As is the case in many developed nations in the world, it is a generally accepted concept that all people should have equal opportunities to succeed. In the paradigm of health, it is often intuitively assumed that in order to achieve equal opportunities amongst all people, there must be universal healthcare offered to everyone as well (Sreenivasan 21). However, Sreenivasan works to challenge this intuitive connection we often make. He analyzes the argument for universal healthcare being a necessity for justice by looking at two primary connections that must be accepted in order to make the conclusion true. The first premise is that we must accept that fair health is needed in order to get a fair share in a certain population (Sreenivasan 22). The author is careful to note the parameters for this assertion in saying that fair share is relative based on the population you are looking at. The second connection that must be made is that healthcare must be equated to health (Sreenivasan 22). The author mentions this in his argument, but the problem is not so much the first premise. In fact, he argues that the argument falls apart with the second premise.
When asserting the intuitive statement that better healthcare leads to better health outcomes, the assumption is made based on the idea that healthcare is the only socially controllable factor (not biology or random chance) that can account for a lack of equality in health outcomes, and therefore in opportunities (Sreenivasan 23). On paper this may be true, but it would be foolish to believe that healthcare is the sole social determinant in health outcomes. A perspective that is more and more on the rise in recent years is the role of socioeconomic stress in health. In a study done by Whitehall, it was shown that socioeconomic stress was a greater determinant in health outcomes compared to healthcare availability. Whitehall looked at a population that was consistent in living environment and other potential confounding factors. He then looked at the mortality rates of people in certain defined employment grades. It was shown that, despite everyone having free healthcare, there was a graded mortality rate as employment status went down (Sreenivasan 24). In another study, it was shown that it is not so much the actual value of the income for a given group or the actual job that makes a difference. It is actually the disparity in the income levels and employment grades present in a given population (Adler 62). Sreenivasan alluded to this when he talked about the relative nature necessary for the first premise to hold true.
The purpose behind Sreenivasan’s argument was to show that the commonly accepted justification for universal healthcare as a form of justice is flawed. He makes it clear that he still supports universal healthcare, but thinks there needs to be a better justification for it (Sreenivasan 21). I would argue that his argument is enough of a support to say that universal healthcare is not where resources need to be allocated. Socioeconomic stress is a huge source of chronic stress for populations across the world and if our aim is to seek justice through the provision of equal opportunity, then socioeconomic stress needs to be what we as a society are working to ameliorate. It has been shown that in nations (even with a low GDP compared to the US) that have a smaller disparity between high and low income groups tend to have better health outcomes (Adler 62). Closing an income gap is by no means easy, but it is arguably one of the best ways to ensure better health outcomes for all members of a population. Therefore, by the premises established by Sreenivasan, seeking to ameliorate socioeconomic stress is the best way to provide justice, not universal healthcare.
Works Cited
Adler, N. E., and K. Newman. “Socioeconomic Disparities In Health: Pathways And Policies.” Health Affairs 21.2 (2002): 60-76. Web. 9 Apr. 2015.
Sreenivasan, Gopal. “Health Care and Equality of Opportunity.” Hastings Center Report 37.2 (2007): 21-31. Web. 8 Apr. 2015.
Relieving socioeconomic stress is a method that I agree with fully. As the quote goes, if you give a man a fish you feed him for a day. If you teach him how to fish you feed him for a life time. Healthcare in America is sometimes criticized to being reactionary. For someone to get healthcare and treatment it’s only when the conditions have become so bad they are life threatening or debilitating. This idea of using socioeconomic as a way to improve healthcare can be seen a preventative medicine. However this argument might not works because of the issue of the fallacy of equivocation. Socioeconomic improvement and universal health care are supposedly equivalent ideas in the author’s argument. He argues we must chose one over the other because from a utilitarian stand point socioeconomic improvement will have better results than universal health care. For me I would argue that this is a pointless argument because health care can be considered part of relieving socioeconomic stress. An often stated reason for justifying health care is that on needs to be in good health to be able to work. Thus health care is a part of socioeconomic improvement already. As if a person has no health they will be in economic troubles. Thus rather than should we pick between socioeconomic improvement or health care it is more of a debate of allocation. Therefore it would be interesting to see what other methods are brought up to relieve socioeconomic stress and how they compare with how healthcare works. As it stands, we are already trying to relieve socioeconomic stress through health care.