One of the most contentious social issues in the United States today is the debate over the responsibility of the state to provide basic health care services for its people. Normal Daniels argues that "if social obligations to provide appropriate health care are not met, then individuals are definitely wronged. Injustice is done to them." The essence of Daniels' argument is correct. This paper will extend Daniels' argument using philosophical tradition. I believe that there is a social obligation to provide appropriate health care for people.
In this essay, I will summarize Daniels' argument, lend it support using a range of philosophical traditions and will address the most critical counterargument against the provision of health care by the state. Daniels' argument can be rooted a utilitarianism or deontological ethics with equal strength. His proposition that libertarian philosophy also supports universal health care is weaker, and indeed the libertarian case is the main counterargument to the provision of health care. However, I believe that the utilitarian perspective offers the strongest case for the provision of health care. This conclusion rests on understanding the basic role of government in our society.
The utilitarian case that Daniels makes for the provision of health care rests on his interpretation of the link between "normal functioning and opportunity." Daniels argues that "social obligations to provide individual only with those services that are part of the design of a system, which, on the whole, protects equal opportunity." Equal opportunity to pursue the life one envisions rests on a few different fundamentals - legal equality, safety and the provision of the basics of life. It can be interpreted from this understanding that government exists to provide, among other things, law enforcement, clean water and a legal framework for equality; Daniels extends this argument to health care. His point is that without health, one cannot pursue one's other rights, such as the right to work, to raise a family or to own land. In this, Daniels is correct; good health is generally a prerequisite to these things. Daniels understands that government cannot guarantee good health for all, but his point is that the provision of basic health care gives most people equal footing with respect to their health. Nobody's pursuit of life, liberty and happiness will be undermined by minor, treatable health issues.
This argument has its roots in utilitarian theory. Daniels understands that the provision of basic health care is no guarantee of good health, but instead delivers an outcome that is consistent with the philosophy of doing the greatest good for the greatest number. Even if government exists only to provide the basic necessities, and leaves the pursuit of anything else to the individual, health care remains a basic necessity. It is a precondition for the pursuit of other activities. For the country to perform better -- to deliver better social and economic outcomes for its people -- it must provide for their basic needs. From a utilitarian perspective, a higher GDP, higher economic growth, more upward mobility and greater social stability all derive from government provision of the essential needs of human beings. From a utilitarian perspective, the provision of basic health care is correlated with these other, positive outcomes, so it is something that the government should pursue as part of its mission to better the lives of the American people. If one accepts the proposition that government exists to facilitate the improvement of its constituent's lives, then one should also accept the proposition that government has an obligation to provide basic health care, because of the correlation between health care and a wide range of positive social and economic outcomes.
There is also a strong deontological argument in favor of the provision of health care. Kantian deontology rests on the idea of the categorical imperative -- that the morally correct action is determined by universal laws about what is morally right. The moral obligation in this sense is the obligation to pursue the correct ethical decision. Daniels rests this side of his argument on Rawls' theory of justice. Daniels' interpretation of Rawls is a weak-form argument that "fair equality of opportunity…is an appropriate principle to govern macro decisions about the design of our health-care system." We as a society have, he is arguing, a moral obligation to provide fair equality of opportunity and the health care system is part of that. The underlying assumption is that the provision of basic health care contributes to equality of opportunity. It is not an obligation that we as a society have to provide people with health care; it is a moral obligation that we have to provide equality of opportunity, and health care is a contributor to equality of opportunity.
Daniels' case is open to criticism, in particular the argument that health care is not a contributor to equality of opportunity. This has two implications. The first is that we can point out that the evidence shows clear correlation between the provision of basic health care and a wide range of positive social and economic outcomes. The second is that the underlying deontological case, based on Rawls, is not touched by the criticism. The provision of equality of opportunity is still the right thing to do, however one might interpret the clauses "equality of opportunity" and "moral obligation."
The most powerful objection to Daniels' argument is not rooted in deontology or utilitarianism, but rather in libertarianism. Daniels notes that libertarianism supports "more general principles governing the distribution of rights, opportunities and wealth, and these issues may bear on the specific issue of health care." In his discussion of this proposition, he does not recognize the opportunity cost associated with the provision of health care. Public services are financed with public dollars, most of which come via taxation. The libertarian counterargument to Daniels is that taxation is an infringement of one's liberty. This argument is underpinned by the fact that when one has less capital as the result of taxation, that does legitimately infringe on one's ability to benefit from the fruits of one's labor (in whatever way he or she might want). Taxation, therefore, is an opportunity cost that must be weighed against the benefits of the provision of basic health care. The libertarian argument is usually that on balance the opportunity cost is higher than the benefits, in part because health care service is available already through free-market mechanisms.
Reply to Objection
The libertarian objection to the provision of basic health care is actually a logical fallacy. The reality that health care is available for purchase on the open market does not counter the point that Daniels makes. The provision of health care is a prerequisite to the pursuit of life, liberty and happiness. For one to purchase health care, one would need money. To acquire money, one would need to be able to work. To work, one must be in good health. Thus, the majority of individuals are only able to maintain good health if they are in good health already; those in poor health will not have the means. Daniels draws his line in the sand with respect to how much health care society should provide (basic level) in the right place. With basic health care, one can work, and therefore be able to pay for more advanced health care. Daniels provides the prerequisite health care, but allows after that point the right of individuals to choose how much additional health care they wish to purchase. The libertarian argument eliminates the prerequisite on the basis of it being a needless opportunity cost, but because basic health care is a prerequisite to equality of opportunity the libertarian argument fails to resolve the ethical dilemma. Daniels' argument does resolve the ethical dilemma.