In this key excerpt from Securing Access to Health Care, Allen Buchanan explores the divergence between the universal right to decent minimums and practical policy of universal decent minimums. While he does assert that the universal right does not imply that such policy should be enacted, he also is cognizant of the fact that certain arguments do warrant such action. The crux of Buchanan’s argument resides in the key distinction between a right to overall, minimal, welfare floor of health for all and the availability of everything that can be done to ensure the overall health of all. A salient aspect of his argument that was specifically resonant to me was his “argument from special rights”.
In this argument, Buchanan identifies three groups that should be given precedence in determining if they have a right-claim to universal decent minimums: historically marginalized groups such as African Americans or Native Americans, groups that have been harmed by a specific health risk such as victims of chemical exposure, and groups that have incurred harm through some sacrifice to the greater good such as veterans. These arguments, at the surface level and even to some scrutiny, hold up very well. They tie back to the central notion of injustices being redeemed or sacrifice being rewarded. I found a strong correlation between these philosophical relationships and prescriptions and the larger ethical ideas of Virtue Ethics, which emphasize mind, character, and sense of honesty. Assisting those who have sacrificed significantly relates to character, and repairing injustices speaks to a notion of honesty.
Generally, I agree with this premise that Buchanan puts forth. However, upon closer examination, his ideas do have some inconsistencies. For example, the definition and scope of “injustice” is very subjective. People may define systemic injustices differently and believe that different groups are deserving of the preference and right-claim that Buchanan supports. This makes forging domestic healthcare policy very difficult. The same can be argued about his notion of sacrifice. Some may believe military service to be a sacrifice for the greater good, but others may deem it an unjust act. Empirically, this can be seen in the treatment of veterans after the Vietnam War. Exactly which groups are deserving of this treatment becomes very ambiguous in such cases. However, extrapolated to a more nuanced understanding of such policy, these ethical ideas may in fact function if and only if they are implemented as one aspect of a multifaceted healthcare objective.