Wednesday, March 05, 2008

Health and Distributive Justice

I've been arguing that one must have ill-health (including insufficient food and shelter) in order to have a claim to distributive injustice. (The other kind of justice is procedural, having to do with fairness in transactions, theft, contractual fulfillment, and so forth. If you're keeping score, "social justice" is the leftist term for "distributive justice.")

However, ill-health is not sufficient for distributive injustice. There is a value placed on people not suffering ill-health. There are other values, too, however: the self-reliance and personal responsibility of the one with ill-health, the property rights of those who have the wealth necessary to to remediate one's ill-health, the chance of any remediation's creating social structures and systems that will be detrimental to society in the future, the corrosion of healthy people's self-reliance, etc. If offering help to someone with ill-health we reward the foolishness which got him into the predicament, cause healthy people to take less responsibility for their health in the future, create a bureaucracy that makes our government worse, or deprive the healthy and wealthy of large amounts of money, then we ought not to offer the help. If offering the help does only one or some of those bad things, then we need to examine further whether we ought to offer the help; deliberation over the trade-offs will tell. But it certainly doesn't follow from the fact that someone has ill-health that he deserves help.

The baseline of health is therefore not a right in any general sense. There are many people in our society who have a right to assistance in remediating their ill-health; there are many who have ill-health and who do not have a right to remediation. Policy makers need only consider the various values at stake (such as those named above) and decide how to target assistance at those who have a right to help and avoid giving assistance to those who have no such right, either because under no circumstances would they deserve the help or because, though they have a prima facie right to help, it is outweighed by other considerations.

It seems unlikely that a national health plan is just, therefore. It seems very likely that government should do whatever prudence dictates to make health insurance cheaper. It should consider liberating the health insurance market from regulation and the medical industry from its litigation load. But the widely believed notion that health care is a right is groundless.

The scope of distributive justice for a conservative is very narrow. The welfare net it prefers is very lean. Where it targets the deserving, the net may be serious and robust, indeed, however, because it is, after all, a genuine matter of justice.