Fair Equality of Opportunity Critically Reexamined: The Family and the Sustainability of Health Care Systems

dc.citation.firstpage583en_US
dc.citation.journalTitleJournal of Medicine and Philosophyen_US
dc.citation.lastpage602en_US
dc.citation.volumeNumber37en_US
dc.contributor.authorEngelhardt, H. Tristram Jr.en_US
dc.date.accessioned2013-03-19T18:01:58Zen_US
dc.date.available2013-03-19T18:01:58Zen_US
dc.date.issued2012en_US
dc.description.abstractA complex interaction of ideological, financial, social, and moral factors makes the financial sustainability of health care systems a challenge across the world. One difficulty is that some of the moral commitments of some health care systems collide with reality. In particular, commitments to equality in access to health care and to fair equality of opportunity undergird an unachievable promise, namely, to provide all with the best of basic health care. In addition, commitments to fair equality of opportunity are in tension with the existence of families, because families are aimed at advantaging their own members in preference to others. Because the social-democratic state is committed to fair equality of opportunity, it offers a web of publicly funded entitlements that make it easier for persons to exit the family and to have children outside of marriage. In the United States, in 2008, 41% of children were born outside of wedlock, whereas, in 1940, the percentage was only 3.8%, and in 1960, 5%, with the further consequence that the social and financial capital generated through families, which aids in supporting health care in families, is diminished. In order to explore the challenge of creating a sustainable health care system that also supports the traditional family, the claims made for fair equality of opportunity in health care are critically reconsidered. This is done by engaging the expository device of John Rawls's original position, but with a thin theory of the good that is substantively different from that of Rawls, one that supports a health care system built around significant copayments, financial counseling, and compulsory savings, with a special focus on enhancing the financial and social capital of the family. This radical recasting of Rawls, which draws inspiration from Singapore, is undertaken as a heuristic to aid in articulating an approach to health care allocation that can lead past the difficulties of social-democratic policy.en_US
dc.embargo.termsnoneen_US
dc.identifier.citationEngelhardt, H. Tristram Jr.. "Fair Equality of Opportunity Critically Reexamined: The Family and the Sustainability of Health Care Systems." <i>Journal of Medicine and Philosophy,</i> 37, (2012) Oxford University Press: 583-602. http://dx.doi.org/10.1093/jmp/jhs044.en_US
dc.identifier.doihttp://dx.doi.org/10.1093/jmp/jhs044en_US
dc.identifier.urihttps://hdl.handle.net/1911/70726en_US
dc.language.isoengen_US
dc.publisherOxford University Pressen_US
dc.rightsArticle is made available in accordance with the publisher's policy and may be subject to US copyright law. Please refer to the publisher's site for terms of use.en_US
dc.subject.keywordfair equality of opportunityen_US
dc.subject.keywordfamily stabilityen_US
dc.subject.keywordhealth care financingen_US
dc.subject.keywordhealth care savings accountsen_US
dc.titleFair Equality of Opportunity Critically Reexamined: The Family and the Sustainability of Health Care Systemsen_US
dc.typeJournal articleen_US
dc.type.dcmiTexten_US
dc.type.publicationpublisher versionen_US
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