Abstract
The univariate distribution of health in a population is of little interest to egalitarians, whether relational or distributional, and the relational egalitarian has a hard time saying anything about how the distribution of health bears on whether individuals can interact as equals. The correlations between health and other factors relevant to well-being are of interest to both kinds of egalitarians, even though the relational egalitarian, unlike the distributional egalitarian, has no ultimate interest in distribution. It is difficult to specify distributional or relational egalitarian ideal distributions of health care and to determine what policies would best implement these ideals. What is of particular interest about health to egalitarians are mainly the links between health and other relevant social factors and the distribution of health care, public health programs, and health research. It might be thought that health care resources should be redistributed in the most cost-effective way, measuring effectiveness not by the consequences for total welfare alone, but by the consequences for some measure of egalitarian value. But there are ethical objections to the use of cost-effectiveness information to allocate health-care resources, even with an egalitarian understanding of “effectiveness.” It is very difficult to adjudicate among the moral considerations that are relevant to the allocation of the health-care budget: efficiency with respect to egalitarian objectives, prioritizing the treatment of those whose health problems are worst, offering fair chances to all, and avoiding discrimination are difficult problems. Regulated markets offer one possible response to these difficulties.
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Notes
Egalitarians will also favor public health care and research aiming to extend medicine’s ability to remedy health deficiencies. I shall not have space in this paper to discuss the issues concerning public health and medical research.
References
Anderson, E. (1999). What is the point of equality? Ethics, 109, 287–337.
Arneson, R. (1989). Equality and equal opportunity for welfare. Philosophical Studies, 56, 77–93.
Brock, D. (2003). Ethical issues in the use of cost-effectiveness analysis for the prioritization of health care resources. In T. Edejer, R. Baltussen, T. Adam, R. Hutubessy, A. Acharya, E. Evans, & C. Murray (Eds.), WHO guide to cost-effectiveness analysis (pp. 289–311). Geneva: World Health Organization.
Cohen, G. A. (1989). On the currency of egalitarian justice. Ethics, 99, 906–944.
Culyer, A. (2001). Equity—Some theory and its policy implications. Journal of Medical Ethics, 27, 275–283.
Daniels, N. (1994). Four unsolved rationing problems: A challenge. The Hastings Center Report, 24(4), 27–29.
Dworkin, R. (1981a). What is equality? Part 1: Equality of welfare. Philosophy & Public Affairs, 10, 185–246.
Dworkin, R. (1981b). What is equality? Part 2: Equality of resources. Philosophy & Public Affairs, 10, 283–345.
Engelhardt, T. (1997). Freedom and moral diversity: The Moral failures of health care in the welfare state. Social Philosophy and Policy, 24, 180–196.
Foley, D. (1967). Resource allocation and the public sector. Yale Economic Essays, 7, 45–98.
Galanis, G., & Veneziani, R. (2017). Equality of when. Œconomia, 7(1). https://oeconomia.revues.org/2539. Accessed 17 Dec 2018.
Gold, M., Stevenson, D., & Fryback, D. (2002). HALYS and QALYS and DALYS, oh my: Similarities and differences in summary measures of population health. Annual Review of Public Health, 23, 115–134.
Hausman, D. (2015). Valuing health: Well-being, freedom, and suffering. New York: Oxford University Press.
Hausman, D., & Waldren, S. (2011). Egalitarianism reconsidered. Journal of Moral Philosophy, 8, 567–586.
Kamm, F. (2015). Cost effectiveness analysis and fairness. Journal of Practical Ethics, 3, 1–14.
Kelleher, J. P. (2014). Relevance and non-consequentialist aggregation. Utilitas, 26, 385–408.
Lomasky, L. (1981). Medical progress and national health care. Philosophy & Public Affairs, 10, 65–88.
McKerlie, D. (1989). Equality and time. Ethics, 99, 475–491.
Nord, E. (1999). Cost-value analysis in health care: Making sense out of QALYs. Cambridge: Cambridge University Press.
Rawls, J. (1955). Two concepts of rules. Philosophical Review, 64, 3–32.
Rawls, J. (1971). A theory of justice. Cambridge, MA: Harvard University Press.
Scanlon, T. (1998). What we owe to each other. Cambridge, MA: Harvard University Press.
Scheffler, S. (2003). What is egalitarianism? Philosophy & Public Affairs, 31, 5–39.
Segall, S. (2016). Incas and Aliens: The truth in telic egalitarianism. Economics and Philosophy, 32, 1–20.
Sen, A. (1992). Inequality reexamined. Cambridge, MA: Harvard University Press.
Temkin, L. (1993). Inequality. Oxford: Oxford University Press.
Temkin, L. (2003). Egalitarianism defended. Ethics, 113, 764–782.
Temkin, L. (2015). Equality as comparative fairness. Journal of Applied Philosophy. https://doi.org/10.1111/japp.12140.
Tobin, J. (1970). On limiting the domain of inequality. Journal of Law and Economics, 13, 263–278.
Varian, H. (1975). Distributive justice, welfare economics, and the theory of fairness. Philosophy & Public Affairs, 4, 223–247.
Veatch, R. (1981). A theory of medical ethics. New York: Basic Books.
Voorhoeve, A. (2014). How should we aggregate competing claims? Ethics, 125, 64–87.
Acknowledgements
An earlier version of this paper was delivered at a Conference on “Inequality, Fairness, and Markets” at the Institute for Advanced Studies in Toulouse in June 2017. I am grateful to the conference participants for helpful criticisms. The final version was completed with support from the Ludwig Lachmann Fellowship at the London School of Economics. Parts of this essay trace back to my 2015 book, Valuing Health: Well-Being, Freedom, and Suffering. I am grateful to two referees for extensive criticisms and suggestions on an earlier version.
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This research was supported in part by a Ludwig Lachmann Fellowship at the London School of Economics.
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Hausman, D.M. Some Remarks on Equality in Health and Health Care. Soc Just Res 32, 137–154 (2019). https://doi.org/10.1007/s11211-018-0320-y
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DOI: https://doi.org/10.1007/s11211-018-0320-y