A Dialectic of Cooperation and Competition: Solidarity and Universal Health Care Provision

Abstract

The concept of solidarity has achieved relatively little attention from philosophers, in spite of its signal importance in a variety of social movements over the past 150 years. This means that there is a certain amount of preliminary philosophical work concerning the concept itself that must be undertaken before one can ask about its potential use in arguments concerning the provision of health care. In this paper, I begin with this work through a survey of some of the most prominent bioethical, political philosophical and intellectual historical literature concerned with the project of determining a philosophically specific and historically perspicacious meaning of the term 'solidarity'. This provides a conceptual foundation for a sketch of a four-tiered picture of social competition and cooperation within the nation-state. Corresponding to this picture is a four-tiered account of health care provision. These two models, taken together, provide a framework for articulating the conclusion that, while there are myriad examples of solidarity in claiming health care for some, or even many, the concept does not provide a basis for claiming health care for all.

Spirituality

“…Solidarity in this context means there is a communal obligation to address health-care needs, especially for the most vulnerable, and some might also suggest that there needs to be more responsibility on the part of international organizations to pressure nations to provide universal access to health care and social security in the case of age, illness, or disability. Of course, it might also be argued that justice, or more specifically distributive justice, is more appropriate to the discussion of universalized health care (Butler 2012), but such a claim echoes the debate regarding the relation between justice and solidarity discussed earlier.…”

“…As a principle in bioethics, solidarity is sometimes articulated as a counter to justice and autonomy (Hoedemaekers and Dekkers 2003;Butler 2012). Whereas autonomy emphasizes the individual, solidarity emphasizes community or the connections between members of communities.…”

Precision medicine and the fragmentation of solidarity (and justice)

“…Though Meulen focuses on the Netherlands, the challenges will be similar across the EU (as discussed below). For other analyses and applications of the concept of solidarity in health care, see (Danis, 2018 ; Schindler et al, 2018 ; Gheaus, 2017 ; Butler, 2012 ; Wilking et al, 2017 ; Groot et al 2020 ; Davies and Savulescu, 2019 ; Reichlin, 2011 ; Gould, 2018 ; Biller-Adorno and Zeltner 2015 ; West-Oram, 2018 ; Derpmann, 2018 ).…”