Universal Health Care, American Pragmatism and the Ethics of Health Policy: Questioning Political Efficacy

Abstract

In this essay, I explore how thinking about the ethics of health policy is distinct from thinking either about ethics or about health policy. This is because a policy that seems ethically optimal may be pragmatically untenable, while a pragmatically tenable policy may be ethically problematic. If ought implies can, then some kind of pragmatic value seems required for any given policy choice to be relevant in policy discourse. I consider one particularly volatile and contentious health policy - universal health care - in light of the tension between ethics and American pragmatism, and conclude that justifying the policy on the basis of a theory of human needs is unlikely to be successful in policy discourse. Moreover, I challenge the common move from the existence of such needs to a theory of rights to such care. All this is not to assail a policy of universal health care per se, but simply to argue that, from a pragmatic (policy) perspective, grounding its justification in a theory of need may be unlikely to persuade stakeholders not already inclined to support such a policy.

Keywords: ethics, health policy, universal health care, pragmatism, rhetoric, needs, rights