A Critique of the Innovation Argument Against a National Health Program

Rajczi, Alex

doi:10.1111/j.1467-8519.2007.00559.x

Cited by 3 publications

(2 citation statements)

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“…If an expensive treatment is available on the market, citizens who need it and cannot pay for it (even after seeking charity) must choose whether to go without needed treatment or to steal the money 28 This empirical claim is speculative, but it is more plausible than the claim that any public health insurance program would reduce the quality of health care by reducing the rate of innovation. For a skeptical assessment of the latter claim, see Rajczi (2007). 29 One might raise the further worry that an egalitarian health care policy would be incompatible with any form of medical research that does not make experimental drugs available to all interested potential subjects.…”

Section: Leveling Down and Welfare Considerationsmentioning

confidence: 99%

Egalitarian Provision of Necessary Medical Treatment

Hughes

2019

J Ethics

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This article offers a new argument for egalitarian provision of genuinely necessary medical treatment. Under economic circumstances in which a government cannot guarantee necessary medical treatment to all citizens, it should prevent citizens' finances from affecting their access to treatments they genuinely need. To do this, government must place restrictions both on the private insurance market (as some Canadian provinces do now) and on out-of-pocket payments for medical services. Government must do this even if doing so would involve leveling down and even if it is unclear whether this policy would lead to better health care to the poor than would a tiered system that allowed people's finances to affect their access to necessary treatment. The grounds for egalitarianism about access to necessary medical treatment include considerations of autonomy and independence. If people's finances affect their access to necessary medical care, they will be subject to objectionable forms of private domination. My argument will build on premises that many liberal non-consequentialists will find attractive. I will not attempt to persuade utilitarians or right-wing libertarians. 5 My aim is to show that some moral premises that have been used to defend basic public support of the poor, including provision of "basic" health care, have more demanding implications. 6 The core of the 5 Left-libertarians may accept the argument, as may consequentialists who believe that individual autonomy or independence has non-instrumental value. 6 The premises I use are close to the premises of Kant's argument for public support of the poor, as recently interpreted by Gilabert (2010), Ripstein (2009, 25-26 and 267-286), andWeinrib (2003).Ripstein and Gilabert both note that Kant's argument supports a requirement to provide health care to all, but they do not claim that it requires equality in access to necessary treatment. My premises are in an important respect weaker than Kant's: I do not assume-as Kant does, on Ripstein's reading-that the only permissible end of government action is to protect citizens' independence, i.e., to prevent some citizens' continued effective exercise of rational agency from depending on others' discretionary good will. I defend the weaker claim that law must not itself empower some citizens to decide, entirely at their discretion, whether other citizens shall be sick or healthy. 4argument is an observation about the relationship between the opportunity to purchase access to health care and the possibility of dependence on charity. If private money can be used to buy access to medical treatment, some citizens' ability to get treatments they genuinely need without lawbreaking (without, e.g., stealing money or medicine) will depend on other citizens' legally discretionary choices to give or to withhold charity. Health law and property law will thus interact in a way that gives some private citizens discretionary power over other citizens' health. This power, I argue, is objectionable. It is objectionable for the s...

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Section: Leveling Down and Welfare Considerationsmentioning

confidence: 99%

Egalitarian Provision of Necessary Medical Treatment

Hughes

2019

J Ethics

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“…The steady flow of innovative drugs has provided clinicians with a plethora of effective treatments. With healthcare providers continuing to struggle with rising costs, clinical effectiveness alone will no longer be the only criteria for evaluating a new treatment [9]. Economic evaluations of health care technologies typically utilize models to make assumptions and synthesize evidence from multiple sources in order to estimate costs and outcomes of new therapies [10].…”

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confidence: 99%