INDIVIDUAL ASSIGNMENT
Please answer the following questions about the assigned materials. Quote your sources and cite them correctly.
What is the distinction between healthcare as a private benefit and healthcare as a private choice?
How does this distinction impact political decisions about healthcare by politicians and voters?

What is the difference between distributive and commutative justice?
How do desert and need factor in ethical decisions about health care?
What are the key features of market ethics?
What kind of system is the NHS? What are its distinctive features?
What kind of healthcare system is the US have?
What kind of system does Australia have?
https://www.theguardian.com/society/2016/jan/18/nye-bevan-history-of-nhs-national-health-service
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Chronic
Condition
Stasis in the health-care debate
BY YUVAL LEVIN &
RAMESH PONNURU
EALTH care played a peculiarly prominent role in
the 2018 midterm elections: peculiar because the
significance of its prominence, which is hard to
parse, has tended to mislead both Democrats
and Republicans.
On the face of it, Democrats ran and won on health care while
Republicans ran away from it. In race after race, the Democratic
candidate attacked the Republican as a threat to Americans with
preexisting health conditions while the Republican tried to
change the subject. The strategy seems generally to have
worked for the Democrats, and they now feel vindicated.
Liberal commentators have been claiming that the election
shows not only that the movement for Obamacare repeal has
been defeated but that the public is open to significant further
leftward advances. Democratic presidential aspirants are racing
to champion assorted Medicare-for-all proposals.
Conservatives, too, seem persuaded that a fight over
single-payer health care is coming. But burned by their
inability to get their act together on Obamacare repeal while
they held the levers of power, most Republican officeholders
want nothing more than to avoid another health-care debate.
Throughout the 2018 campaign, they seemed implicitly to
accept the Democratic caricatures of their positions, and they
now yearn to return to their Obama-era mode of boldly
asserting an abstract distaste for Obamacare while neither
offering an alternative nor knowing anything in particular
about health policy.
Yet the political and policy pressures acting on both parties
suggest that their activists are mistaken about where things are
headed and why. Both the left-wing enthusiasm and the rightwing fear are exaggerated. We are likely at a moment of
sustained stalemate on health care rather than on the brink of
another progressive breakthrough.
That’s because political realities are at odds with policy
ambitions on both sides. The revealed preferences of
Republican politicians over the past two years suggest that
they do not actually want to eliminate some key provisions of
Obamacare (especially insurance rules requiring coverage at
standard rates for people who are already sick) but think they
cannot simply say so. They are therefore essentially stuck
pretending to be frustrated libertarians on health care rather
than pursuing more-effective market-friendly means to their
(and most of their voters’) actual ends.
Democrats, meanwhile, face pressure from their activists
to push for radical transformations of American health care
H
even as voters register strong disapproval of sharp disruptions
in the system. Voters didn’t like the disruption Obamacare
created, and they don’t like the prospect of disruption in the
course of replacing Obamacare. Democrats too, therefore,
are stuck pretending to be ideological purists while hoping
they don’t have to follow through. They would much rather
keep attacking Republicans for threatening to disrupt
existing arrangements.
I
RONICALLY, then, the strongest argument both parties
have is, roughly, “Our health-care system is terrible and
the other party threatens to change it; you must help us
stop them.” But that is not the argument either party’s most
devoted activists want to make or hear.
For Republicans, this meant they couldn’t really answer the
Democrats’ most effective attack throughout 2018. Charged
with wanting to disrupt protections for Americans with
preexisting medical problems, they could have answered, as
was plainly true, that their proposed Obamacare replacements
offered alternative ways to protect such people and that they
were open to doing more. But Republicans did not wish to
discuss the alternatives and in many cases might not have
been capable of doing so; nor did they wish to signal their
flexibility on the issue. Instead they offered the bland
assurance that they understood the fears of people with
preexisting conditions and were committed to protecting
them—a pledge that was so devoid of policy specificity that
Democrats were able to portray it, in some cases not
unreasonably, as dissembling.
Democrats faced their own bind. Instead of attacking
Republicans on preexisting conditions and then stopping,
many had to push toward proposals involving disruptions and
costs that would create massive and probably insurmountable
practical and political problems. Single-payer may offer a
gratifying ideological totem for the Left, but it offers very
little that voters seem to want.
As the Mercatus Center’s Charles Blahous showed this
summer, the most commonly cited Medicare-for-all
proposal would cost more than $30 trillion in its first ten
years, and even “doubling all currently projected federal
individual and corporate income tax collections would be
insufficient to finance the added federal costs of the plan.” It
would also disrupt the existing coverage arrangements of
nearly all Americans, likely including those now on
Medicare, and would face enormous opposition from
providers of coverage and care at every level. Moreover,
Blahous’s cost estimates are almost certainly too low, because
they assume that the proposal would succeed in slashing
payments to providers.
Democrats have placed immense weight on the circumstances
of people with preexisting medical conditions. But even before
Obamacare, only a small segment of the population experienced significant difficulty in getting affordable insurance
for that reason. The Republican alternatives to Obamacare
advanced during 2017 and 2018 would have kept this serious
but limited problem from returning in anything like its
previous dimensions.
Beyond this scare tactic, Democrats have lined up a series
of flimsy and contradictory arguments. First they say that
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Obamacare has been a great success. But while there is no
question that more Americans have insurance coverage now
than did in 2014, this modest expansion has come at
immense cost per person, and the basic health economics at
the core of Obamacare have not worked out. Indeed, the
program has decimated the individual-insurance market. As
the market-analysis firm Mark Farrah Associates recently
noted, there were 20.2 million consumers in the individual
market in March 2016 and only 15.7 million by March
2018—a decline of more than 20 percent (or 4.5 million
people) in two years, as a result of exploding costs for all
those not receiving subsidies. This decline has been offset
largely by the expansion of Medicaid, which is hardly a sign
that the economic model underlying Obamacare has been a
great success.
Second, Democrats argue that any ongoing problems of this
sort must be the result of the Trump administration’s
“sabotage” of Obamacare. This explanation is obviously in
some tension with the claim that things are going great, and it
also isn’t particularly compelling in itself. The administration
has taken a series of contradictory steps, some intended to
reinforce the exchanges, others to allow people some exit
ramps. The net effect seems to have been modest so far, but
it’s hard to say whether it has meant more harm than good for
Obamacare, or quite what things would have looked like if not
put it, “rather than offering a solution to the inefficient and
costly fragmentation of American health care, Medicare’s
structure is responsible for much of the current situation.” By
politicizing payment rates, it favors the most politically
powerful providers of care and has encouraged the
consolidation of such providers into local monopolies able to
impose their will on insurers and patients.
The universalization of this system does not seem like what
voters were demanding in the midterm elections at all. In fact,
as they generally have when the political system has forced
them to express some preferences on health care, American
voters mostly asked for less disruption and more security in
their current arrangements. Such a desire appeals to neither
party’s ideological base, but its power has long shaped healthcare politics in America.
That means we are likely entering a period of relative stasis
in our health-care debates. Neither party is in a position to
campaign on what its activists demand, and so each will
probably focus on criticizing the most unattractive elements of
the other’s health-care message. Democrats will continue to
accuse Republicans of wanting to disrupt protections for
Americans with preexisting conditions while exaggerating the
scope of that population and of the risks it faces. Republicans
will continue to accuse Democrats of wanting to upend
everyone’s health arrangements through a government takeover
for these administrative measures. And indeed, liberal
commentators have seemed unsure whether the conclusion
they want to draw from the administration’s measures is that
Republicans have given up the fight against Obamacare or
that Republicans are at fault for any remaining problems with
the program.
But third, Democrats imply that all of this argues for a
massive upending of the entire American health-financing
system in favor of a move to single-payer. This does not follow
from either the first or the second claim, or from the
combination of the two. A true single-payer program would by
definition require conscripting scores of millions of Americans
to a new government-designed system. Even incremental
moves toward it would pose a threat to Medicare’s current
beneficiaries, who would face a new level of competition for
government dollars.
An imperative to move toward a more radically governmentcentered health-care system also does not follow from the
experience of American health care over the past half century.
Single-payer, after all, is not a new proposal in American
health care. As the term “Medicare for all” suggests, we have
run a 50-year experiment with this idea.
that would involve crushing costs and introduce horrible
inefficiencies. Each party’s claims will be true of part of the
other’s activist fringe, and neither party will really speak to
what voters have long sought and wanted.
This peculiarly dysfunctional situation can continue
because the notion that voters are worked up about health care
is not quite true. Health care was the top policy issue in the
last election, but this was hardly a policy-focused election.
In order to achieve anything on health care, either party
would have to speak in the language of voter priorities in this
arena: It would have to offer reforms that reduce costs and
improve access to coverage and care while avoiding sharp
disruption of existing arrangements. That means it would need
to present ideas that address problems such as the plight of the
remaining uninsured, rising premiums, and the unsustainable
fiscal trajectory of our entitlement programs while recognizing
that for most voters the biggest health-care worry is the fear of
losing the arrangements they have.
Republicans are actually well positioned to offer ideas such
as these, even if they often seem not to know it. For the
individual market, conservative health experts have been
developing proposals to use some of the resources now
directed to Obamacare’s subsidies to enable states to tailor
programs to the particular needs of their residents. Let
different states develop different policies while allowing
individuals the option of taking the money that would be spent
on them and using it to buy private insurance of their choice:
Neither party is in a position to campaign on what its activists
demand, and so each will probably focus on criticizing the
most unattractive elements of the other’s health-care message.
I
30
F rising costs are at the bottom of our health-care troubles
in America, then Medicare is more like the problem than
the solution. As the Manhattan Institute’s Chris Pope has
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Such an approach could encourage the provision of highervalue options while protecting the sick.
Conservative ideas for Medicaid reform, meanwhile, have
long coalesced around a number of potential block-granting
approaches. These remain appealing as a way of transforming
the perverse financial incentives that now distort the
program—states get more federal money the more they spend,
even if they spend wastefully—while the funding involved
could be modulated to find some balance between the need to
protect the most vulnerable beneficiaries and the need to
contain costs.
In Medicare, too, conservatives can offer Republican
politicians a variety of ideas to balance such competing
demands. These range from a greater emphasis on the more
market-oriented Medicare Advantage program to morefundamental if gradual long-term reforms such as those
proposed by the American Enterprise Institute’s James
Capretta in recent years. He would better target financial
support to beneficiaries who need the most assistance while
bringing greater market discipline to the provision of medical
services, especially for those who are not most in need.
Debates about reforms such as these are what our healthcare politics have always needed. They are not a distinct
response to the last election, because the last election did not
suggest that public attitudes about health care have changed
in any significant way. That should come as a relief to
Republicans concerned that single-payer is around the
corner. But they should not feel too relieved: A healthy
debate about health care will require them to find ways to
promote better policies when health care again assumes a
lower profile. And that has not exactly been a Republican
strength in recent decades.
What’s the
Matter with
White Liberals?
The answer, they increasingly believe,
is that they’re racist
BY THEODORE KUPFER
USINESS is booming for Robin DiAngelo, a retired
sociologist and the author of White Fragility: Why
It’s So Hard for White People to Talk about Racism.
Since resigning from Westfield State University
three years ago, DiAngelo has become a full-time “writer and
presenter.” What she writes about is the pathological inability
of white people to understand their passive complicity in
America’s “white supremacist culture,” and whom she presents it to is white people looking for lessons in how to overcome it. “Now breathe,” she instructs her readers. “I am not
saying that you are immoral. If you can remain open as I lay
out my argument”—here, the argument that she can credibly
judge your racism by virtue of your whiteness even if she has
B
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