The Social Contract, Distributive Justice, and Health Care in the U.S.

Abstract

The President’s Commission, released in 1983, studied the ethical implications and unintended consequences of the disparity in health care availability in the U.S. and concluded that health care is a special type of commodity, and thus, it is unethical to leave health care subject to market forces. Their recommendation was that society as a whole has a social obligation to ensure equitable access to health care and that the federal government does not maintain the largest responsibility to guarantee success. The aim of this thesis is to show that Americans live under a system of social contract, albeit, a system that requires extreme amounts of tinkering, and as such, the government is failing its citizens by not providing adequate incentive for them to leave the state of nature, such as a protection of equitable access to health care would do. This paper will attempt to use modern liberal theory to show why health care is a social good that should be protected by the government and why individuals should see access to health care as an essential component of individual dignity. The second task of this paper is to compare the United States and French systems of health delivery and health insurance in order to decide what an ideally ethical system of health distribution would be. The conclusion of this thesis is that the U.S. system is too riddled with bureaucratic inefficiencies and political timidity to function as an ethical and just scheme. In order to correct for disproportionate levels of care, minorities being further disadvantaged, and unfair political rhetoric, this thesis recommends adopting a single-payer, government run system of national health insurance that is predicated upon membership in our society alone and ending the current use of employment-based health insurance. In conclusion, President Obama’s Patient Protection and Affordable Care Act does not go far enough without creating a national health insurance to ensure equitable access to health care and needs to be revisited if the U.S. truly lauds a system of equitable distribution and justice as fairness.