Just Healthcare? The Moral Failure of Single-Tier Basic Healthcare

Abstract

This article sets out the moral failure of single-tier basic healthcare. Single-tier basic healthcare has been advocated on the grounds that the provision of healthcare should be divorced from ability to pay and unequal access to basic healthcare is morally intolerable. However, single-tier basic healthcare encounters a host of catastrophic moral failings. Given the fact of human pluralism it is impossible to objectively define "basic" healthcare. Attempts to provide single-tier healthcare therefore become political processes in which interest groups compete for control of scarce resources with the most privileged possessing an inherent advantage. The focus on outputs in arguments for single-tier provision neglects the question of justice between individuals when some people provide resources for others without reciprocal benefits. The principle that only healthcare that can be provided to everyone should be provided at all leads to a leveling-down problem in which advocates of single-tier provision must prefer a situation where some individuals are made worse-off without any individual being made better-off compared to plausible multi-tier alternatives. Contemporary single-tier systems require the exclusion of noncitizens, meaning that their universalism is a myth. In the light of these pathologies, it is judged that multi-tier healthcare is morally required.

Medical need and health need

“…21 As Daniel Skinner 4 notes, the concept of 'medical need', sometimes assumed to be objectively ascertainable, thus becomes a political matter of how much we can cram inor, if we are aiming to resist spending increases, keep outto best suit our priorities. 22 Contrast Kaposy's argument with Horne's discussionmentioned aboveof whether interventions are medically necessary, which is concerned both with what I have termed medical and health need. By virtue of focusing on medical interventions, Horne is necessarily concerned with medical need, while the justification for including a condition under medical insurance is that it treats a 'pathological condition', a and thus is focused on health need.…”

“… 21 As Daniel Skinner 4 notes, the concept of ‘medical need’, sometimes assumed to be objectively ascertainable, thus becomes a political matter of how much we can cram in – or, if we are aiming to resist spending increases, keep out – to best suit our priorities. 22 …”

Values-Based Foundation for a U.S. Single Payer Health System Model

“…Americans are really not the “fairest of them all.” In looking in the mirror Americans must evaluate who we really are as a society what we should be, using our values to provide directionality as we struggle to provide a more rational, a more just health system. Dr Martin Luther King Jr reminded the nation, soon after the 1964 Civil Rights Law and the passage of Medicare and Medicaid, there was more to be done when he proclaimed: “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” ( Meadowcroft, 2015 ) The provision of healthcare as a means of providing life, liberty and access to should not be determined by market forces.…”

“…Dr Martin Luther King Jr reminded the nation, soon after the 1964 Civil Rights Law and the passage of Medicare and Medicaid, there was more to be done when he proclaimed: "Of all the forms of inequality, injustice in health care is the most shocking and inhumane." (Meadowcroft, 2015) The provision of healthcare as a means of providing life, liberty and access to should not be determined by market forces.…”

Healthcare: between a human and a conventional right

“…In the South African case Soobramoney v. Minister of Health, the plaintiff, a person with acute kidney failure, brought a suit against a state hospital that denied him dialysis treatment, arguing that the hospital violated his human right to life and health, both 5 Proponents of rights to healthcare often ignore the further fact that resource allocation in the absence of easily discernible criteria often privileges powerful interest groups. As Meadowcroft (2008Meadowcroft ( , 2015 has shown, in the UK healthcare system, the patterns of allocation of resources favour those with high socio-economic status.…”