Just healthcare? The moral failure of single-tier basic healthcare

Medical need and health need

I introduce a distinction between health need and medical need, and raise several questions about their interaction. Health needs are needs that relate directly to our health condition. Medical needs are needs which bear some relation to medical institutions or processes. I suggest that the question of whether medical insurance or public care should cover medical needs, health needs, or only needs which fit both categories is a political question that cannot be resolved definitionally. I also argue against an overly strict definition of medical need on the grounds that this presupposes, wrongly, that medical intervention should always be a last resort.

Values-Based Foundation for a U.S. Single Payer Health System Model

A universal, single payer model for the American health system aligns with and should emanate from commonly held values contained within the country's foundational religious teachings, morals, ethics and democratic heritage. The Affordable Care Act in its attempt to create expanded health access has met with significant challenges. The conservative Supreme Court decreases the likelihood of a federal mandated single payer model. As uncertainty of the structure of the healthcare system increases, this paper supports its transformation to a single payer model. Healthcare should be considered a duty within the framework of a Kantian approach to ethics and a social good. Evidently ignoring this duty, the American health system perpetuates a healthcare underclass, with underserved portions of the population, with unequal access to quality care and persistent health status and outcome disparities. The COVID-19 pandemic demonstrated the effect of social determinants on optimal health outcome. A health insurance system based on the nation's commonly held values has the potential to eliminate these disparities.

Ontological Classifications and Human Rationality in Bioethics

Metaphysics often has an important role in deciding ethical questions. Specifically, in the realm of bioethics, metaphysical questions such as the nature of persons, diseases, and properties in general can be crucial to determining what is right or wrong. In this article, I tie together various metaphysical themes that recur throughout the rest of the issue: rationality as an element of human nature, ontological classifications, and kinds of action. I will explain that each has ethical implications. Actions that contravene reason will be morally problematic, whereas our classification of illnesses will have important implications for how we ought to respond to ill persons. Metaphysical questions appear, or are at least suggested, in each article, pointing to the need for metaphysics in answering bioethical questions.

Introduction to the Special Issue: Precarious Solidarity-Preferential Access in Canadian Health Care

Systems of universal health coverage may aspire to provide care based on need and not ability to pay; the complexities of this aspiration (conceptual, practical, and ethical) call for normative analysis. This special issue arises in the wake of a judicial inquiry into preferential access in the Canadian province of Alberta, the Vertes Commission. I describe this inquiry and set out a taxonomy of forms of differential and preferential access. Papers in this special issue focus on the conceptual specification of health system boundaries (the concept of medical need) and on the normative questions raised by complex models of funding and delivery of care, where patients, providers, and services cross system boundaries.

Medical Need: Evaluating a Conceptual Critique of Universal Health Coverage

Some argue that the concept of medical need is inadequate to inform the design of a universal health care system-particularly an institutional (universal, comprehensive) rather than a residual (minimalist, safety net) system. They argue that the concept (a) contradicts the idea of comprehensiveness; (b) leads to unsustainable expenditures; (c) is too indeterminate for policy; and (d) supports only a prioritarian distribution (and therefore a residual system). I argue (a) that 'comprehensive' understood as 'including the full continuum of care' and 'medically necessary' understood as 'prioritized by medical criteria' are not contradictory, and (b) that UHC is a solution to the problem of sustainability, not its cause. Those who criticize 'medical need' for indeterminacy (c) are not transparent about the source (ethical, semantic, political, or other) of their commitment to their standards of determinacy: they promote standards that are higher than is necessary for legitimate policy, ignoring opportunity costs. Furthermore, the indeterminacy of concepts affects all risk-sharing systems and all systems that rely on medical standard of care. I then argue that (d) the concept of need in itself does not imply a minimal sufficientist standard or a prioritarian distribution; neither does the idea of legitimate public policy dictate that public services be minimalist. The policy choice for a system of health care that is comprehensive and offers as good care as can be achieved when delivered on equal terms and conditions for all is a coherent option.