Two thinkers have crafted visions of how they believe health-care resources ought to be allocated if there were universal health-care coverage in the United States. One is The Ends of Human Life (1994), in which Ezekiel Emanuel proposes to base resource allocation on community preferences. More recently, Charlene Galarneau has written Communities of Health Care Justice (2016), partly in response to Emanuel's earlier work. Both thinkers center their visions of just health care on communities, albeit differently structured from one another. This essay examines the similarities and differences in their proposals for resource allocation and addresses questions that arise from their proposals, such as: What are the advantages of their community-based approaches compared with more universal, nationalized options? What might prevent communities from excluding certain individuals from active participation? And finally, does positing active engagement in a community, all by itself, guarantee that justice and fairness will be served? The essay concludes that although community allocation of health services has some desirable elements, allocating resources in a centralized, national manner would be more efficient, practical, and more likely to prevent bias and discrimination against those at the margins of their communities.

中文翻译：

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应该如何分配医疗保健？两个提案

两位思想家对他们认为在美国实现全民医疗覆盖的情况下应该如何分配医疗资源提出了设想。一是 The Ends of Human Life (1994)，其中 Ezekiel Emanuel 建议根据社区偏好分配资源。最近，Charlene Galarneau 撰写了 Communities of Health Care Justice (2016)，部分是为了回应 Emanuel 早期的工作。两位思想家都将他们对医疗保健的愿景集中在社区上，尽管彼此的结构不同。本文研究了他们在资源分配建议中的异同，并解决了他们的建议中出现的问题，例如：与更普遍的方法相比，他们基于社区的方法有哪些优势？国有化选择？什么可能阻止社区将某些个人排除在积极参与之外？最后，在社区中积极参与是否能够保证正义和公平得到伸张？这篇文章的结论是，尽管卫生服务的社区分配有一些可取的因素，但以集中的、全国性的方式分配资源会更有效、更实用，并且更有可能防止对社区边缘人群的偏见和歧视。