Abstract
An ‘ideal’ health care system would be unencumbered by economic considerations and provide an ample supply of well-paid health care professionals who would supply culturally appropriate optimal health care to the level desired by patients. An ‘ideal’ health care system presupposes an ‘ideal’ society in which resources for all social goods are unlimited. Changes within health care systems occur both because of changes within the system and because of changes or demands in and by the ‘exterior environment’. Social systems must be in a homeostatic balance. If one component fails to accommodate itself to other forces, needs and interests within the system, the system is imperiled. It is difficult to create a just health care system in an unjust society, just as it is difficult to practise truly ethical medicine in an ethically corrupt system.
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Reference and Notes
In past works I have argued that health care systems like all other systems necessarily reflect the values of the society in which they occur. The way the poor are treated or education and the arts funded in the US, compared to the way prevalent in other societies in an example outside the health care system. Ultimately, I have argued, one can only practise one’s profession ethically within the context of an ethical system and one can only build an acceptably just system within the context of an acceptably just society. That may be the very reason why the US has never accomplished that task. See: Loewy, E.H. (1997). What a socialist health-care system would look like: a sketch.Health Care Analysis 5(3), 195–204.
The use of a homeostatic model in dealing with the perceived tension between individual rights and communal interests is discussed in several of my works. In particular, see: Loewy, E.H. (1994).Freedom and Community: The Ethics of Interdependence, SUNY Publishers, Albany, NY.
Rawls, J. (1971).A Theory of Justice, Harvard University Press, Cambridge, MA.
Dewey has extensively developed his notion of democracy—a word which we tend to use glibly and with little understanding. It is, as he has argued, far more than a political way of life: democracy, in fact, is an ethical ideal. See: Dewey, J. (1991). Creative democracy: the task before us. In,John Dewey: The Later Works 1939–1941, ed. by J.A. Boydston and A. Sharpe, Southern Illinois University Press, Carbondale, IL; Dewey, J. (1991). The public and its problems. In,John Dewey: The Later Works 1925–1953, ed. by J.A. Boydston and B.A. Walsh, Southern Illinois University Press; Carbondale, IL.
Among many others, Kant has pointed out the fact that the development of intellectual ideas depends upon social interchange. See Kant, I.Eternal Peace.
Rousseau’s idea of the general will which has been often misunderstood and which would have Rousseau supporting despotism (to anyone who has studied Rousseau’s works in depth that claim is absurd) is formulated throughout his works. See, Rousseau, J.J. (1993).The Social Contract or Principles of Political Right (transl. G.D.H. Cole). In,J.J. Rousseau: The Social Contract and the Discourses, Everyman Library, New York, NY; Rousseau, J.J. (1993).Discourse on the Origin of Inequalities (transl. G.D.H. Cole). In,J.J. Rousseau: The Social Contract and the Discourses, Everyman Library, New York, NY. For a wider discussion of Rousseau’s concept, refer to Loewy, E.H. (1997).Moral Strangers, Moral Acquaintance and Moral Friends: Connectedness and its Conditions, SUNY Press, Albany, NY.
Habermas argues that to have justice requires more than merely the summing of essentially asocial individuals out to maximise their own selfish interests. It requires a communal dialogue which, guided by reason, would reach agreement on certain things such as the universalisation principle of Kant’s categorical imperative. See, Habermas, J. (1992).Moralbewusztsein und kommunikatives Handeln, Frankfurt a/M, Suhrkamp.
Moreno, J. (1992). The social individual in clinical ethics.Journal of Clinical Ethics 3(1), 53–55.
In a paper of this length, I cannot repeat the compelling argument for providing at least basic health care for everyone. The language used here can be found in Daniels, N. (1985).Just Health Care, Cambridge University Press, New York, NY. There is a plethora of literature on the question of all persons having a justified claim to having their basic health care needs met. The counter argument is a libertarian one. See: Engelhardt, H.T. (1994).Foundation of Bioethics, Oxford University Press, New York, NY; as well as Engelhardt, H.T. (1981). Health-care allocations: responses to the unjust, the unfortunate and the undesirable. In,Justice and Health-Care, ed. by E. E. Shelp, D. Reidel, Dordrecht, the Netherlands. Loewy, E.H. (1987). Communities, obligations and health-care.Social Science and Medicine 25(7), 783–791. That these arguments have been generally compelling is confirmed in that the discussion has turned from a discussion of ‘are we ethically compelled to provide health care’ to one of ‘how and in what way do we do it’.
Smith’s view which is what is generally appealed to when it comes to supporting a capitalist argument was far broader than this ‘hidden hand’ concept or hisWealth of Nations alone would suggest. He certainly had a robust idea of public responsibility towards the less fortunate. See: Smith, A. (1993). An inquiry into the nature and the causes of the wealth of nations. Ed. by Fred R. Glahe, Rowman and Littlefield, Savage, MD; as well as Smith, A. (1982). The theory of moral sentiments. In,Liberty Classic, ed. by D.D. Raphael and A.L. MacFie, Indianapolis.
See: Loewy, E.H. (1994). Of markets, technology, patients and profits.Health Care Analysis 2(2), 101–110. In the US today some have a full opportunity for the most exotic forms of treatment while others cannot, until they are deathly ill, get medical care at all. No one who even has an elementary concern for justice other than for justice within the libertarian definition can support such a state of affairs.
The role of curiosity and imagination is crucial to this process. It is what makes the interaction between compassion and reason possible. See: Loewy, E.H. (1997).Moral Strangers, Moral Acquaintance and Moral Friends: Connectedness and its Conditions, State University of New York Press Albany, NY; and also Loewy, E.H.The Role of Curiosity and Imagination in Ethics and Science (unpublished manuscript).
Loewy, E.H. (1997). What a socialist health-care system would look like: a sketch.Health Care Analysis 5(3), 195–204.
Marber, M., MacRae, C. and Joy, M. (1991). Delay to investigation and revascularisation for coronary heart disease in South West Thames region: a two-tier system?British Medical Journal 302, 1189–1191.
Reinhardt, U.E. (1985). Future trends in the economics of medical practice and care.American Journal of Cardiology 56, 50C-59C.
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Loewy, E.H. Justice and health care systems: What would an ideal health care system look like?. Health Care Anal 6, 185–192 (1998). https://doi.org/10.1007/BF02678103
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DOI: https://doi.org/10.1007/BF02678103