Menzel Paul T
Pacific Lutheran University, 1010 122nd Street South, Tacoma, WA 98447, USA.
J Med Philos. 2003 Jun;28(3):281-306. doi: 10.1076/jmep.28.3.281.14585.
In their normative role in shaping the basic structure of a health care system, liberty and equality are often thought to conflict so sharply that health policy is condemned to remain an ideological battleground. In this paper, I will articulate my own view of why much of the apparently fundamental conflict between individual liberty and responsibility, on the one hand, and equality and equality's related concern for cost-efficiency, on the other hand, is less intractable than it is usually assumed to be. The result will be to break the rigid and stereotypical association of liberty-emphasizing social philosophies with the pluralistic market paradigm for a health care system and egalitarian, equity-emphasizing social philosophies with the unitary public system paradigm. Understanding better the moral ingredients of liberty and equitable distribution as well as the complexity of how liberty and equality actually intersect in a health care system opens the door to seeing the possibility of significant reconciliation. I will conclude, among other things, that even semi-libertarian views of distributive justice should strongly embrace compulsory, universal coverage of health care for some significant level of care, and that egalitarian views ought not to regard different levels of coverage for people of different income levels as necessarily unjust.
在塑造医疗保健系统基本结构的规范作用中，自由和平等常常被认为冲突激烈，以至于卫生政策注定仍将是一个意识形态的战场。在本文中，我将阐明我自己的观点，即为何一方面个人自由与责任，另一方面平等以及平等对成本效益的相关关注之间，许多明显的根本冲突并不像通常认为的那样难以解决。结果将是打破强调自由的社会哲学与医疗保健系统的多元市场范式之间，以及强调平等主义、公平的社会哲学与单一公共系统范式之间刻板僵化的关联。更好地理解自由和公平分配的道德要素，以及自由和平等在医疗保健系统中实际交叉的复杂性，为看到重大和解的可能性打开了大门。我将得出的结论之一是，即使是关于分配正义的半自由主义观点，也应强烈支持对某种重要医疗水平实行强制性的全民医保，而且平等主义观点不应将不同收入水平人群的不同医保覆盖水平视为必然不公正。
