A moral right to health or health care is a special instance of a right to fair equality of opportunity. Nation-states generally have the capabilities to specify the entitlements of such a right and to raise the resources needed to satisfy those entitlements. Can these functions be replicated globally, as a global right to health or health care requires? The suggestion that “better global governance” is needed if such a global right is to be claimed requires that these two central (...) capabilities be present. It is unlikely that nation-states would concede these two functions to a form of global governance, for doing so would seriously compromise the authority that is generally included in sovereignty. This claim is a specification of what is often recognized as the “sovereignty problem.” The argument of this paper is not an “impossibility” claim, but a best guess about whether the necessary conditions for better global governance that supports a global right to health or health care can be achieved. (shrink)

Discourse in EuroAmerica in connection with menopause is selectively naturalized, with specific consequences for practice, deflecting attention away from non-biological aspects of ageing. The medicalized discourse of North America is compared with that of contemporary Japan, where emphasis is focused predominantly on social rather than biological change. Following Latour and Haraway, it is argued that culture and nature are not dichotomous. Further, both biology and culture are contingent. `Local biologies', that is, subjective experience constituted from culturally informed knowledge, expectations and (...) practices, are in part shaped by physical sensations and symptoms, that differ quantitatively in Japan and North America. This difference influences - but does not determine - the production of discourse and medical responses to this stage of the life cycle. Situated cultural practices of creating culture/nature boundaries are sites for moral and political disputes, which in turn influence subjective experience, the discourse of medicalization and the politics of ageing. (shrink)

American health policy today faces dual problems of too little coverage at too high a cost. The mix of private and public financing leaves about one seventh of the population without any insurance coverage. At the same time, the coverage Americans do have costs an ever-larger share of our country’s productive capacity. The U.S. pays well above what other countries pay and what many people, health plans, businesses, and governments want to pay. This “paradox of excess and deprivation” results from (...) the incremental approach the U.S. has taken to promoting incompatible policy goals of increasing health insurance coverage and medical quality while trying to control costs, without squarely confronting tradeoffs. This essay examines the record of incremental developments and draws lessons for current efforts at reform. (shrink)

A central question in many debates on paternalism is whether a decision analyst can ever go against the stated preference of a client, even if merely intending to improve the decisions for the client. Using four gedanken-experiments, this paper shows that this central question, so cleverly and aptly avoided by libertarian paternalism (nudge), cannot always be avoided. The four thought experiments, while purely hypothetical, serve to raise and specify the critical arguments in a maximally clear and pure manner. The first (...) purpose of the paper is, accordingly, to provide a litmus test on the readers’ stance on paternalism. We thus also survey and organize the various stances in the literature. The secondary purpose of this paper is to argue that paternalism cannot always be avoided and consumer sovereignty cannot always be respected. However, this argument will remain controversial. (shrink)

An explosion in the varieties of life-extending interventions for older persons is changing the face of many medical specialties in the United States, altering the nature of end-stage disease, and reshaping societal expectations about normal old age, longevity, and the time for death. There is no doubt that the rapid growth of the over-85 age group and better health in late life for many people in the United States are redefining “old.” Robert Butler, founding director of the National Institute on (...) Aging, has stated that “80 is the new 60,” adding to other popular remarks that signify a changed understanding of life course expectations, especially for those who can access all that medicine has to offer. Overall .. (shrink)