Access to Healthcare: Right or Commodity?

Every four years in the United States, the topic of health care is a heated debate
on whether or not it should be a civil right or not. Philosophers T. Tristam Engelhardt
and Robert Nozick are proponents of a multi-tier health care system. However,
philosophers Kai Nielsen and John Rawls support the single-tier health care system. In
order to determine whether health care should be a civil right or not, the conflicting
positions must be analyzed so that the most compelling choice can be ascertained.
The concept of health care differs around the world, where some countries utilize
a multi-tier system while others use a single-tier system. In general, a multi-tier system
allows for levels of health care related to the ability to pay for the care. Thus, a richer
citizen has the power to purchase healthcare that is deemed better than what the average
citizen can afford. In contrast, the single-tier system allows for the same amount of health
care to all citizens, regardless of the individuals ability to pay. In essence, a multi-tier
health care system suggests that health care is commodity, or a valuable thing that can be
bought. A single-tier health care system implies that health care is a civil right, or moral
obligation, to provide the means to its citizens. For the sake of this paper, proponents of
the multi-tier health care system will be discussed and refuted with the overriding
advantages of a single-tier healthcare system.
Health care costs in the United States are predicted to reach 20% of the gross
domestic product by the year 2018 (Munson 2011, p. 685). This amount of spending can
be due to high drug costs, aging population, advanced technology, improved therapies,
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aggressive medicine, antirationing, and administrative costs (2011, p. 686-687). Given

these expenses, the United States spends more on health care than any other county in
the world (2011, p. 687). In order to limit this spending, the cost of these factors can be
diminished. Critics of high drug costs ensure that the new and effective drugs are just
as effective as the previous, lower cost drugs on the market. The United States is only
one of two countries that has direct-to-consumer drug advertising. This implies that the
pharmaceutical uses this marketing venue as an advantage to build profit first and
foremost rather than as a means to care for every citizen. Currently, there are more
elderly than young citizens in the United States. Furthermore, this trend will cease as the
baby boom generation reaches their life expectancy, diminishing the problem that
currently exists. With the high usage of advanced technologies such as CT scans, MRIs,
sonograms, and endoscopic examinations (p. 686) and improved therapies such as
surgery, radiation, chemotherapy, and transplants, (p. 687) the procedure costs are
likely to decrease. This reduction may result in less profit for the hospital, which does not
present a real obstacle if the real aim of the health care system is to meet societal needs.
Administrative costs can be substantially eliminated with the use of electronic devices or
cards that record and maintain all patient medical information. To combat these high cost
issues, the health care system can focus on preventive medicine rather than aggressive
medicine. If preventive medicine were readily available, then there would be a lower
demand for the said factors that substantially raise the price of health care. Health care is
available to every citizen, but there are limitations in regards to the fact that no doctor or
hospital has the obligation to provide the treatment to meet everyones needs (p. 691).
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In order to keep the United States a market economy, Munson claims that health care is a
commodity like that of an expensive car or a large house, not a right (p. 692). Munson
critiques single-tier health care system by saying that health care is one social good
among others such as education, defense, environmental protection, housing, legal
assistance (p. 693). If health care becomes a right to all citizens, then will society be
obligated to offer every social good? In theory, all of these social goods would need to be
provided for; however, there are not enough funds to do so, making these provisions
impossible. On the contrary, critics may say that health care is the basis of all social
goods that all citizens should have the opportunity to have. Without good health, other
social goods such as education are of no use.
According to Engelhardt, a single-tier health care system is a coercive
actwhich fails to recognize the diversity of moral visions, moral limits of state
authority, and the authority of individuals over themselves and their own property
(Engelhardt 1996, p. 702). Likewise to Munson, Engelhardt believes that with merit
comes the privilege to buy better goods and services of value. In essence, some lives are
worth more than other lives. In Engelhardts claim, a multi-tier system provides some
amount of health care to all while allowing some to purchase additional or better
services (1996, p. 707). Moreover, this system allows for the love and pursuit of
private advantage while still sympathizing for those in need (p. 707). Engelhardt
discusses three critiques against a single-tier system: one cannot restore all to equal state
of health, the amount provided would be far too much for some and much too little for
others, and one would have immorally confiscated private property and restricted
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freedom of individuals to join in voluntary relationships and associations (p. 705).

Nozick, also a proponent of a multi-tier health care system, uses the freedom-based
justice principle as an explanation for health care resources. This principle states that
justice will require the consent of the individuals involved (p. 706). Moreover,
freedom-based justice must concur with the constraint to respect the free choices of a
person (p. 706). Engelhardt states that the property of one will not be undercut by the
tragedies and needs of others (p. 704). In other words, people have the right to
personhood and property and if they choose to do so, they must be allowed to use their
expenses to better their access to social goods such as health care.
Contrary to Engelhardt, Nozick, and Munson, philosopher Kai Nielson is a
proponent of a single-tier health care system where health care is a civil right. Nielson
believes in moral equality, or that the life of everyone matters and matters equally
(Nielson 1989, p. 708). Nielson states that liberty cannot be present in society unless
equality is first met. Likewise, Rawls claims that one has justifiable title to goods if such
a title is part of a system that ensures the greatest benefit to the least advantaged...under
conditions of fair equality and opportunity (Engelhardt 1996, p. 706). Proponents of a
single-tier health care system aim to provide equal satisfaction for basic needs (1989, p.
709), concluding a single-tier health care system is based off of the goals-based justice
principle. This principle encompasses the concepts of morality, freedom, and equality
(1996, p. 706). The goals-based justice principle can be applied in the cases of giving
every person an equal share, meeting every persons needs, achieving the greatest balance

of benefits over harms for the greatest number of people, as well as maximizing the
advantage of the least-well-off class (1996, p. 706). By implementing a single-tier
health care system, the amount of care is optimized for everyone unlike a multi-tier
system which favors the small elite population.
Engelhardt criticizes a single-tier health care system when he states that there is
no way in defining or providing basic level of [health] care (Engelhardt 1996, p. 707).
On the other hand, Nielson suggests criteria to determine this basic level of care. He
states that there are the course-of-life needs related to physical functioning such as food,
water, excretion, exercise, and rest (Nielson 1989, p. 710). There are also the basic
needs in regards to social functioning such as companionship, education, social
acceptance, sexual activity, recreation, and relaxation (1989, p. 710). In an egalitarian,
or equal-promoting society, these needs would be provided for and met in order to
function in everyday life. Nielson is also a proponent of preventive medicine. If
preventive medicine is utilized more, then it will result in considerable health care
savings and a very much healthier and perhaps even happier population (p. 712). Not
only will the use of this medicine benefit the health care system, but the training of the
nurses and paramedics (p. 712) has the potential of redefining routine work and job
responsibilities, allowing individuals, rather than a doctor to perform specific duties.
Nielson is confident that this would evoke teamwork and morale in the hospital, which
inevitably will improve medical treatment and eliminate costs (p. 712). With the use of a
single-tier health care system, Nielson clarifies that equality does not mean that every
citizen will receive the same treatment, but more so that every individual has the equal
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claim to have their needs satisfied (p. 710). In practicality, the greater the need, the
higher priority the treatment. It is important to note that all needs will be met where
possible with the same quality and availability of care (p. 711). In order for a singletier health care system to function properly, Nielson suggests that the health care system
become publically owned and controlled (p. 711). This transition will eliminate the
need for companies to make a profit off of basic health care, prioritizing the single-tier
systems core value of meeting the needs of all citizens, rather than making a profit.
The structure of health care continues to be debated, specifically whether a multitier health care system or a single-tier health care system is necessary for effectiveness.
Philosophers Engelhardt and Nozick are determined to keep a multi-tier health care
system and view health care as a commodity. Contrary, philosophers Nielson and Rawls
are committed to a single-tier system where health care is a civil right for everyone.
Listed in this discussion were several advantages for a single-tier system to override the
stance on a multi-tier health care system. While a multi-tier system has worked thus far in
the United States, it has also driven us to have one of the most expensive and complicated
health care systems in the world.

References
Engelhardt, H. (1996). Rights to Health Care, Social Justice, and Fairness in Health
Care Allocations: Frustrations in the Face of Finitude. Intervention and
Reflection. (pp. 702-708). Munson, R. Boston, MA: Cengage Learning.
Munson, R. (2011). Distributing Health Care. In Kozyrev, J. (Ed.), Intervention and
Reflection (pp. 674-726). Boston, MA: Cengage Learning.
Nielson, K. (1989). Autonomy, Equality, and a Just Health Care System. Intervention
and Reflection. (pp. 708-713). Munson, R. Boston, MA: Cengage Learning.