Question: Think of World Health and the Allocation of Health Care. How should Health Care be allocated? Do all human beings have a claim and right to proper Health Care? How should we pay for Health C
Week 6, Reading Section 6.1: Introduction
Introduction
As you will recall, from Week 3, the Plagues of the Fourteenth Century had disastrous effects on Europe. Many of today’s developments can be traced as having their root, causative factors in that Century. There were two others: the Protestant Reformation of the Sixteenth Century and successive Religious Wars, culminating in the Thirty Years War, 1618-48 and the English Civil War, 1642-48. In the wake of these events, the Renaissance and the Enlightenment, respectively, Philosophers began to question all the presuppositions of Life.
You are about to encounter another such development, which grew from this questioning: Social Contract Theory.
Resource: Social Contract Theory [PDF]
Up to the times of the Sixteenth and Seventeenth Centuries, few, if anyone, in Europe, questioned the origins of Society and the State. The prevailing theory was Aristotle’s, as it had been imported into Western Christianity, by Thomas Aquinas. This theory said that human beings were “Social Animals.” The underlying interpretation of that position is that human society is a given of human existence and has always been that way.
Week 6, Reading Section 6.2: Thomas Hobbes and John Locke
II. Thomas Hobbes and John Locke
The questions that Social Contract theorists, starting with Thomas Hobbes and continuing with John Locke, asked were: What were the origins of Society? What makes a “good” form of society? How does the State (meaning “government”) come into being?
Both Hobbes and Locke started from what they called the “State of Nature,” a wilderness, where all “men” (Hobbes speaks only of “men”; one wonders from whence he believed “men” came, without mention of women;) begin, having absolute rights and equality. Put another way, if one “man” encountered another, and a conflict arose about a resource, like food, came about, the right to kill would, regrettably, still be available to both. Fortunately, it occurred to our species that that was a lousy way to run a planet. Thus, the idea of “forming society” by “social contracts” occurred to someone. That was the moment that human beings left “the State of Nature,” and founded Society (a/k/a “Civil Society”).
A. Hobbes
Resource: End-of-Life Decisions [PDF]
Hobbes, being a friend and confidant of the Stuart Family, was a monarchist, and presupposed the existence of a “Sovereign.” In The Leviathan, Hobbes suggested that, in forming the Civil Society, people had to surrender their rights, in exchange for two things: (1) protection from each other, and (2) protection from outside threats. The question was: to what or whom did they have to surrender those rights? Hobbes’ answer was “the Sovereign,” a/k/a “the Leviathan,” an allusion to a mythical sea creature. What Hobbes meant was that “the Sovereign,” was the English Monarchy. The Stuart Family at the time, sat on the unified Throne of England, Wales, and Scotland at the time.
Resource: Thomas Hobbes: Moral and Political Philosophy
Resource: Hobbes's Moral and Political Philosophy
Hobbes also argued, rather unpersuasively, that, since the Sovereign had all the power and could not be held to obey a Social Contract, the people should still cede all their rights to the Sovereign. What he was saying was, “Trust me,” or, more aptly, “Trust the Sovereign, which you cannot hold accountable.” Sound silly?
Resource: Thomas Hobbes: Social Contract
B. Locke
John Locke thought so. After Hobbes’ death, Locke, in his Two Treatises on Government coined the concepts of the “consent of the governed,” of government as agent/servant of society, and of representative government, such as parliamentary or legislative supremacy, rather than monarchical reign. The English colonists, including Tom Paine, in the Late-18th Century drew on Locke’s writings, for the justification of their break with the Mother Country, between 1775-83.
Resource: John Locke: Political Philosophy
Resource: John Locke
Week 6, Reading Section 6.3: Later Theorists: John Rawls and Martha Nussbaum
III. Later Theorists: John Rawls and Martha Nussbaum
In the 20th Century, writers such as John Rawls, Sandra Harding, and Martha Nussbaum, breathed new life into Social Contract Theory. Rawls revisited the origins of society with his concepts and thought-experiment of the Veil of Ignorance and the Original Position. Harding removed the inherent sexist presuppositions of Rawls’ theories, and Nussbaum focused on the idea of “capabilities” as ways to enforce and protect rights.
Resource: Contemporary Approaches to the Social Contract
A key thing to remember is that Social Contract Morality systems are not based on Cultural Relativism. Social Contract theorists are Natural Rights thinkers, who have believed in Universal moral and politico-social rights and values. While social agreement on norms is important, those norms also have to be “good” and “right” ones. The premise on which the Social Contract theorists have operated, over the centuries after Hobbes, is that, if given their own “enlightened self-interest,” as well as a sense of compassion, human beings, following their Reason, will pick those “good” and “right” values. There have been nasty exceptions, of course, in History, but, fortunately, for our species those are still seen as exceptions.
Those are the theories and concepts, underlying Social Contract. In the following section, we shall briefly address this week’s substantive issues, World Health and the Allocation of Health Care.
Week 6, Reading Section 6.4: World Health and the Allocation of Health Care
IV. World Health and the Allocation of Health Care
A. World Health
As the Planet “shrinks,” due to mass communications, transportation systems, and global/international trade and socio-economics, the interdependence of the human populations, divided by national loyalties and geography, becomes more pronounced. Along with that interdependence comes the necessities of addressing on supra-national levels, issues of world health, including spread of diseases and overall health care provision. These are not the only relevant issues, but they are two of the more important ones. Thus, allocation of health care is no longer only a national concern, but also an international and global one.
Who cares about health inequalities? Cross-country evidence from the World Health Survey. King, Nicholas B.; Harper, Sam; Young, Meredith E.; Health Policy and Planning, Vol 28(5), Aug, 2013 pp. 558-571. Publisher: US National Library of Medicine.
Global Aging and the Allocation of Health Care Across the Life Span. (UMUC Library One Search) Daniels, Norman; American Journal of Bioethics, Aug2013; 13(8): 1-2. 2p. ISSN: 1526-5161 PMID: 23862589, Database: CINAHL Complete
Commentary: Globalization, Health Sector Reform, and the Human Right to Health: Implications for Future Health Policy. (UMUC Library One Search) Schuftan, Claudio; International Journal of Health Services, Jan2015; 45(1): 187-193. 7p. ISSN: 0020-7314, Database: CINAHL
B. Allocation of Health Care
Over the past eighty years, ever since the advent of the New Deal, the questions of Allocation of Health Care and the responsibilities of the Health Care Professions have existed in public policy forums. It was during the New Deal that activists, such as Eleanor Roosevelt campaigned for provision of Health Care to Children and Adults. Medicare and Medicaid were Federal programs, created in the 1960s, for the Aged and for poor people, against considerable opposition. Some of the States have also created programs for both groups, over the decades.
Proposals for national health care for all Americans, were put forth on the Federal level, by the Administration of Bill Clinton. But those proposals were defeated those interests, which benefited from the existing system of private provision of health care to selected portions of the working public.
Those proposals were raised once more in 2009 at the Federal level, and legislation was passed in 2010, requiring all Americans to have health insurance. The Supreme Court has subsequently upheld the general outline of that program. That program has been called “Obamacare,” but the irony of that title is that the various forms of proposals have existed, since, first, the Progressive Era and, then, FDR, Eleanor Roosevelt, and the New Deal.
The ethical/moral questions, regarding Allocation and Provision of Health Care, involve, among others, the following: (1) should all people be provided Health Care? (2) How can such programs be paid for? (3) Should there be a so-called “One-Payer” system, administered by government? (4) How can “the market” be used to keep Health Care affordable for most Americans, i.e., the middle and working classes, who cannot afford it, but aren’t “poor enough” to qualify for Medicaid or similar State programs. These are some, but not all, the issues within this field, as you will see in the Weekly Discussion.
Resource: Justice, Inequality, and Health
Resource: Public Health Ethics
