The health care debate raises several interesting questions. Among them is the question of justice.
Americans, as Tocqueville notes, live and breathe equality, even as we praise competition and excellence. Asking what we ought to pay for collectively asks, by implication, what individuals (and families, and private charity, to a degree) ought to pay for themselves.
I suspect most Americans would agree that it’s perfectly fair for people who make more money to be able to afford bigger houses and nicer restaurants. Beyond that, it gets harder. Should wealth buy better schools and doctors? What about less than life-saving surgery? Cosmetic plastic surgery, probably. Would it be fair for a wealthy 65-year-old to be able to pay for hip replacement when someone without the means could not have the same procedure? Tougher question.
Would it be fair for a wealthy person to buy better prescription drugs? On the other hand, would drug companies create such things without such a market? Is the drug market like the TV market. Few Americans think it is unjust that the wealth can buy the latest, biggest TVs. And many understand that, over time, the cost will drop for the rest of us. The market for the wealthy is the entry way. But is the drug market like that? And if so, why is that fair? If there’s an anti-cancer drug, is it just for only people who happen to be wealthy to get it? What if, allowing the wealthy to get it, at first, it is most likely to become widely available most quickly?
On one hand, I suspect most Americans would say that someone who works hard, is prudent, and saves, ought to benefit from that. Is it fair that someone who eats right, works hard, lives within his means, and saves up money for a rainy day can pay for special medical care when bad luck happens? Most Americans, I suspect, would say that’s fine. But what about someone who eats junk food, does not exercise, has run into debt buying fast food, big-screen TVs, etc., and has the same bad luck? Is it fair that he can’t affort health care? Should we not treat him? On the other hand, is it fair to the prudent guy that he has to pay for someone who has been self-indulgent?
But what about people who are poor by bad luck? Should they get less than the prudent guy? If not, what is the incentive to live prudently? If yes, why is that fair to the poor?
How about schools? When we focus on the individual who has earned his way, Americans would probably be comfortable with such a person paying extra for private school for his children. (After all, many Americans do exactly that). They might even say that it is not unreasonable that such a person is, through his children, able to help his grandchildren go to good schools, etc. But when we ask the opposite question, is it fair that a child born in a poor household cannot attend a good school, it bothers most Americans.
The question of who should pay for health care, and how, raises, among many others, this very question of what advantages wealth ought to bring in America.