Pacific Lutheran University, Tacoma, WA, USA.
J Law Med Ethics. 2012 Fall;40(3):582-97. doi: 10.1111/j.1748-720X.2012.00691.x.
The case for U.S. health system reform aimed at achieving wider insurance coverage in the population and disciplining the growth of costs is fundamentally a moral case, grounded in two principles: (1) a principle of social justice, the Just Sharing of the costs of illness, and (2) a related principle of fairness, the Prevention of Free-Riding. These principles generate an argument for universal access to basic care when applied to two existing facts: the phenomenon of "market failure" in health insurance and, in the U.S., the existing legal guarantee of access to emergency care. The principles are widely shared in U.S. moral culture by conservatives and liberals alike. Similarly, across the political spectrum, the fact of market failure is not contested (though it is sometimes ignored), and the guarantee of access to emergency care is rarely challenged. The conclusion generated by the principles is not only that insurance for a basic minimum of care should be mandatory but that the scope of that care should be lean, efficient, and constrained in its cost.
实现更广泛的人口保险覆盖范围并控制成本增长的美国医疗体系改革的理由从根本上说是一个道德问题，其基础是两个原则：（1）社会公正原则，即公平分担疾病成本；（2）相关的公平原则，即防止搭便车。当这两个原则应用于两个现有事实时，即医疗保险市场失灵现象以及在美国，现有的获得紧急护理的法律保障，它们为基本护理的普遍获得提供了依据。保守派和自由派在美国道德文化中都广泛认同这些原则。同样，在整个政治领域，市场失灵的事实没有争议（尽管有时被忽视），而获得紧急护理的保障也很少受到质疑。这些原则产生的结论不仅是，基本护理的保险应该是强制性的，而且护理的范围应该是精简、高效且成本受限的。
