General vs. Distributive Justice

The word of the day is “healthcare.” It’s what the entire country is talking about, especially after President Obama’s address, and I haven’t had a class this week in which it wasn’t mentioned, so forgive me if it seems as though I’m just beating a dead horse here. First allow me to establish the context of my musings:

I watched a program on TLC recently entitled “Half-Ton Mom” that chronicled the story of Rene, a 900 pound woman on a quest for gastric bypass surgery. Within the program there was a great deal of information about the “obesity epidemic” in the United States and the ever-expanding category of people considered, as Rene was, “super super morbidly obese” (SSMO). One of the points this woman repeatedly emphasized in her interviews was that everyone in a situation similar to hers should have surgery to save their own lives. In fact, after the media gave so much attention to the process Rene went through (including emergency services cutting her out of her own home just to get her to the hospital), the number of people requesting gastric bypasses went up drastically, according to TLC.

Now, one of Aristotle’s themes, as we discussed in class, is justice of distribution, which emphasizes proportionality; basically, if a system is just, what you get from it is equal to what you put in. So, if the healthcare system were just in this sense, a person like Rene would have been paying quite a lot compared to the services she received. A $30,000 procedure would require a substantial insurance policy. However, under the current system, many insurance providers do not take on clients with “pre-existing conditions,” which super super morbid obesity surely is. If a SSMO person were able to find health insurance, it would almost certainly cost more than his or her means—considering that a person that size cannot move, let alone do real work—with no income and no employee health insurance. So who pays for these surgeries? Are the benefactors of these surgeries, people who have eaten themselves to the brink of death, getting more out of the system than they put in? What about the uninsured who take trips to the emergency room?

This brings up the larger issue of what Aristotle calls general justice, “whatever produces and maintains happiness and its parts for a political community” (75). Assuming that physical health is one “part” of happiness, it follows that justice would involve maintaining the health of all members of a community. Does this mean that we, as Americans, have a social responsibility to help maintain the health of our fellow citizens, as that contributes to general justice?

Concerning the current state of the healthcare system in America, there cannot be both general justice and distributive justice. According to President Obama’s speech, the insured pay an average of $1000 a year that goes to someone else’s medical care. This is obviously unjust, because some are reaping the benefits without making a proportional contribution, while others overpay thousands of dollars in insurance that they may rarely have to use. Complete government-provided universal healthcare would be unjust in the same way, because of the sliding scale of taxation. But the other extreme, the radical conservative-backed private voucher program, would be against the ideals of general justice because much of the population’s health and, thus, happiness would not be maintained. The plan President Obama proposed last night, while not nearly perfect, represents a reconciliation of general and distributive justice, not only because everyone would be required to pay into the healthcare system and have insurance, but also because everyone would have the opportunity to do so. Not everyone can afford to pay into the system right now, but by making it affordable, available, and indispensable to all, the problem of spreading public good to an undeserving public can be eliminated.