Who is Really Responsible for Those Who Are Unfortunate?

Tiffany Tong

February 11^th, 2007

In this essay, I will argue that a mandatory, single-tier healthcare system in a well-off country is morally incorrect because citizens should have the right to purchase alternative healthcare services if desired. Although I believe that every citizen should have a positive right to adequate healthcare relative to the prosperity of their country (Daniels, 2003), I also accept that citizens should have the freedom to spend money earned on any legitimate service they desire (T. Engelhardt, 2003).

First I will briefly provide the reasons why the government has a responsibility to provide with all of its citizens a sufficient level of services which are a positive right, such as healthcare. Most arguments for or against universal healthcare rest on the degree of rights to equal opportunity people should be given. Those against claim that only laws refraining from violating negative rights apply; as long as society provides opportunities for everyone to have a possibility of succeeding, then whether particular individuals have particular hardships is irrelevant (T. Engelhardt, 2003). Those for universal healthcare claim that equal opportunity also includes ‘normalizing’ differences, which are a result of the social and natural lotteries, so that everyone can start off on equal ground (Daniels, 2003). I agree with the latter and would also like to focus my argument on children.

Although some may argue that individuals who are economically disadvantaged deserve to receive treatment of lesser quality because they made unwise choices in the past and should face the consequences (T. Engelhardt, 2003), I fail to see how this argument can be applied to innocent young children and other groups that are discriminated against by the dominant group. Also, the social lottery (T. Engelhardt, 2003) affects people precisely because of bad policy decisions, not because of the fault of the individual, thus the government, as the policy maker, has the responsibility to correct for these shortcomings.

Imagine an orphan born with the HIV virus. This child has an insurmountable (by him or herself) barrier to equal opportunity; he or she has lost both of the social and natural lotteries through absolutely no fault of his or her own. No amount of earning private property by the child at a young age can cause the situation to change for the better without help from the government and the whole society. Libertarians talk about how other citizens should not be held responsible to those who have had misfortunate social and natural lotteries because it is unfair to coerce people into giving up their hard earned property (T. Engelhardt, 2003). However, is it fair that this child should be held responsible for the life-taking consequences of his or her parents’ irresponsible actions?

Compared to citizens who are helping to perpetuate the injustice in society, the child is more victimized and thus should deserve help from society as a way to make up for his or her misfortunes. The system should strive to help those who are victimized rather than predominantly support those who have already been lucky due to circumstances not under their control. Thus, as it is hard to ascertain the hardships each individual face, a universal healthcare system will ensure that no one is being victimized by either society or nature.

On the other hand, a mandatory, single-tier system would force all citizens to receive only a limited level of healthcare, even when they want to and are willing to pay for more (Daniels, 2003). I believe this sort of coercion violates the principle of freedom of choice which most value highly in affluent countries such as Canada (T. Engelhardt, 2003). Assuming money is earned through lawful means in a society, then one should be able to budget one’s expenses according to one’s preference. The rights to equal opportunity should only give equal opportunities, not enforce equal modes of spending. Whether one can spend more money on food, education, leisure, or new gadgets is rarely debated; it is accepted that legitimately earned money less taxes is personal property and can be treated in any way by the owner. For example, in general, as a society, Canadians have agreed that access to food is a fundamental right and no one in such a well-off country should starve to death. However, we do not stop people from buying more food if desired! Why should healthcare be any different? Positive rights should not limit the range of choices an individual has.

In fact, a mandatory single-tier system may turn out to be less fair than a two-tier system because only those who personally know a doctor will get more treatment than what the system allows. Since we cannot factor out human emotions, such as wanting to help those dear to one regardless of regulations or laws, when designing a successful healthcare system, a two-tier system will ensure that those without personal connections can also receive good treatment when needed.

Therefore, I conclude that, due to the conflict between fulfilling basic positive rights and freedom of choice, the most morally correct compromise would be a two-tier system. The government should provide basic healthcare needs that ‘normalizes’ differences to ensure that every individual can have a relatively equal starting point in life. Moreover, ‘lucky’ citizens, those who have won both of the social and natural lotteries, should have the duty to support those more unfortunate. At the same time, if other health care needs are desired, individuals should have the freedom to purchase legitimate services at their own costs.

Works Cited

Daniels, N. (2003). Is There a Right to Health Care and, If So, What Does It Encompass? Contemporary Issues in Bioethics, 6th ed. , 46-52.

T. Engelhardt, J. (2003). Rights to Health Care, Social Justice, and Fairness in Health Care Allocations: Frustrations in the Face of Finitude. Contemporary Issues in Bioethics, 6th ed. , 64-71.