1. Dividing Up Health Care Resources
Vaughn, Ch. 11

2. Is U.S. Health Care Bad?
According to the Organization for Economic Cooperation and Development (OECD), the U.S. spends the most on health care per capita:
U.S. $6,102
Luxembourg $5,352
Canada $3,326
U.K. $2,724
Japan $2, Vaughn, p614

3. Is U.S. Health Care Bad?
Nonetheless, the U.S. has a lower life expectancy than the average of 30 other democracies:
77.8 years, compared to 78.6 years
The infant mortality rate (deaths per live births) in the U.S. is:
6.8 deaths, compared to 5.6 in those other democracies

4. Is U.S. Health Care Bad?
Because of lack of insurance, it is estimated that 18,000 people died prematurely in 2000 (due to not getting tested for diseases like ovarian and prostate cancers). Vaughn, p614 What, besides health care alone, might explain some of these numbers?

5. Defining Health and Disease
Garrett’s definition of disease:
Any deficit in the physical form or the physiological or psychological functioning of the individual in terms of
what society wants or expects from that individual, or
in terms of what the individual wants or expects for himself

6. Defining Health and Disease
Health, then, is defined as a lack of any such deficit.
Note that there is great opportunity for disagreement between what an individual considers “being diseased” and what society considers that state to be.
With society’s interest in decreasing the cost of healthcare, we can expect tension to arise between individuals and society on this question, especially:
in nursing homes
for the homeless
parental concern for children

7. Goals of Healthcare
In defining the goals of healthcare … is the main idea …
trying to live forever?
¼ of all Medicare funds are spent in the last year of life, and more than ½ of that spent in the last month
trying to alleviate suffering?
trying to eliminate the pain, or
trying to eliminate the cause of the pain

8. Goals of Healthcare
If healthcare is the effort to protect and preserve the dignity of patients, then some efforts in prolonging life and alleviating suffering may not always be good
trying to optimize happiness?
what does it cost to relieve all anxiety of patients?
how much money should be spent, how many resources consumed, in trying to ensure full mental health and happiness to only some individuals?

9. Goals of Healthcare
Ultimately, the individual’s desire for a certain level of functioning cannot control the definition of adequate care. With the expense and scarcity of care, society will have to have a say in what is reasonable accommodation of patient desire. This leads us to consideration of the components that form the basis of that accommodation…

10. Three Theories of Distributive Justice
Libertarian – social goods are distributed by the workings of the free market, not government Utilitarian – social goods are distributed based on maximization of the good of society (the greatest good for the greatest number) Egalitarian – social goods are distributed based on maximization of equality (the good of each) Vaughn, p

11. Libertarian Distribution
Joe the Plumber!
Taking from individuals and redistributing to needy is theft
People pooling their money in a company for easing the costs of health care is permissible
Government taking money from the rich to dispense to the poor is not
Classic Problem:
many will go without health care

12. Utilitarian Distribution
Our current system
A mix of insurance and public funding for easing the costs of health care
Covering the most while maintaining high quality of care
Taking from rich to give to poor is okay
Classic Problem:
many will go without health care
freeloaders

13. Egalitarian Distribution
Ideal of socialism, communism, progressivism
Public funding (government) eases the cost of health care by managing distribution based on taxes
Covers everyone equally
Classic Problem:
freeloaders