We have just completed an exhausting nine‐month debate on the future of the Affordable Care Act. I see this debate as having ended—as of this writing—in a draw. After months of repeal efforts, Republicans in the House barely passed in early May, with a 217‐to‐213 margin, the American Health Care Act, which would have significantly amended the ACA. Republicans in the Senate spent the summer trying to arrive at amendments to the AHCA that could attract fifty of their fifty‐two votes, (...) but in the end, the clock ran out on their opportunity to enact an amendment without Democratic input. With this legislative failure, we appear to be in a stalemate. The Affordable Care Act remains in place as the law of the land, but the Trump administration seems committed to at best condemning the ACA to malign neglect and at worst actively undermining it at every opportunity. Given the political stalemate, the time is right to reassess the deeper issues at stake and ponder the prospects for a considered compromise on health reform. (shrink)

Even Americans who have only a vague knowledge of health policy know that the U.S. is different. We do not have “socialized medicine,” like our European or Canadian neighbors. We believe that health care is not rationed here, and that, unlike citizens of other nations, we do not have to wait in long queues when we need medical care. We believe that U.S. health care is the best in the world.At the same time, the U.S. spends more on health care (...) - both per capita and as percentage of gross domestic product - than other nations do. One in six non-elderly Americans has no health insurance, and voluminous studies show that lack of health insurance has a dramatic effect on both access to care and on health status. Furthermore, on many of the most important indicators of population health, such as infant mortality and life expectancy, the U.S. scores worse than do other nations. (shrink)

Even Americans who have only a vague knowledge of health policy know that the U.S. is different. We do not have “socialized medicine,” like our European or Canadian neighbors. We believe that health care is not rationed here, and that, unlike citizens of other nations, we do not have to wait in long queues when we need medical care. We believe that U.S. health care is the best in the world.At the same time, the U.S. spends more on health care (...) - both per capita and as percentage of gross domestic product - than other nations do. One in six non-elderly Americans has no health insurance, and voluminous studies show that lack of health insurance has a dramatic effect on both access to care and on health status. Furthermore, on many of the most important indicators of population health, such as infant mortality and life expectancy, the U.S. scores worse than do other nations. (shrink)

Since the Supreme Court of New Jersey decided the Quinlan case a quarter of a century ago, three American Supreme Court decisions and a host of state appellate decisions have addressed end-of-life issues. These decisions, as well as legislation addressing the same issues, have prompted a torrent of law journal articles analyzing every aspect of end-of-life law. In recent years, moreover, a number of law review articles, many published in this journal, have also specifically addressed legal issues raised by palliative (...) care. Much less is known in the United States, however, as to how other countries address these issues. Reflection on the experience and analysis of other nations may give Americans a better understanding of their own experience, as well as suggest improvements to their present way of dealing with the difficult problems in this area.This article offers a conceptual and comparative analysis of major legal issues relating to end-of-life treatment and to the treatment of pain in a number of countries. In particular, it focuses on the law of Australia, Canada, the United Kingdom, Poland, France, the Netherlands, Germany, and Japan. (shrink)

Since the Supreme Court of New Jersey decided the Quinlan case a quarter of a century ago, three American Supreme Court decisions and a host of state appellate decisions have addressed end-of-life issues. These decisions, as well as legislation addressing the same issues, have prompted a torrent of law journal articles analyzing every aspect of end-of-life law. In recent years, moreover, a number of law review articles, many published in this journal, have also specifically addressed legal issues raised by palliative (...) care. Much less is known in the United States, however, as to how other countries address these issues. Reflection on the experience and analysis of other nations may give Americans a better understanding of their own experience, as well as suggest improvements to their present way of dealing with the difficult problems in this area.This article offers a conceptual and comparative analysis of major legal issues relating to end-of-life treatment and to the treatment of pain in a number of countries. In particular, it focuses on the law of Australia, Canada, the United Kingdom, Poland, France, the Netherlands, Germany, and Japan. (shrink)

In her classic 1993 article, “The Struggle for the Soul of Health Insurance,” Deborah Stone contrasted the principle of mutual aid—“the essence of community” in the face of sickness—and the principle of actuarial fairness, under which “each person should pay for his own risk.” Stone claimed that “in most societies sickness is widely accepted as a condition that should trigger mutual aid,” while in the United States, a competitive insurance industry fosters in people “a sense of their difference, rather than (...) their commonalities, and their responsibility for themselves only, rather than their interdependence,” leading to the fragmentation of “communities into ever‐smaller, more homogeneous groups” and “the destruction of mutual aid.” The United States has, as Stone observes, long been an outlier in its approach to financing care for sickness. Over the past half century, we have developed mutual aid‐based programs to care for some, but most Americans have had to pay the “actuarially fair” cost of their care, either as individuals or as employee groups. Mutual aid has existed only on a limited scale. The Affordable Care Act is the most comprehensive attempt to date to remedy this situation. (shrink)

Health insurance exchanges can organize the market for health insurance by connecting small businesses and individuals into larger insurance pools. HIEs have been proposed as a possible means of making insurance more accessible, increasing competition among health plans, and promoting choice of insurer. President Obama's campaign proposal and various congressional leaders have proposed establishing insurance exchanges through federal legislation. However, whether the federal or state government, or even a private entity, can organize an insurance exchange to connect health insurance sellers (...) and buyers under the law is the question explored in this paper. Specifically, the paper addresses legal restraints or limitations to such an exchange at the federal, state or private entity level, and offers solutions. Although exchanges implicate many design and policy issues regardless of whether they are implemented at a federal, state, or private entity level, the paper concludes that are no absolute legal bars to the establishment of health insurance exchanges. (shrink)

This “Legal Solutions in Health Reform” paper identifies and analyzes the legal issues raised by health insurance exchanges. Like all Legal Solutions papers, it does not purport to provide a concrete proposal as to how health insurance exchanges should be organized or even whether they should play a role in health care reform. Rather, it attempts simply to describe the legal issues that health insurance exchanges raise, and to propose alternative solutions to legal problems where useful. More specifically, it analyzes (...) and offers alternative solutions to the legal problems raised by proposals to establish insurance exchanges by the federal government, by state governments, and by private entities or associations. Because the focus of this project and paper is on legal issues, discussion of policy and design issues is attenuated. Nevertheless, some attention to policy issues is unavoidable because law is the realization of policy. (shrink)

The Affordable Care Act is an essential first step toward making health insurance more affordable for lower and moderate income Americans. It has accomplished historic reductions in the proportion of Americans who are uninsured. The number of Americans reporting delaying medical care for financial reasons has declined by approximately one-third since 2010. Medicaid expansions, in particular, have significantly reduced financial burdens and accompanying anxieties experienced by low-income Americans in states that have embraced this opportunity. Consistent with these finding, one recent (...) analysis of credit report data finds that Medicaid expansion was associated with between a $600 and $1000 decline in collection balances among individuals who gained coverage. Notwithstanding these gains, premiums and cost-sharing are still too high for many Americans. And cost-sharing has continued to edge higher for the majority of Americans who have coverage through employer-based plans. Measures to address these challenges must build on the ACA to provide greater protection to millions of Americans and to address continued dissatisfaction with our health care financing system among middle-income Americans. (shrink)

Regardless of how health reform proceeds, we will continue to need public insurance programs to care for the poor, cover health problems not addressed by private insurance, and support the nation's health care infrastructure. This article examines that continuing role.

As we write this paper in spring 2008, many are hopeful that November’s election will open the door to some form of comprehensive health care reform. In all likelihood, we will elect a president who has campaigned to a greater or lesser extent on promises of improving access to health care, improving quality, and reducing costs. Equally important, it seems likely that the 111th Congress is preparing to undertake meaningful health care reform. And perhaps most important, despite recent attention to (...) energy issues and the economy, opinion polls consistently show that the American public continues to rank health care as one of the two or three most important domestic issues in the fall elections and supports comprehensive health care reform. (shrink)

Originally edited by Timothy Stoltzfus Jost, this text examines how different countries around the world approach the same challenges in health care law and ethics: how to finance care for as many people as possible; how to ensure quality care; how to best secure patients' rights; how to regulate abortion, end of life decision making, and assisted reproduction; and how to manage infectious diseases, tobacco use, and human subject research. The new edition considers a broader array of (...) countries, particularly from Asia, Latin America, Africa, and the Middle East. (shrink)

The United States, unlike all other industrialized nations, does not have a comprehensive public system for financing health care. Nevertheless, the magnitude of America's public health care financing effort is remarkable. Of the one trillion dollars the United States spent on health care in 1996, almost half, $483.1 billion, was spent by public programs. In 1995, Medicare—our social insurance program for persons over sixty-five and the long-term disabled—overed 37.5 million Americans; Medicaid—our program for indigent elderly and disabled persons and indigent (...) children and their families—covered 36.3 million. In 1996, Medicare and Medicaid spent $203.1 and $147.7 billion, respectively. The payment policies of these massive public health care programs have a profound effect on the provision of health care.Many of the recipients of Medicare and Medicaid suffer pain. In 1994, 376,200 Americans over age sixty-five died of cancer. Virtually all of these would have been Medicare recipients, and as many as 70 percent of them died in unrelieved pain. Nearly four million Americans over sixty-five endured the pain of inpatient surgery in 1995, again nearly all of whom were Medicare recipients. (shrink)

The United States, unlike all other industrialized nations, does not have a comprehensive public system for financing health care. Nevertheless, the magnitude of America's public health care financing effort is remarkable. Of the one trillion dollars the United States spent on health care in 1996, almost half, $483.1 billion, was spent by public programs. In 1995, Medicare—our social insurance program for persons over sixty-five and the long-term disabled—overed 37.5 million Americans; Medicaid—our program for indigent elderly and disabled persons and indigent (...) children and their families—covered 36.3 million. In 1996, Medicare and Medicaid spent $203.1 and $147.7 billion, respectively. The payment policies of these massive public health care programs have a profound effect on the provision of health care.Many of the recipients of Medicare and Medicaid suffer pain. In 1994, 376,200 Americans over age sixty-five died of cancer. Virtually all of these would have been Medicare recipients, and as many as 70 percent of them died in unrelieved pain. Nearly four million Americans over sixty-five endured the pain of inpatient surgery in 1995, again nearly all of whom were Medicare recipients. (shrink)

The last year, June 1992 through September 1993, has seen a great deal of ferment with respect to access to and financing of health care in the United States. The elections of 1992 portend dramatic changes in the American health care system, and vigorous debate regarding both expansion of access to health care and transformation of the health care financing system is taking place at the federal and the state levels. In fact, however, the time period covered here produced remarkably (...) few changes in the law, particularly at the federal level. The one piece of Medicare and Medicaid legislation passed by Congress in the fall of 1992, H.R. 11, was vetoed by President Bush immediately after the election. The Omnibus Budget Reconciliation Act of 1993 contained a host of minor adjustments to the Medicare and the Medicaid programs, but only the Medicaid asset transfer provisions and extensions to the self-referral provisions of the fraud and abuse laws, discussed below, are of import to us. (shrink)

The last year, June 1992 through September 1993, has seen a great deal of ferment with respect to access to and financing of health care in the United States. The elections of 1992 portend dramatic changes in the American health care system, and vigorous debate regarding both expansion of access to health care and transformation of the health care financing system is taking place at the federal and the state levels. In fact, however, the time period covered here produced remarkably (...) few changes in the law, particularly at the federal level. The one piece of Medicare and Medicaid legislation passed by Congress in the fall of 1992, H.R. 11, was vetoed by President Bush immediately after the election. The Omnibus Budget Reconciliation Act of 1993 contained a host of minor adjustments to the Medicare and the Medicaid programs, but only the Medicaid asset transfer provisions and extensions to the self-referral provisions of the fraud and abuse laws, discussed below, are of import to us. (shrink)

What does 'if' mean? Timothy Williamson presents a controversial new approach to understanding conditional thinking, which is central to human cognitive life. He argues that in using 'if' we rely on psychological heuristics, fast and frugal methods which can lead us to trust faulty data and prematurely reject simple theories.

Two opposing tendencies in the philosophy of language go by the names of ‘referentialism’ and ‘inferentialism’ respectively. In the crudest version of the contrast, the referentialist account of meaning gives centre stage to the referential semantics for a language, which is then used to explain the inference rules for the language, perhaps as those which preserve truth on that semantics (since a referential semantics for a language determines the truth-conditions of its sentences). By contrast, the inferentialist account of meaning gives (...) centre stage to the inference rules for the language, which are then used to explain its referential semantics, perhaps as the semantics on which the rules preserve truth. On pain of circularity, we cannot combine both directions of explanation. (shrink)

We discuss three varieties of affective dynamics. In each case, we suggest how these affective dynamics should be operationalized and measured in daily life using time-intensive methods, like ecological momentary assessment or ambulatory assessment, and recommend time-sensitive analyses that take into account not only the variability but also the temporal dependency of reports. Studies that explore how these affective dynamics are associated with psychological disorders and symptoms are reviewed, and we emphasize that these affective processes are within a nexus of (...) other components of emotion regulation. (shrink)

Assertions are praised as true, informative, relevant, sincere, warranted, well-phrased, or polite. They are criticized as false, uninformative, irrelevant, insincere, unwarranted, ill-phrased, or rude. Sometimes they deserve such praise or criticism. If any respect in which performances of an act can deserve praise or criticism is a norm for that act, then the speech act of assertion has many norms. So has almost any act; jumps can deserve praise as long or brave, criticism as short or cowardly. But it is (...) natural to suppose that some norms are more intimately connected to the nature of asserting than any norm is to the nature of jumping. One might suppose, for example, that someone who knowingly asserts a falsehood has thereby broken a rule of assertion, much as if he had broken a rule of a game; he has cheated. On this view, the speech act, like a game and unlike the act of jumping, is constituted by rules. Thus, not all norms for assertion are on a par. Norms such as relevance, good phrasing, and politeness are just applications of more general cognitive or social norms to the specific act of assertion. Perhaps the norm of informativeness results from a more complex interaction between a general norm of cooperativeness and the nature of assertion as a source of information. But on this view, not all norms for assertion derive from more general norms; otherwise nothing would differentiate it from other speech acts. (shrink)

Is philosophy a unique discipline, or are its methods more like those of other sciences than many philosophers think? Timothy Williamson explains clearly and concisely how contemporary philosophers think and work, and reflects on their powers and limitations.

The harms associated with wireless mobile devices (e.g. smartphones) are well documented. They have been linked to anxiety, depression, diminished attention span, sleep disturbance, and decreased relationship satisfaction. Perhaps what is most worrying from a moral perspective, however, is the effect these devices can have on our autonomy. In this article, we argue that there is an obligation to foster and safeguard autonomy in ourselves, and we suggest that wireless mobile devices pose a serious threat to our capacity to fulfill (...) this obligation. We defend the existence of an imperfect duty to be a ‘digital minimalist’. That is, we have a moral obligation to be intentional about how and to what extent we use these devices. The empirical findings already justify prudential reasons in favor of digital minimalism, but the moral duty is distinct from and independent of prudential considerations. (shrink)

Is philosophy a unique discipline, or are its methods more like those of other sciences than many philosophers think? Timothy Williamson explains clearly and concisely how contemporary philosophers think and work, and reflects on their powers and limitations.

The author argues that all forms of life are interconnected and that no being, construct, or object can exist independently from the ecological entanglement, nor does "nature" exist as an entity separate from the uglier or more synthetic elements of life. Realizing this interconnectedness is what the author calls the ecological thought. He investigates the philosophical, political, and aesthetic implications of this interconnectedness.

Timothy Williamson; VII*—Equivocation and Existence, Proceedings of the Aristotelian Society, Volume 88, Issue 1, 1 June 1988, Pages 109–128, https://doi.org/10.

Critics of persuasive advertising argue that it undermines the autonomy of consumers by manipulating their desires in morally problematic ways. My aim is this paper is to refine that argument by employing a conception of autonomy that is not at odds with certain forms of manipulation. I argue that the charge of manipulation is not sufficient for condemning persuasive advertising. On my view, manipulation of an agent’s desires through advertising is justifiable in cases where the agent accepts the process through (...) which the desires were developed. I show how the standard manipulation objection proves too much as it would also condemn cases of that kind. I argue that this distinction is especially important when we consider the implications of “new media.” In addition to increasing vulnerability to manipulation, new media have considerable impacts on well-being. By siding with the traditional autonomy argument, we would be compelled to take an implausible stand against all forms of manipulation through advertising, but I suggest that only a proper subset of those cases are morally problematic. This conclusion opens up a space for persuasive advertising that is permissible while nevertheless condemning cases that violate consumers’ autonomy. (shrink)

Four people with radically different views meet on a train and talk about what they believe. Each starts off convinced that he or she is right; then doubts creep in. Timothy Williamson uses a fictional conversation to explore the philosophical debate over whether one point of view can be right and the other wrong. He invites the reader to decide.

Things in common: an introduction -- Life -- Specters -- Subscendence -- Species -- Kindness.

A striking feature of the traditional armchair method of philosophy is the use of imaginary examples: for instance, of Gettier cases as counterexamples to the justified true belief analysis of knowledge. The use of such examples is often thought to involve some sort of a priori rational intuition, which crude rationalists regard as a virtue and crude empiricists as a vice. It is argued here that, on the contrary, what is involved is simply an application of our general cognitive capacity (...) to handle counterfactual conditionals, which is not exclusively a priori and is not usefully conceived as a form of rational intuition. It is explained how questions of metaphysical possibility and necessity are equivalent to questions about counterfactuals, and the epistemology of the former (in particular, the role of conceiving or imagining) is a special case of the epistemology of the latter. A non-imaginary Gettier case is presented in order to show how little difference it makes. (shrink)

The paper criticizes epistemological conceptions of analytic or conceptual truth, on which assent to such truths is a necessary condition of understanding them. The critique involves no Quinean scepticism about meaning. Rather, even granted that a paradigmatic candidate for analyticity is synonymy with a logical truth, both the former and the latter can be intelligibly doubted by linguistically competent deviant logicians, who, although mistaken, still constitute counterexamples to the claim that assent is necessary for understanding. There are no analytic or (...) conceptual truths in the epistemological sense. The critique is extended to purportedly analytic inference rules. An alternative account is sketched on which understanding a word is a matter of participation in a linguistic practice, while synonymy and concept identity consist in sameness of truth-conditional semantic properties. Although there are philosophical questions about concepts, the idea that philosophical questions in general are conceptual questions generates only an illusion of insight into philosophical methodology. (shrink)

In this paper, I give an explanation and defense of Kant’s claim that we cannot comprehend how freedom is possible. I argue that this is a significant point that has been underappreciated in the secondary literature. My conclusion has a variety of implications both for Kant scholars and for those interested in Kantian ideas more generally. Most notably, if Kant is right that there are principled reasons why freedom is beyond our comprehension, then this would release his ethical views from (...) an undesirable explanatory burden. It would be a boon for Kantians if they could ground their lofty claims about the unique, elevated status of rational agency without committing to an implausible view of libertarian freedom. I also suggest that there are certain debates concerning moral motivation and transcendental idealism that might have to change in response to Kant’s claims about the incomprehensibility of freedom. (shrink)

In the paper, titled ‘Choosing death in unjust conditions: hope, autonomy and harm reduction,’ Wiebe and Mullin argue that people living in unjust social conditions are sufficiently autonomous to request medical assistance in dying (MAiD). The ethical issue is that some people may request MAiD primarily because of unjust social conditions, not their illness, disease, disability or decline in capability. It is easily agreed that people living in unjust social conditions can be autonomous. Nevertheless, Wiebe and Mullin fail to appreciate (...) that autonomy is only a necessary condition for MAiD. In addition to autonomy, one must decide that providing assisted dying to a patient because they are living in unjust social conditions is ethical. Central to making this ethical decision is the principle of non-maleficence, famously articulated as ‘do no harm.’ The authors admit that performing MAiD in response to unjust social circumstances is harmful, but they justify this harmful action by appealing to the principle of harm reduction. A fundamental flaw of their approach is that it relies on the legislative definition of intolerable suffering, which is based on circular reasoning and given that 99.2% of patients that have applied for MAiD satisfied this criterion, it is essentially equivalent to no standard/criterion. Canadian society is struggling with the ethical implications of its permissive MAiD programme, and, fundamental to this debate, will be determining the proper balance between autonomy and non-maleficence for people living in unjust social conditions. (shrink)

The paper criticizes epistemological conceptions of analytic or conceptual truth, on which assent to such truths is a necessary condition of understanding them. The critique involves no Quinean scepticism about meaning. Rather, even granted that a paradigmatic candidate for analyticity is synonymy with a logical truth, both the former and the latter can be intelligibly doubted by linguistically competent deviant logicians, who, although mistaken, still constitute counterexamples to the claim that assent is necessary for understanding. There are no analytic or (...) conceptual truths in the epistemological sense. The critique is extended to purportedly analytic inference rules. An alternative account is sketched on which understanding a word is a matter of participation in a linguistic practice, while synonymy and concept identity consist in sameness of truth-conditional semantic properties. Although there are philosophical questions about concepts, the idea that philosophical questions in general are conceptual questions generates only an illusion of insight into philosophical methodology. (shrink)

The paper outlines and explores a possible strategy for defending both the action/omission distinction and the principle of double effect. The strategy is to argue that there are degrees of actionhood, and that we are in general less responsible for what has a lower degree of actionhood, because of that lower degree. Moreover, what we omit generally has a lower degree of actionhood than what we actively do, and what we do under known-but-not-intended descriptions generally has a lower degree of (...) actionhood than what we do under known-and-intended descriptions. Therefore, we are in general less responsible for what we omit than for what we do—which is just what AOD says. And we are in general less responsible for what we do under known-but-not-intended descriptions than for what we do under known-and-intended descriptions—which is just what PDE says. (shrink)

If anti-realism is defined as the principle that all truths are knowable, then anti-realists have a reason to revise logic. For an argument first published by Fitch seems to reduce anti-realism to absurdity within classical but not constructivist logic. One might try to sever this link between anti-realism and revisionism in logic by giving either a modified version of anti-realism not vulnerable to Fitch's argument within classical logic or a modified version of Fitch's argument to which anti-realism is vulnerable within (...) constructivist logic. (shrink)

Abstract: Kant follows a substantial tradition by defining judgment so that it must involve a relation of concepts, which raises the question of why he thinks that single-term existential judgments should still qualify as judgments. There is a ready explanation if Kant is somehow anticipating a Fregean second-order account of existence, an interpretation that is already widely held for separate reasons. This paper examines Kant's early (1763) critique of Wolffian accounts of existence, finding that it provides the key idea in (...) his mature model of existential judgment, which is in fact sharply opposed to the Fregean strategy. By relating this to Kant's theory of judgment in general—in particular, to his claim for an isomorphism between the assertoric function of judgment and the category of existence—a preliminary case is made that absolute positing, far from being a marginal special case, accomplishes the primary function of judgment. This argument shows the importance of distinguishing between contexts in which Kant is treating judgment as a vehicle for inference (e.g. pure general logic) and contexts in which he is treating it, more robustly, as the cognition of an object. (shrink)

In light of the recent symposium, this paper analyses integral theory through original and dialectical critical realism. This paper maintains that Integral theory is unable to sustain its critique against modernity and postmodernity as a result of the adoption of Kantian, Hegelian, and Heideggerian ontology. The resulting actualism and structure, perpetrates ontological violence, as it attempts to resolve the problems of modernity and postmodernity. An adoption of critical realism as underlabourer would call into question many of the theoretical underpinnings of (...) integral theory resulting in a serious re-evaluation of its core features. (shrink)