In this paper I argue that, since institutions must reflect the societies in which they are placed, a socialist health-care system cannot be understood unless democratic socialism—which would assure all of basic necessities of existence, full education and health-care to all members of the community—is not incompatible with a flourishing market for other products. In contrasting single with multiple tiered health care systems, I suggest that a single tiered system in which all have equal access to health care and none (...) can buy more, is most consistent with the ideals of democratic socialism. (shrink)

In this paper I: (1) Describe something of the present situation in the United States and briefly contrast this with the state of affairs in other nations of the industrialised world. I emphasise health care but also allude to other social conditions: health care is merely one institution of a society and, just as do its other institutions, the system of health care reflects the basic world-view of that society. (2) Sketch the world-view and the philosophy which underwrites the use (...) of a market system in distributing what are acknowledged to be critically important social goods like health care and higher education. I show that a well-functioning market can indeed be useful when it comes to distributing some, but not when distributing other goods. (3) Suggest that when competition and the market are used to ‘regulate’ health care, technology—instead of being used to benefit patients—is apt to be used primarily to maximise individual profit: it becomes a weapon between what is often painted as ‘warfare’ among health care providers and institutions. I argue that this state of affairs is based on an undue emphasis upon the demands of individual freedom to the detriment of the community. Finally (4) I suggest an alternative approach to balancing individual with communal interests, an approach which is neither based on a predominance of one with neglect of the other, nor on a dialectic balance between them, but rather upon an approach which sees both individual and communal interests as modifying forces in a complex homeostatic balance. Individual success, in any civilised sense of the term, is possible only in a viable and well-functioning community, and a well-functioning community is not possible without individual success: the two are inevitably interdependent and linked. (shrink)

Book reviewed in this article: The Needs of Strangers. By Michael Ignatieff. The Health Economy. By Victor Fuchs. Just Health Care. By Norman Daniels.