In this paper I argue that a narrow view of justice dominates the bioethics literature. I urge a broader view. As bioethicists, we often conceive of justice using a medical model. This model focuses attention at a particular point in time, namely, when someone who is already sick seeks access to scarce or expensive services. A medical model asks how we can fairly distribute those services. The broader view I endorse requires looking upstream, and asking how disease and suffering came (...) about. In contrast to a medical model, a social model of justice considers how social determinants affect the health of a population. For example, social factors such as access to clean drinking water, education, safe workplaces, and police protection, profoundly affect risk for disease and early death. I examine one important social determinant of health, health care coverage, to show the limits of a medical model and the merits of a broader view. (shrink)

Voluntary, employment‐based insurance is afflicted by a variety of internal imbalances: inequities in the way health insurance is paid for, a conflict of interest in the selection of health insurance, the concentration of the healthy and the sick into separate plans, and free‐ridership. But while all these imbalances generate severe problems, those seeking to reform health insurance in the United States should concentrate on the last two.

The bestselling biography of one of the 20th century's most remarkable and controversial writers. Author Barbara Branden, who knew Rand for nineteen years, provides a matchless portrait of this fiercely private and complex woman.

The book challenges the values of much of contemporary bioethics and health care policy by confronting their failure to secure the moral norms they seek to apply.