Health reform 2010: the missing philosophical premises in the long-running health care debate.

摘要

The American health care reform debate of 2008-2010 produced millions of words of commentary. But one of the most striking features of that debate is how little attention was paid to general philosophical principles and what particular conception of social justice the reform was meant to serve. There was little discussion of what fundamental fairness was at stake, let alone what solidarity should mean in this context. On what basis should patient cost sharing be permitted? And how did that bear on whether this reform would affect equality of access, as distinct from the goal of protecting families from catastrophic financial consequences of serious illness or injury? These issues, some have argued, were essential in other societies to the political process that produced universal health insurance or its equivalent.