Politics, Philosophy & Economics, Volume 21, Issue 2, Page 165-189, May 2022. It is generally acknowledged that a certain amount of state intervention in health and health care is needed to address the significant market failures in these sectors; however, it is also thought that the primary rationale for state involvement in health must lie elsewhere, for example in an egalitarian commitment to equalizing access to health care for all citizens. This paper argues that a complete theory of justice in (...) health can be derived from a commitment to correcting market failure, or in other words promoting Pareto-efficiency, in the domain of health. This approach can address familiar problems around access to care, as well as problems related to resource allocation and rationing, the control of health care costs, and the foundations of public health. Egalitarian theories of justice in health cannot make sense of the depth and pervasiveness of state involvement in health and health care; only a theory rooted in the need to correct market failure can. (shrink)

The Market Failures Approach (MFA) is one of the leading theories in contemporary business ethics. It generates a list of ethical obligations for the managers of private firms that states that they should not create or exploit market failures because doing so reduces the efficiency of the economy. Recently the MFA has been criticised by Abraham Singer on the basis that it unjustifiably does not assign private managers obligations based on egalitarian values. Singer proposes an extension to the MFA, the (...) Justice Failures Approach (JFA), in which managers have duties to alleviate political, social, and distributive inequalities in addition to having obligations to not exploit market failures. In this paper I describe the MFA and JFA and situate them relative to each other. I then highlight a threefold distinction between different types of obligations that can be given to private managers in order to argue that a hybrid theory of business ethics, which I call the MFA +, can be generated by arguing that managers have obligations based on efficiency and duties based on equality to the extent that these latter obligations do not lead to efficiency losses. This argument suggests a novel theoretical option in business ethics, elucidates the issues that are at stake between the MFA and the JFA, and clarifies the costs and benefits of each theory. (shrink)

This discussion revises and extends Jonny Anomaly's ‘public goods’ account of public health ethics in light of recent criticism from Richard Dees. Public goods are goods that are both non-rival and non-excludable. What is significant about such goods is that they are not always provided efficiently by the market. Indeed, the state can sometimes realize efficiency gains either by supplying such goods directly or by compelling private purchase. But public goods are not the only goods that the market may fail (...) to provide efficiently. This point to a way of broadening the public goods account of public health to accommodate Dees' counterexamples, without abandoning its distinctive appeal. On the market failures approach to public health ethics, the role of public health is to correct public health-related market failures of all kinds, so far as possible. The underlying moral commitment is to economic efficiency in the sense of Pareto: if we can re-allocate resources in the economy so as to raise the welfare of some without lowering the welfare of any other, we ought to do so. (shrink)

Theorists of the welfare state increasingly recognize that social insurance programs are not well-justified by distributive egalitarianism—meaning concern for equality considered as a pattern in the distribution of some good. However, recent work by several relational egalitarian theorists suggests that these programs may be justified on relational egalitarian grounds. Relational egalitarians hold that the proper object of egalitarian concern is the way that citizens relate to one another. In this paper, I review the problems facing a distributive egalitarian justification for (...) social insurance before considering and rejecting three relational egalitarian justifications. I close by offering a justification for these programs grounded in efficiency, not equality. (shrink)

Citizens in wealthy liberal democracies are typically expected to see to basic needs like food, clothing, and shelter out of their own income, and those without the means to do so usually receive assistance in the form of cash transfers. Things are different with health care. Most liberal societies provide their citizens with health care or health care insurance in kind, either directly from the state or through private insurance companies that are regulated like public utilities. Except perhaps for small (...) co-pays or deductibles, citizens are not expected to see to their health needs out-of-pocket, at least for some basic level of care. Instead, when a citizen gets sick, the state or her insurance company foots the... (shrink)

Until recently, climate scientists were unable to link the occurrence of extreme weather events to anthropogenic climate change. In recent years, however, climate science has made considerable advancements, making it possible to assess the influence of anthropogenic climate change on single weather events. Using a new technique called ‘probabilistic event attribution’, scientists are able to assess whether anthropogenic climate change has changed the likelihood of the occurrence of a recorded extreme weather event. These advancements raise the expectation that this branch (...) of climate science can contribute to climate adaptation efforts. This paper examines the normative underpinnings of these policy discussions. To date, the debates revolve around whether the findings of attribution science can be used to establish moral liability for harms resulting from climate change. On close analysis, this normative framework has serious shortcomings. The paper rejects the moral liability framework and suggests, through a review of the international climate negotiations under the UNFCCC, that the science of event attribution can inform adaptation policy within a risk-pooling and climate risk insurance framework. The proposed framework is defended both on normative grounds and on the basis of its potential application within the Warsaw International Mechanism for Loss and Damage under the Cancun Adaptation Framework. (shrink)

In bioethics and health policy, we often discuss the appropriate boundaries of public funding; how the interface of public and private purchasers and providers should be organized and regulated receives less attention. In this paper, I discuss ethical and regulatory issues raised at this interface by three medical practice models in which physicians provide insured services while requiring or requesting that patients pay for services or for the non-insured services of the physicians themselves or their associates. This choice for such (...) practice models is different from the decision to design an insurance plan to include or exclude user fees, co-payments and deductibles. I analyze the issues raised with regards to familiar health care values of equity and efficiency, while highlighting additional concerns about fair terms of access, provider integrity, and fair competition. I then analyze the common Canadian regulatory response to block fee models, considering their extension to wellness clinics, with regards to fiduciary standards governing the physician–patient relationship and the role of informed consent. I close by highlighting briefly issues that are of common concern across different fundamental normative frameworks for health policy. (shrink)

Mon objectif dans cet article est de mieux cerner les contours d’une conception institutionnelle de la corruption. Je tenterai de contribuer à ce programme de recherches sur la corruption institutionnelle d’une double façon. Premièrement, j’essaierai de clarifier le concept de « corruption institutionnelle » en mettant en lumière quatre de ses principales caractéristiques et certains de ses avantages. Deuxièmement, je tenterai d’exposer trois problèmes auxquels sont confrontés ses partisans : les problèmes de la portée, du faux-diagnostic et de l’essentialisme. Malgré (...) la sympathie que j’ai pour cette approche, j’espère montrer qu’elle recèle certains points problématiques. Je tenterai essentiellement de montrer que les « institutionnalistes » risquent de faire de la corruption un concept normativement surchargé. (shrink)

This article reviews and criticizes Joseph Heath’s market failures approach (MFA) to business ethics. Our criticism is organized into three sections. First, we argue that, even under the ideal assumptions of perfect competition, when markets generate Pareto-efficient distributions, Heath’s approach does not rule out significant harms. Second, we show that, under nonideal conditions, the MFA is either too demanding, if efficiency is to be attained, or not sufficiently demanding, if the goal of Pareto efficiency is abandoned. Finally, we argue that (...) Heath’s appeal to regulations and specific moral requirements as a remedy for market failures is unlikely to safeguard efficiency and exposes a number of general worries regarding the moral force of the MFA. We end this article with a constructive suggestion on how to adjust the MFA to avoid these problems while preserving its contractualist and Paretian spirit. (shrink)

Business, management, and business ethics literature pay little attention to the topic of AI robots. The broad spectrum of potential ethical issues pertains to using driverless cars, AI robots in care homes, and in the military, such as Lethal Autonomous Weapon Systems. However, there is a scarcity of in-depth theoretical, methodological, or empirical studies that address these ethical issues, for instance, the impact of morality and where accountability resides in AI robots’ use. To address this dearth, this study offers a (...) conceptual framework that interpretively develops the ethical implications of AI robot applications, drawing on descriptive and normative ethical theory. The new framework elaborates on how the locus of morality and moral intensity combine within context-specific AI robot applications, and how this might influence accountability thinking. Our theorization indicates that in situations of escalating AI agency and situational moral intensity, accountability is widely dispersed between actors and institutions. ‘Accountability clusters’ are outlined to illustrate interrelationships between the locus of morality, moral intensity, and accountability and how these invoke different categorical responses: illegal, immoral, permissible, and supererogatory pertaining to using AI robots. These enable discussion of the ethical implications of using AI robots, and associated accountability challenges for a constellation of actors—from designer, individual/organizational users to the normative and regulative approaches of industrial/governmental bodies and intergovernmental regimes. (shrink)

Some argue that the concept of medical need is inadequate to inform the design of a universal health care system—particularly an institutional rather than a residual system. They argue that the concept contradicts the idea of comprehensiveness; leads to unsustainable expenditures; is too indeterminate for policy; and supports only a prioritarian distribution. I argue that ‘comprehensive’ understood as ‘including the full continuum of care’ and ‘medically necessary’ understood as ‘prioritized by medical criteria’ are not contradictory, and that UHC is a (...) solution to the problem of sustainability, not its cause. Those who criticize ‘medical need’ for indeterminacy are not transparent about the source of their commitment to their standards of determinacy: they promote standards that are higher than is necessary for legitimate policy, ignoring opportunity costs. Furthermore, the indeterminacy of concepts affects all risk-sharing systems and all systems that rely on medical standard of care. I then argue that the concept of need in itself does not imply a minimal sufficientist standard or a prioritarian distribution; neither does the idea of legitimate public policy dictate that public services be minimalist. The policy choice for a system of health care that is comprehensive and offers as good care as can be achieved when delivered on equal terms and conditions for all is a coherent option. (shrink)

So-called activation policies aiming at bringing jobless people into work have been a central component of welfare reforms across OECD countries during the last decades. Such policies combine restrictive and enabling programs, but their characteristic feature is that enabling programs are also mandatory, and non-compliers are sanctioned. There are four main arguments that can be used to defend mandatory activation of benefit recipients. We label them efficiency, sustainability, paternalism, and justice. Each argument is analysed in turn. First we clarify which (...) standards it invokes, thereafter we evaluate each argument according to its own standards and introduce competing normative concerns that have to be taken into account. (shrink)

Public insurance is commonly assimilated with redistributive tools mobilized by the welfare state in the pursuit of an egalitarian ideal. This view contains some truth, since the result of insurance, at a given moment, is the redistribution of resources from the lucky to unlucky. However, Joseph Heath considers that the principle of efficiency provides a better normative explanation and justification of public insurance than the egalitarian account. According to this view, the fact that the state is involved in the provision (...) of specific insurance is explained and justified by the greater efficiency of the state, in comparison with markets, in addressing market failures such as moral hazard or adverse selection. Our argument is that while insurance, intrinsically and idealistically, may diverge from a redistributive scheme, it is nevertheless difficult to deny that insurance has nothing to do with equality. More precisely, we argue that insurance may be understood as an egalitarian tool if our understanding of equality is broadened to include relational equality. Our paper aims to briefly recap the debates surrounding public insurance as a redistributive tool, advancing the idea that public insurance may be a relational egalitarian tool. It then presents a number of relational arguments in favor of the involvement of the state in the provision of specific forms of insurance, arguments that have been overlooked given the domination of luck egalitarian approaches in these debates. (shrink)

Public insurance is both everywhere and nowhere. It is everywhere in the sense that it is omnipresent in industrialised societies: public health insurance, unemployment benefits and pensions. It is a sizeable part of modern nations’ public budget . It has permeated our understanding of societal institutions to the extent that now access to public insurance coverage is understood as being a struggle for equality and equal citizenship .Public insurance is only one aspect of a broader phenomenon: the transformation of modern (...) societies into insurance societies, i.e. societies that are orientated toward risk-management . Nevertheless, public insurance is at the core of the welfare state as insurance system. Paul Krugman once said of the modern state that it is ‘an insurance company with an army’ while David Moss argues that government is the ultimate risk manager ( .. (shrink)

Unemployment is one of the greatest social problems all around the world including in modern capitalistic welfare states. Therefore its social critique is a necessary task for any critical social philosophy such as Axel Honneth's recognition approach, which understands social justice in terms of social conditions of recognition. This paper aims to develop an evaluation of unemployment and its moral weight from this perspective. I will lay out the recognition approach and present a moral evaluation of unemployment as socially unjust (...) based on the knowledge of its negative consequences for those affected. I will then discuss two objections to this conclusion, namely that a mere correlation of suffering and moral wrongness is not enough and that there are legitimate differences in the experience of recognition which could justify the existence of unemployment as deserved. In the next section, I will then refute both objections and first show that unemployment can be understood as socially unjust based on the knowledge that it is involuntary and that the unemployed are not responsible for their condition. Then I will discuss the relationship between the idea of meritocracy and unemployment to examine the assumption of unemployment as being deserved. I will finally conclude that unemployment is not a necessary side effect of meritocracy and that there are good reasons to argue for a moral and justified obligation to provide an actual access to paid work for all who want to work. However, such changes face serious obstacles and are not likely to happen under the current interpretation of meritocracy and social esteem which are one-sided and flawed. (shrink)

When is state coercion for the provision of public goods justified? And how should the social surplus of public goods be distributed? Philosophers approach these questions by distinguishing between essential and discretionary public goods. This article explains the intractability of this distinction, and presents two upshots. First, if governments provide configurations of public goods that simultaneously serve essential and discretionary purposes, the scope for justifiable complaints by honest holdouts is narrower than commonly assumed. Second, however, claims to distributive fairness in (...) the provision of public goods also turn out to be more complex to assess. (shrink)

In "Public Health and Precarity," Michael Doan and Ami Harbin have done important work extending Sherwin's concept of relational autonomy to encompass relational agency—including agents such as communities and states. This opens up new ways of thinking about responsibility for public health in long-standing debates about the role of the state in public health.The case studies Doan and Harbin analyze are also important for thinking of the account of relational solidarity that Sherwin developed together with Baylis and Kenny, one element (...) of relational public health. The discussion may even open the space for a reformulation of relational solidarity. I will use the... (shrink)

Recent efforts by legislative officials and public health advocates to reform the US food stamp program, or Supplemental Nutrition Assistance Program, have focused on restricting the types of foods eligible for purchase with SNAP benefits, specifically sugar-sweetened beverages. We argue that it is, in principle, permissible for the US government to enact a SNAP-specific SSB ban prohibiting the purchase of SSBs with SNAP benefits. While the government has a duty to ensure that citizens meet their nutritional needs, since SSBs provide (...) negligible nutrition, it has no obligation to subsidize them. Additionally, there is good reason to think that a SNAP-specific SSB ban would enable the government to better fulfill two other duties—improving citizens’ health and providing public services like Medicaid and Medicare in a more cost-effective manner. Still, because the costs and benefits of such a ban remain uncertain, we argue that the government should conduct well-designed pilot projects to help determine the effects of an SSB ban. (shrink)

A number of recent authors, most notably Joseph Heath, have persausively defended a market‐centered account of corporate responsibility that grounds standards of business conduct upon the normative presuppositions of the market. They have us focus on two important items: first, the value of welfare, or Pareto efficient outcomes, which underwrites the legitimacy of market arrangements; and second, the behavioral requirements needed to assure that corporations conduct business in a manner consistent with this value. This article critically examines the aspirations of (...) this literature by embracing its basic method but questioning how well it understands the aim of the market. It puts forth a limited case for corporate responsibility anchored in other dimensions of the public good, distinct from the value of efficiency, and argues that a plausible understanding of corporate responsibility arises from the notion that market arrangements are sites of delegated social authority to provision other aspects of the common good. (shrink)