What is equality?
Healthcare, benefits, and reform
British physician Anthony Daniels has been contributing some interesting pieces on healthcare to the Wall Street Journal under the nom de plume Theodore Dalrymple. Over the weekend, he wrote a fun piece on costs and outcomes, with some enjoyable detail on the quality of dog veterinary care in the UK. There’s lots of good stuff in there, but one passage struck me in particular:
The latter is the fear that also haunts Americans, at least those Americans who think of justice as equality in actual, tangible benefits. That is the ideological driving force of health-care reform in America. Without manifest and undeniable inequalities, the whole question would generate no passion, only dull technical proposals and counterproposals, reported sporadically on the inside pages of newspapers. I have never seen an article on the way veterinary services are arranged in Britain: it is simply not a question.
I don’t know about the dog part, but this a relatively bold assessment of the public justification for healthcare reform. It may also be inaccurate.
Most recent polling on why people support healthcare reform of some kind indicates two primary motivations. First, the significant number of uninsured Americans and, second, the continuing escalation of already astronomical costs. What people think healthcare reform looks like, and who pays for it, are related questions. But these are the two reasons most Americans want Congress to do something.
The first of these justifications has a lot to do with equality, the second less so. But what kind of equality is at stake?
Dalrymple says that some Americans “think of justice as equality in actual, tangible benefits,” and calls this the “ideological driving force of healthcare reform.” That would suggest he thinks a lot of Americans believe justice is precise equality of resources. You get free x-rays and ER visits? Then equality means I, too, should get free x-rays and ER visits.
But is this really the primary argument for healthcare reform? Do people want to see the government provide a health plan (private or public) to the uninsured that gives them exactly what suburban, upper-middle class folks get? And do they want to see individuals who can afford to pay for whatever services they want yanked down from the heights to mingle with the hoi polloi in a community clinic?
That may be a bridge too far. The majority of Americans who would like to see the government provide coverage to the 50 million or so uninsured are endorsing equality, but not the kind Dalrymple describes. These Americans define equality as everyone crossing some minimum threshold. As long as everyone gets some coverage, then we’ll worry less about those who can afford to move beyond the basics.
It’s this equality that is the driving ideological force behind reform. Not that everyone gets the same, but that everyone has enough.
–Sam
Related posts:
- Healthcare is nice, but (morally) expensive
- What if equality and growth were compatible?
- Who should pay for health care reform?
- “Dalrymple” on health care
- Health care overload: whither inequality?
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9 Responses to “What is equality?”
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Sam,
Is this really a kind of equality? Sounds more like Harry Frankfurt-esque sufficency than equality to me.
-Marc
I think sufficientarianism is a kind of equality.
Equality is treating the people alike in some way. One way to treat people alike is to give them all the same distribution of some good. Another way is to subject them all to the same process. Still another way is to treat relevant differences differently.
Of course, different kinds of equality lead to corresponding kinds of inequality. What you’re calling “sufficiency” could lead to an inequality whereby everyone is over the baseline, but some at the top have far more than those close to the baseline.
But giving everyone the same leads to inequality, too. Some people need some health services more than others, so giving everyone the same leads to unequal health outcomes. The people who need more healthcare will be less healthy.
There’s a debate to be had about the kind of equality we want, but I think if we try to pin down equality to one thing, we miss out on some important parts of the debate. We’ll also trick ourselves into ignoring the inequalities that come with equalities.
In some ways figuring out the kind of inequality we want to avoid is as important as figuring out which equality we want to promote.
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