ISU health care reform forum: Norman Daniels

Chelsea Davis

“Social justice is good for our health.”

This is Norman Daniels‘ slogan. Daniels, ethics professor at Harvard School of Public Health, presented a different way of looking at the health care reform controversy: He looked at every component that contributes to overall health, not simply just health care.

“Health is only a part of the broader idea of well-being,” Daniels said. “If we have a social obligation to protect the opportunity range, then there is a framework to think about how to reform health needs.”

Daniels said in the 20th century the theory that gave the most prominence to the issue of health care is philosopher John Rawls‘ theory of justice.

There are three basic principles behind this theory: equal basic liberties, fair equality of opportunity and a difference principle, which Daniels referenced as being the most controversial component.

“It says that we need to compress socioeconomic inequality all together,” Daniels said.

He also said there are many unsolved rationing problems.

“All health systems use some kind of rationing principle, trading off compassion for people with stewardship. We give the sickest people some priority in access,” Daniels said. “But we don’t want to turn them into bottomless pits if we can’t do anything for them. There are people who we can do a lot more for if we treat them. We need to retreat to a more fair process.”

Though Daniels has found flaws within the reform, he still believes it is better that it has finally happened.

“It’s hardly an ideal reform,” Daniels said. “Nevertheless it’s better that we had it. I don’t think the search for a perfect reform should drive out improvements, though we didn’t address costs as much as we could have, it’s something we can work on over time.”

Daniels said health care costs are higher in the U.S. than they are in the rest of the world.

“It suggests that how efficient the system is matters to concerns about justice,” Daniels said. “If it’s so inefficient then it’s an important problem concerning the fair distribution of resources.”

One inefficiency Daniels cited was the fact that the U.S. is still not able to meet all the health needs people make claims about.

“How can we meet health needs fairly when we can’t meet them all?” Daniels said.

Daniels discussed the inequalities that plague the relationship between white and black Americans.

“Even if we had perfect universal coverage in this country, it would not eliminate health inequalities between blacks and whites,” Daniel said. “Five-sixths of the inequality between blacks and whites is simply a result of pushing blacks into a lower socioeconomic status in the U.S.”

Daniels said the U.S. is not going to produce health equity without broader forms of social justice.