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Health, Health Care, and Equality of Opportunity: The Rationale for Universal Health Care
Published online by Cambridge University Press: 24 January 2023
Abstract
This article discusses what arguments best support universal health care (UHC), with a focus on Norman Daniels’ equality of opportunity account. This justification for UHC hinges on the assumption of a close relationship between health care and health. But in light of empirical research that suggests that health outcomes are shaped to a large extent by factors other than health care, such as income, education, housing, and working conditions, the question arises to what extent health care is really necessary to protect and promote health, and thereby opportunity. The author argues that, although this challenge to the equality of opportunity rationale is legitimate, it is not sufficiently specified to allow us to adequately assess the extent to which universal health succeeds in protecting equality of opportunity. The article concludes by outlining a more promising strategy for developing a viable rationale for UHC.
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- © The Author(s), 2023. Published by Cambridge University Press
References
Notes
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4. FEOP is modified in the sense that Daniels broadens the concept of opportunity from the Rawlsian “opportunity for jobs and offices” to “opportunities to pursue life plans and projects.”
5. Furthermore, the distribution of opportunities is exempt from the efficiency concerns incorporated into the DP and the FEOP is also lexically prior to the DP.
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13. Cases of extreme inequality in length of life are an exception to this general rule: we can be fairly certain that a life of 70 years would contain much more opportunity than a life of 10 years. I will return to this point in section “The Equality of Opportunity Rationale Revisited.”
14. Different variations of this measure exist. They vary with respect to, for example, conceptions of “good health,” the kinds of data they use, and methods for aggregating morbidity and mortality.
15. Eurostat. 2017; available at https://ec.europa.eu/eurostat/statistics-explained/index.php/Healthy_life_years_statistics (last accessed 6 July 2021).
16. See note 15, Eurostat 2017.
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23. Scarce and inelastic supply is mostly a concern for Tobin for goods he considers as biological and social necessities. But interestingly, he also considers the case for specific egalitarianism for tea in wartime Britain.
24. For the reasons explained below, this would be an insurance-based market.
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28. I would especially like to thank Jo Wolff for his continuous support and encouragement of my work with this paper. I would also like to thank Kristin Voigt, Shlomi Segall and Gopal Sreenivasan for very helpful comments on earlier drafts of the manuscript.