Abstract
In recent literature, there has been much debate about whether and how luck egalitarianism, given its focus on personal responsibility, can justify universal health care. In this paper we argue that, whether or not this is so, and in fact whether or not egalitarianism should be sensitive to responsibility at all, the question of personal responsibilization for health is not settled. This is the case because whether or not individuals are responsible for their own health condition is not all that is relevant when considering whether we should somehow hold them responsible for their own health condition, e.g. cost-wise. There may also be efficiency-based reasons to hold them responsible, and there may even be egalitarian reasons. Defining universal health care as an insurance system where everyone’s deductible and premium is 0, we will argue that efficiency-based reasons for cost-responsibilization are not convincing, but that there are egalitarian reasons for cost-responsibilization. Luck egalitarianism, therefore, cannot, at least not on its own term, justify universal health care.
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Notes
An exception to this is Gerald Lang who has suggested to replace the notion of responsibility in luck egalitarianism with a notion of moral hazard (Lang 2009).
Note that this is similarly relevant for other principles of distribution that might incorporate an egalitarian element, such as prioritarianism and sufficientarianism.
Here we do not wish to imply anything about genuine responsibility. The point is only that if a persons’ disease is caused (partly) by her behaviour, and she behaved in that way, responsibly or not, because she knew she was covered, then there is room for believing that she would have acted differently if she knew she was not covered.
Of course we cannot exclude the possibility that a complete cure is attainable in the future, such that e.g. just a pill or a very simple surgery could exterminate all cancer cells in some organ leaving the patient with no side effects at all. If so, then it is definitely one reason to revise our considerations about moral hazard.
Note that this reasons may also be non-paternalism, but yet very similar. This is because individuals may consent to being held responsible for their own good, in the same way as Homer’s Ulysses was bound to the mast.
There may still be cases where we would want not to treat the worse off individual in need of health care, especially since as always, resources are scares. Would we prioritize giving the fifth liver transplantation to an otherwise sick alcoholic?
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Acknowledgments
For comments and discussions related to this paper we would very much like to thank Nils Holtug, Carl Knight, Xavier Landes, Pedro Rosa Dias, Shlomi Segall and Res Publica’s anonymous referee.
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Andersen, M.M., Nielsen, M.E.J. Luck Egalitarianism, Universal Health Care, and Non-Responsibility-Based Reasons for Responsibilization. Res Publica 21, 201–216 (2015). https://doi.org/10.1007/s11158-015-9272-3
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DOI: https://doi.org/10.1007/s11158-015-9272-3