PHIL 235 Lecture Notes - Lecture 5: Society 1, Mark Siegler, Commodification
11 May 2018
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Lesson 5 -5.1
Access to Health Care
• Allocation= the distribution of funding and recourses among alternative
possibilities for their use
• There are 3 categories of allocation within Health Care
1. Macroallocation= decisions made at the federal or provincial government
level about the distribution of resources among services such as health
care, education, the environment… they decide how much money is put
into health care vs. other services.
2. Mesoallocation= Decisions made at the regional level about the
distribution of recourses among particular health care facilities or, within
those facilities, among particular units.
3. Microallocation= decisions made by particular institutions or HCPs
concerning the distribution of available resources among individual
patients.
Ex) who gets the organ, who needs to be in ICU, who gets access to the
MRI machine, and so on.
• We must ask whether there is there a right or an entitlement to health care.
• If it’s a right → it would mean that Macroallocation of resources for health care
would be based on justice, with citizens given what they are entitled to receive
• If not, then Macroallocation of resources would be based on benevolence,
compassion, or charity.
• In the United States, health care is regarded as neither a right nor an entitlement;
Canadians, for the most part, take the opposite view.
• The US system is thus set up along libertarian lines→ if they want health care
insurance then they pursue that but if not and want to use that money to go to
Egypt then they accept to pay medical bills out of pocket.
• The libertarian believes that since the government has great power to influence
and harm us, we must take steps to minimize government interference in our
lives, even if that interference is intended for social benefit.
• Canadians take a more liberal/socialist approach. Liberals believe in providing
some social services paid for by the least taxation possible. Socialists believe that
the good of the individual can be achieved only when everyone in society is
supported in their basic needs.
• The wheelchair bound individual will be prohibited from pursuing some interests,
such as education or even just shopping, if her city doesn’t have wheelchair ramps
and lift buses. Regardless of how much education an individual has or how far he
has advanced in his job, his interests and future plans and goals will be greatly
affected if he suffers significant brain impairment from injury or a brain tumor.
Since an individual’s ability to contribute to society and general social interests is
dependent upon his level of health, maximizing individual health will improve
society as a whole.
find more resources at oneclass.com
find more resources at oneclass.com
• Allen Buchanan’s article (decent minimum health care)→ What does the right to
a decent minimum of health care entail? One of the foundations of socialism is
equality, but applying equality in health care is problematic. To provide equal
health is unrealistic, because variations in health are to a great extent determined
by biological, social, and behavioural factors—factors that are largely beyond the
control and influence of health care providers.
• To provide equal health care is also inefficient because it would require an
inappropriate redistribution of resources. Not only would this fail to sufficiently
benefit those most in need, it would also waste resources on those not in need.
• The Canadian system thus depends on equity, or a more fair distribution of health
care resources, which requires the reduction of wide disparities in health care,
such as between the poor and the wealthy. This approach seeks to apply those
services that most effectively help prevent illness, disease, disability, and
premature death, and that best serve and treat those with ill health
• Kai Neilson, in his article at the end of the chapter, argues for equality and a right
to have one’s health care needs met, but he does so by considering the role of a
two- or three tiered medical system → Two-tier systems look appealing because
they promise to reduce the number of patients burdening the public pay system
when many people leave for the faster, more efficient private system.
→ Problem: the doctors would leave low paying job in public and want to work
less hours and get paid more in private sector
find more resources at oneclass.com
find more resources at oneclass.com
Lesson 5.2
Pg. 353-355
Macroallocation: Is There a Right to Health Care?
The Assumption That There Is s right to a Decent Minimum
• A consensus that there is (at least) a right to a decent minimum of health care
pervades recent policy debates and much of the philosophical literature on health
care
• Disagreement centres on two issues →Is there a more extensive right than the
right to a decent minimum of health care? What is included in the decent
minimum to which there is a right?
Preliminary Clarification of the Concept
• “Is there a right to a decent minimum? & “What comprises the decent minimum?”
→ we get different answers
• To say that person A has a right to something, X, is first of all to say that A is
entitled to X, that X is due to him or her.
• This is not equivalent to saying that if A were granted X it would be a good thing,
even a morally good thing, or that X is desired by or desirable for A.
• Recent rights- theorists have also emphasized a third feature of rights, or at least
of basic rights or rights in the strict sense: valid rightclaims “trump” appeals to
what would maximize utility, whether it be the utility of the right- holder, or
social utility → if A has a right to X, then the mere fact that infringing A’s right
would maximize overall utility or even A’s utility is not itself a sufficient reason
for infringing it.
• The second feature—enforceability—is of crucial importance for those who
assume or argue that there is a universal right to a decent minimum of health care.
• I think it is fair to say that many who confidently assume there is a (universal)
right to a decent minimum of health care have failed to appreciate the significance
of the first feature of our sketch of the concept of a right. it is crucial to observe
that the claim that there is a right to a decent minimum is much stronger than the
claim that everyone ought to have access to such a minimum, or that if they did it
would be a good thing, or that any society which is capable, without great sac-
rifice, of providing a decent minimum but fails to do so is deeply morally
defective. None of the latter assertions implies the existence of a right, if this is
understood as a moral entitlement, which ought to be established by the coercive
power of the state if necessary.
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Ex) who gets the organ, who needs to be in icu, who gets access to the. Mri machine, and so on: we must ask whether there is there a right or an entitlement to health care. If it"s a right it would mean that macroallocation of resources for health care would be based on justice, with citizens given what they are entitled to receive. If not, then macroallocation of resources would be based on benevolence, compassion, or charity. In the united states, health care is regarded as neither a right nor an entitlement; Liberals believe in providing some social services paid for by the least taxation possible. One of the foundations of socialism is equality, but applying equality in health care is problematic. Problem: the doctors would leave low paying job in public and want to work less hours and get paid more in private sector.
