The operating assumption in mostdiscussions of health policy is that governmenthas some responsibility for the health of itscitizens and that it may legitimately tax,subsidize, and regulate its citizens in theexercise of that responsibility. On thisassumption, public obligations to HIV/AIDSpatients are a function of their needs inrelationship to other health needs. This paperchallenges the operating assumption by arguingthat it cannot be grounded in the obligationsthat individuals have to each other.The paper rests on its own assumption: themoral theory of individualism. On this (...) theory,individuals are ends in themselves who have theright to choose their own actions and uses oftheir resources; they do not have unchosenobligations to help others. In regard toHIV/AIDS patients, consequently, individualshave no duty to help, nor any other obligationbeyond that of respecting their rights; andthere is no valid basis for governmentregulations or subsidies on their behalf.The paper argues against the two approachescommonly used to defend a more expansive viewof individual obligations and the role ofgovernment. The first is the assumption ofwelfare rights to goods and services; thesecond is the assumption that distributivejustice requires some redistribution of healthcare resources. (shrink)

Proposed solutions to the problems of this country's health care system range along a spectrum from central planning to free market. Central planners and free market advocates provide various ethical justifications for the policies they propose. The crucial flaw in the philosophical rationale of central planning is failure to distinguish between normative and metanormative principles, which leads to mistaken understanding of the nature of rights. Natural rights, based on the principle of noninterference, provide the link between individual morality and social (...) order. Free markets, the practical expression of natural rights, are uniquely capable of achieving the goals that central planners seek but find beyond their grasp. The history of this country's health care system and the experiences of other nations provide evidence of the superiority of free markets in reaching for the goals of universal access, control of costs, and sustaining the quality of health care. (shrink)

Abstract In his critique of modern libertarian thinking, Jeffrey Friedman (1997) argues that libertarian moral theory makes social science irrelevant. However, if its moral claims are hypothetical rather than categorical imperatives, then economics, history, sociology, and other disciplines play a central role in libertarian thought. Limitations on human knowledge necessitate abstractly formulated rules, among which are claims of rights. Further, Friedman's remarks on freedom rest on an erroneous understanding of the role of definitions in philosophy, and his characterization of the (...) ?right to do wrong? as a ?logical contradiction? reveals a misunderstanding of logic. (shrink)