Abstract

How can the United States devise a health policy that provides adequate care at an affordable price? Justice in the design of a health care system--a more equitable system of health resources allocation--is the focus of this dissertation. ;In studying the issue of rationing/allocating medical resources, it is apparent that philosophical liberalism with its central symbol of individualism and its principle focus on individual rights fails to provide policy-makers with sufficient direction and moral resources to deal adequately with the bioethical issue of the 1990's. The need for a "public philosophy" in American health care as an alternative ethic to the privatized individualism of philosophical liberalism is evident. ;In a "public philosophy," the primacy of interdependency over the central symbols of philosophic liberalism--individualism and self-interest--is highlighted. A just health care system will require this recognition of our sociability. A different kind of argument, one that shows how our "common good" rather than simply our personal self-interest is at stake in any discussion of allocation, is needed. This dissertation advances a reconstructed theory of the "common good" as a possible public philosophy to overcome the failure of philosophical liberalism in American health care. ;After discussing the context of health care in the United States, and the shortcomings of philosophical liberalism within the health care context, this dissertation defines a public philosophy for American health care, incorporating a reconstructed ethic of the "common good." Finally, it analyzes as a case study Oregon's controversial attempt at creating a basic health care package using prioritization, investigating the existence and legitimacy of "common good" thinking in this political and very public process