All posts by Samantha Segall

Equitity rather than Equality

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For the most part I think the logic in Gopal Sreenivasan’s “Health Care and Equality of Opportunity” is well reasoned. While he argues well what he sets out to, my issue with his paper is not how he reasons through his argument, but what his argument is. As highlighted in the title, Sreenivasan article discusses how health care interacts with the equality of opportunity. I believe that we should not be talking about equality in terms of opportunity or health care, but rather equity. In our current world equality is not something that exists on a large scale and it is unreasonable to believe that we can solve this problem or even come close to a solution. So when talking about health care I think we should try to base our discussions in reality and center our discourse on how to move towards equity rather than equality.

Sreenivasan spends a large portion of the article outlining why it is better to put money towards decreasing socioeconomic inequality rather than putting that same amount of money towards universal health. While considering the data and options he presents this appears to be a correct conclusion, it is based off the incorrect assumption that these are the only options. It would be possible to use the money for other programs such as a progressive health care plan. In a progressive health care system, the lower someone’s income the more support they get from the government and vice versa. While this system is not at all equal, it is equitable. A progressive health care program would access many of the benefits of universal health care and decreasing socioeconomic inequalities without have to pick one or the other.

To be optimal, this system would also have to take into account some of the social determinants of health (i.e. “those social factors outside the traditional health care system that have an effect-either positive or negative-on the health status of individuals in a given population” (23-24)). It is not clear what the balance should be between progressively funding health care and working on public health initiatives to decrease/increase the negative/positive social determinants of health especially focusing on those which affects people in lower income brackets more than others. More in depth research would be needed to be done to figure out the optimal balance between funding these two options and the ideal amount would vary on a case to case basis. Due to this variation, it would be impossible to get the absolute best solution, but I believe that a system can realistically be developed that is better than Sreenivasan’s framework allows for if we strive for equity instead of equality.

Universal Healthcare: A Moral Responsibility

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34 countries make up the OECD (Organisation for Economic Co-operation and Development) a group of countries dedicated to global development, almost all of which have a high Human Development Index and are high-income economies. Of these countries Mexico, Chile, and the US are the only countries where less than half of spending on healthcare is publicly financed (OECD).

Countries with Universal Healthcare

Green represents countries with universal healthcare; grey represents countries without universal healthcare (Fisher)

Mexico and Chile have two of the lowest three GDPpc (gross domestic product per capita) adjusted for purchasing power in the OECD with $17,019 and $21,486 respectively (OECD). The US is clearly an outlier being one of the only developed countries without universal healthcare and by far the richest without it. It is well within the ability of the United States to provide universal healthcare. People can argue about the economic pros and cons of universal healthcare, but at its core, the lack of healthcare provided to everyone in the US is a moral issue. “While other countries have declared health care to be a basic right, the United States treats health care as a privilege, only available to those who can afford it” (Chua).

According to Lawrence Gostin, a government “is compelled by its role as the elected representative of the community to act affirmatively to promote the health of the people” yet “cannot unduly invade individuals’ rights in the name of the communal good” (11). This seems paradoxical, but a government must consider whether the benefits of promoting the health of its people outweigh and justify the invasion of the individuals’ rights. Considering the wealth of the US (GDPpc = $51,689), the impact on each individual would be relatively little with a small portion of people’s paychecks being diverted specifically for healthcare as opposed to the more generic taxes where it is not immediately clear where the funds are going. And the impact would be dramatic. Every year 18,000 excess deaths occur among the uninsured under the age of 65 (Institute of Medicine) and many more live with aliments that could be relatively easily treated or crippling debt due to necessary healthcare costs. The problems from the United States’ lack of universal healthcare falls, like many societal harms, disproportionally on minority groups. Hispanics are two to three times more likely to be uninsured than non-Hispanic whites (Institute of Medicine). Viewing healthcare as a privileged also perpetuated the cycle of poverty which so many Americans are trapped in.

The United States has a moral obligation to provide universal healthcare to its citizens. There is “No ethical principle can eliminate the fact that individual interests must sometimes yield to collective needs” (Childress) and the case of universal healthcare is a time where the rights of the individuals must be infringed upon in order to provide for the general population.

 

Work Cited

Childress, James E. “Public Health Ethics: Mapping the Terrain.” Journal of Law, Medicine & Ethics (2002): 170-178.

Chua, Kao-Ping. “The Case for Universal Health Care.” 2005. American Medical Student Association. 16 March 2014.

Fisher, Max. Here’s a Map of the Countries That Provide Universal Health Care (America’s Still Not on It). 28 June 2012. 16 March 2014.

Gostin, Lawrence. Public Health Law: Power, Duty, Restaint. University of California Press, 2008.

Institute of Medicine. Care Without Coverage: Too Little, Too Late. National Academies Press, 2002.

OECD. “Gross Domestic Product.” 2013. OECD. 16 March 2014.

OECD. “OECD Health Data 2013: How does the United States Compare.” 2013. OECD. 16 March 2014.

Net Positive Externalities from Genetic Enhancements

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As a society, we praise those who are exceptional, whether it be intellectually or musically talented, athletically gifted or artistically genius. Part of this is sheer awe of their talent, but also part is because of the positive externalities they have on our society. Those who make great discoveries in math or science often help us to understand the way the world works and these discoveries can also be used for medical discoveries. Great athletes provide entertainment for those who watch them compete and also can inspire young athletes to strive to train harder and be better. Even those who are not classified as “exceptional” can benefit society. It is relatively clear that having a smarter population helps society as a whole and the same goes for a healthier population; whereas having a taller population or a prettier one does not. When discussing transhumanism (H+) and genetic enhancements it is important to focus on the enhancements which would benefit the individual and society rather than only the individual.

While the main argument of many opponents to genetic enhancement is “If the gap between the privileged and the underprivileged continues to grow, wealth-based access to health care and future genetic enhancements will threaten the basic structures of society” (Mwase, 88), this is a not a valid argument as to why genetic enhancement should not be allowed. “[The] increase in unjust inequalities due to technology is not a sufficient reason for discouraging the development and use of the technology. We must consider its benefits, which include not only positive externalities but also intrinsic values that reside in such goods as the enjoyment of health, a soaring mind, and emotional well-being” (Bostrom, 113). Also it is not clear that (at least to begin with) genetic enhancements would increase inequality, but might actually decrease it. One of the greatest benefits of the discovery of the human genome is the ability to understand genetic disorders. While many genetic disorders are extremely complicated, there are over 4000 genetic disorders which are the result of a defect in a single gene (News Medical). While today we are still trying to figure out how to fix many of these defects, it seems likely that this will be a much easier problem to solve than how to enhance something such as memory or health where multiple genes play a role. This seems to indicate that, minimally, initial genetic enhancements would decrease the inequality gap rather than widen it. Also, in the same fashion that most countries provide free public education and many free accesss to health care, it would make sense for governments to provide free or reduced cost genetic enhancements to those who can not afford the enhancements if they have a net benefit to society.

While there are clearly issues with genetic enhancement that need to be flushed out as they become a more realitic options, enhancements which have positive externalities should be allowed in theory.

 

Work Cited.

Bostrom, Nick. “Human Genetic Enhancement: A Transhumanist Prespective.” Holland, Stephen. Arguing About Bioethics. New York: Routledge, 2012. 105-115.

Mwase, Isaac M. T. “Genetic Enhancement and the Fate of the Worse Off.” Kennedy Institute of Ethics Journal (2005): 83- 89.

News Medical. http://www.news-medical.net/health/Single-Gene-Genetic-Disorder.aspx. 8 February 2014.