Why Universal Access to Healthcare Isn’t a Constitutional Right, It’s Just Plain Fair

Rawls’ treatise, A Theory of Justice, is considered to be one of the seminal works of modern political philosophy, in which he attempted to elaborate on the traditional theory of the social contract. Rawls’ goal was to find a method for constructing a “just society,” and he did so by describing the concept of the “original position.”

“This original position is understood as a purely hypothetical situation characterized so as to lead to a certain conception of justice. Among the essential features of this situation is that no one knows his place in society, his class position or social status, nor does any one know his fortune in the distribution of natural assets and abilities, his intelligence, strength, and the like The principles of justice are chosen behind a veil of ignorance. This ensures that no one is advantaged or disadvantaged in the choice of principles by the outcome of natural chance or the contingency of social circumstances The principles of justice are the result of a fair agreement or bargain This explains the propriety of the name “justice as fairness”: it conveys the idea that the principles of justice are agreed to in an initial situation that is fair.”—John Rawls, A Theory of Justice

Dr. Brasington ties on a new fly while fly fishing the North Fork of the White River.

Thus, one would develop rules for society from the “original position,” without knowing what your own position in society would be, without knowledge of one’s intellect (or lack thereof), physical ability (or disability), socioecomic status at birth, etc. The idea is that if we were to design a just society, we would want to do so in a way that, no matter what our circumstances in life, we would find the society to be fair. It is perhaps a naive idea, but an interesting way of approaching a controversial subject, like access to healthcare, for which it is extremely difficult to form an opinion.

My argument for universal access to healthcare is supported by reference to the “original position.” I have had the good fortune of having never lived in poverty or political chaos, having been blessed with a wonderful education, having always had a job when I wanted to work, and for many years a well-paying job with good benefits, including health insurance. I only know about the opposite situations through the opportunity of providing care to some patients who are much less fortunate, generally through no fault of their own, in which poverty, family dysfunction, loss of job, or other tragedy has left them in the position of being unable to have what I would consider adequate access to healthcare: not cosmetic surgery, or bariatric surgery, or in vitro fertilization, but rather treatment for basic medical problems.