Health care finance reform and the multiple goods of health: An ethical inquiry.

摘要

This dissertation argues that successful health care finance reform requires recognition of the growing variety and changing nature of health care goods. Most health care finance reform proposals assume that health care is a single good. Against this, the dissertation argues: (1) that advances in medicine have created a wide variety of health care goods; (2) that the benefits and costs of the different health care goods should be distributed differently depending on their medical, economic and ethical features; and (3) that health care financing should be designed with attention to each category of health good. Using historical analysis, insurance theory and ethics, the dissertation identifies five categories of health care goods. It then examines recent ethical proposals for health care finance reform, showing that their failure to take into account the diversity of goods leads to ethically and economically problematic proposals. Protection of the common good with society's duty to provide necessary care for sustenance to those unable to provide it for themselves, and the concepts of stewardship and subsidiarity are employed as the appropriate ethical approach for health care finance reform. The dissertation then proposes a method for health care financing, beginning with the Roman Catholic conception of the common good, stewardship of scarce resources, and the principle of subsidiarity, but supporting this ethical basis with contemporary secular arguments about goods & justice. The proposal employs health savings accounts that can accept both private and public funding to allow individuals to accumulate the resources needed to buy health services during their life. It combines (1) a preference for individual payment for health services; (2) government payment where private funding is not available for services that society deems to be necessary care; and (3) limits on certain "health enhancements" even if privately affordable by some in society.