as in the case of the drowning child scenario.

Another scenario is how we deal with disaster relief; we do not worry about the trivial matters since saving lives (beneficence) comes as a first priority in any relief operation. In the same way, Moderate Principalism argues that we have an obligation to provide everyone with an adequate level of care, to facilitate a reasonably full and satisfying life without the imposition of excessive burdens.

But to address the concerns raised by the President’s commission and the Moderate Principalism, Norman Daniels raises an important perspective on Health Care. He says that society has a normal opportunity range for each individual and each individual’s share in the normal range is determined by their talents and skills. Thus an impairment of normal functions restrict a individual’s share in the normal opportunity range so every health need is a deviation from species typical (normal) functioning of the organism. Thereby, on the basis of choices in the opportunity, equality of opportunity trumps any right to differential economic advantage. It is the same principal as the rights to education; we value equality of opportunity over rights to differential economic advantages.

So justice requires that everyone have equality of opportunity to make the most of their talents and skills. And thus, Justice requires everyone have access to Health Care that restores them to or close to their normal functioning and/or of their normal opportunity range. Thus, Norman Daniels argues that just like the concept of Equality of Opportunity or the Rights to Education, everyone has a right to Health Care and it is up to the society to make sure they are functioning normally as individuals. However, Daniels is also careful in pointing out that going beyond your normal functioning range, meaning “enhancements” that you do are not included in the health care because you are trying to are doing a procedure to restore a normal functioning range that you “lost” but rather trying to enhance a already typical functioning range.

This philosophy is based on the Rawlsian principle of fair quality of Opportunity, where a person has no unfair advantage due to socioeconomic position or any other factors and all aspects of society, power, post or officers are attainable by the individual without any restrictions. This means that we give everyone a chance to succeed and make something out of them, but the outcome does not matter because we are only asking for the opportunity for the people to make a difference. But that opportunity cannot be utilized or used if the person is sick, so Normal Daniel’s argument says that society must do what it can to restore the person to normal functioning.

Now on the other side of the spectrum, a conservative Christian from Texan also a libertarian, make a persuasive argument against Health Care. Engelhardt take a unique approach to this issue, in that he argues that for a person to resolve a moral controversy, one must have particular specific background on the moral premises involved. And he further states that neither an appeal to God nor reason nor intuition can give a universally accepted content-full moral premises. Thus, there is no canonical content-full morality, so Health Care policy can’t derive its moral authority from a prior understanding of Justice, fairness or equality. Thus everything we just stated just goes out the window because those arguments for Health Care are based on “prior understanding” of the theories of justice, fairness, equality and philosophy. So, according to Engelhardt, Health Care policy can only derive its moral authority from the consent of the governed. But he begs the question, how much consent do we need? A majority?

According to Engelhardt, we will need the consent of the governed to get the moral authority for a Health Care policy. However, Engelhardt in his theory did not think that the American public would support such a policy, but following with Engelhardt’s theory, 60%-75% of Americans support Universal Health Care. So clearly, Engelhardt’s objection to Health Care through the “consent of the governed” argument is completely refuted. But Engelhardt shows what he thinks are problems to such a Health Care policy. Engelhardt says that if we employ a Universal Health Care policy, people will feel at liberty to gamble with their health by engaging in risky behavior since others are paying for it. But such a statement is utterly false because we cannot just rule out something as renovating as Health Care based on a probable behavior people may or may not exhibit.

And in many cases, this is already a problem, as seen by our speedy drunk drivers or addicted smokers. And in order to discourage any increases in such reckless behavior or a “gambling with life” act, we can employ a “sin tax.” Much like what we do with cigarette smokers (and their taxes) in New York State, we can have those people engaging in more risky behavior pay more towards their own care. Another issue Engelhardt raises is the multiple notions of equality or the unavoidable inequalities such as women living longer than men, or the wealthier healthier than the poor or people with higher social status getting better health care. But we must make a big distinction here, we are not asking or urging for an equality of the treatment or health care outcome. Such a thing would be too varied and impossible to actually implement in real life.

Rather, we ask for the equality of opportunity, for every single person to receive the Health Care they deserve as citizens on this nation. So Engelhardt argues that Health Care intrudes on particular moral visions, but in reality, this is already a problem. 9 million children without health care and 47 million American with nowhere to go for their health needs are already intruding on many people’s “particular moral visions.” However, to seriously address Engelhardt’s concerns, we can look towards the systems employed by our brothers in Canada or Western Europe that have employed vouchers and/or tier systems (UK & Germany) to help provide us with the necessary “blueprint” we need for our own custom system here in the states. The system is Europe is this: the single payersystems, in which healthcare is paid for and organized by the government with money from income taxes (as in Britain and Sweden) and the other is social insurance or sickness fund systems (as in Germany and France), in which healthcare is financed through mandatory premiums calculated as a percentage of wages.

There is also the option of private insurance, which many people tend to use as well. But overall, all aspects of health care are covered in the cost efficient manner. With health being taken to such serious lengths, many people worry that there will be temptation to restrict freedom of choice in such a Universal Health Care system or that there will be a medicalized view of lifestyles. However, we must realize that these concerns are already problems in our society. For example, our freedom of choice is being limited and narrowed considerably when our employer covers our health care costs with certain physicians or plans (or procedures) and not others. And for the millions, who are uninsured, their freedom of choice is certainly restricted to a point where they have no choice and none to turn to once they get sick. And the medicalized view of lifestyles are already in full swing in our society, with fat or obese people seen in a negative context and smokers and alcoholics in the same boat as the fat people. So to say that these are problems already in our existing systems would be no unfair exaggeration.

Just like Engelhardt, Robert Nozick enters the picture to provide his views on the issue of Health Care. Like Engelhardt, Nozick is a Libertarian and the basic core of his argument is that if everyone follows the rules of just acquisition and exchange, then the resulting distribution is just. Thus he asks, “What right do we have to redistribute a person’s justly acquired wealth or possessions?” In a free society, people have the freedom to share their goods at their will with anyone and whomever they like, and any “distributor” who tries to take goods from a person to give to another in order to have equal distribution is essentially not leading a free society. What you have earned fairly and justly, no matter how unequal the distribution is, are yours and no one has the right to take that away from you.

Thus from a moderate principalism perspective, Nozick is arguing for the individuals’ autonomy, that they can choose not to contribute to a Health Care system and no one has the right to make them to participate or contribute. Robert Nozick is keen to use an example to show his argument in realistic terms, with his Wilt Chamberlain scenario. Let’s say that Wilt starts from a position of your favorite just distribution. But as he plays, people pay him money to see him use his talents. So after a while, he becomes filthy rich. So then, what right do we have to redistribute his money? Did he earn his money justly? Yes, he did indeed earn his money following all the rules. So how can we distribute his money?

However, John Rawls replies to Nozick by saying that natural and social “lotteries” determined a person’s place in society, but from the original position with a veil of ignorance, anyone would want the lucky to help the unlucky. So if you were to pick principals with a veil of ignorance from the original position, then anyone would choose that they want the rich to help the poor, because in the veil of ignorance, you do not know what your status or class will be in society. Simple case of human’s self-interest to be well off will drive humans to make that choice. From the original position, you would not know your social standings or your natural skills (social and natural lotteries), so you would want a fair system for everyone to be well off. You would want, from the original position, that the lucky help the unlucky.

So Rawls says that even Wilt Chamberlain would choose this idea, from the original position. In the difference principle, Rawls argues that just like society believes in the right to education, right to health care should be addressed. Fair equality of opportunity for all individuals to pursue all they can be, whatever it may be… education, position or offices, it does not matter what. However, as stated by the President’s Commission, Health Care is a social product and it is of special importance since it broadens our opportunities. Meaning, if you are sick or is not receiving adequate health care, then how can you pursue what you want to be or even have a fair equality of opportunity in society? Thus, just as or even more important than right to education or right to opportunity is the right to adequate Health Care.

However, the President’s Commissions goes just short of saying we need a reform in the Health Care, they stated that it is a required commodity and it has a huge impact in our lives, yet due to the administration in the White House, they did not express the full view. But if we are to follow up the Commission’s views with what Moderate Principalism tells us, it is can be derived that we do indeed an obligation to provide everyone with an adequate level of care, to facilitate a reasonably full and satisfying life without the imposition of excessive burdens. Not only is Health Care an issue of morals and ethics but it goes much deeper from philosophical to theological realms. In theological terms, many religions urge its followers to be good to others and provide for the needy, and right now the needy are the majority of Americans with little to no adequate Health Care.

Even the simple principles of Utilitarianism urges us to take a action that will promote the net happiness with the people, and with over 75% of Americans urging for a Universal Health Care system, I am sure that the net happiness is on the side of improving our Health Care system. To sum it all up, if we consider all the “pros” and the “cons”, we see a distinct answering emerging. The direction our current Health Care System is heading is showing numerous warning signs that our system needs some serious overhaul (stats and figures). And from what we can gather from the President’s Commission, Moderate Principalism, Daniel’s Rawlsian approach as well as from the arguments against Nozick’s and Englehardt’s objections, we can rationally deduce that it is within our moral responsibility to provide our citizens with the adequate Health Care they need and deserve, without imposing excessive burdens to facilitate a full and satisfying life. As our constitution’s preamble says – “in order to form a more perfect union, establish justice, insure domestic tranquility, promote the general welfare” – we need to fix and improve or introduce a new Health Care system for our nation.