Abstract

What constitutes a just health care system? Since the publication of his book, Just Health Care, in 1985, many bioethicists have agreed with Norman Daniels' claim that a just health care system is one that meets distributes its scarce resources in a way that protects citizens' fair equality of opportunity. Despite the popularity of Daniels' view, however, I maintain that his framework has serious limitations, many of which originate in Daniels' unjustifiable restriction of the scope of health care justice to distributive questions. This restriction is problematic for three reasons. First, it misidentifies the U.S. health care crisis solely as a distributive justice problem when health care justice involves both distributive and non-distributive matters. Second, the restriction leads Daniels' theory to ignore an entire area of health care injustice, non-distributive issues. Third, this restriction leads Daniels' framework to misidentify the aim of justice. All of these limitations suggest that Daniels view is, at best, an incomplete account of health care justice and, at worst, an account that allows or perpetuates health care injustice . ;Since I argue that Daniels' view is incomplete, I then offer an alternative framework that will not fall victim to Daniels' problems. Specifically, I suggest that we employ a framework based on social justice, which I define as the active process of creating a world without oppression. Based on this definition of social justice, in contrast to Daniels, I argue that a just health care system is one that aims to eliminate institutionalized oppression, especially in the health care system. A just health care policy, system, or practice is one that does not create, reflect, or perpetuate institutionalized oppression. Given all of the above, I argue that we must move beyond Just Health Care