progressivism, individualism, and the public ... - Telmarc Group

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The Telmarc Group PROGRESSIVISM, INDIVIDUALISM, AND THE PUBLIC INTELLECTUAL individuals in the society. This approach to Contractarianism is one related to individuals in a non-bargaining environment establishing between and amongst themselves a “contract” to govern their society. There are two elements contained herein. The first is the essence of a contract, and in fact a form of social contract between the members of society and amongst them as a whole. The second element is that of a view towards man as a constrained and unconstrained view of human nature. The unconstrained view states that man, individually and in concert, has the capabilities of feeling other people’s needs as more important than his own, and therefore we all act impartially, even when the individuals own interest are at stake. The constrained view is to make the best of the possibilities which exist within the constraint. For example, the constrained view of health care is one which would state that if it costs a certain amount to provide the service, an there is a portion of the society not able to purchase the service, then there is no overriding need to provide it if such a provision is uneconomical and places a significant burden on the other member of society. The unconstrained view, as a form of socialism, states that if there is the least of us in want for whatever the telecommunications revolution has in store, then they should have access to it at whatever cost. One can see that the current trend in Health care is such an unconstrained view. Rawls approach to this contract is one wherein the individuals in the society collect themselves as individuals, and agree to a plan for the operations of that society. First Principle of Justice: each person shall have equal rights and access to the greatest set of equal fundamental personal liberties. Second Principle of Justice: social and economic inequalities are to be arranged so that they both, (i) provide the greatest benefit to the least advantaged., and (ii) attached to positions available to each individual under conditions of fair equality of opportunity. Now let us see how this may be and is being applied to health care. In the recent paper entitled Principles for allocation of scarce medical interventions, by Govind Persad, Alan Wertheimer, and Ezekiel J Emanuel (Rham Emanuel's brother and health care advisor to the current President) the authors, all apparently Government employees develop a suggested plan to ration health care. They state: "Principles must be ordered lexically: less important principles should come into play only when more important ones are fulfilled. Rawls himself agreed that lexical priority was inappropriate when distributing specific resources in society, though appropriate for ordering the principles of basic social justice that shape the distribution of basic rights, opportunities, and income. As an alternative, balancing priority to the worst-off against maximizing benefits has won wide support in discussions of allocative local justice. As Page 164
The Telmarc Group PROGRESSIVISM, INDIVIDUALISM, AND THE PUBLIC INTELLECTUAL Amartya Sen argues, justice “does not specify how much more is to be given to the deprived person, but merely that he should receive more”. This is a clear statement of not just giving health care but of rationing health care. They continue: "Accepting the complete lives system for health care as a whole would be premature. We must first reduce waste and increase spending. , The complete lives system explicitly rejects waste and corruption, such as multiple listing for transplantation. Although it may be applicable more generally, the complete lives system has been developed to justly allocate persistently scarce life-saving interventions. , Hearts for transplant and influenza vaccines, unlike money, cannot be replaced or diverted to non-health goals; denying a heart to one person makes it available to another. Ultimately, the complete lives system does not create “classes of Untermenschen whose lives and well being are deemed not worth spending money on”, but rather empowers us to decide fairly whom to save when genuine scarcity makes saving everyone impossible." The begin the paper by stating their basic premise of rationing in health care. Specifically they state: "In health care, as elsewhere, scarcity is the mother of allocation. Although the extent is debated, the scarcity of many specific interventions—including beds in intensive care units, organs, and vaccines during pandemic influenza —is widely acknowledged. For some interventions, demand exceeds supply. For others, an increased supply would necessitate redirection of important resources, and allocation decisions would still be necessary …" Now although they suggest that this be applied in times of crisis for such things as vaccines, they have set the stage for expanding this to overall health care as is currently envisioned. Thus it is critical to bring Rawls and Emanuel into resonance. The seek a "justice" based argument rather than a moral based argument. They try to seek a solution based on humanistic elements rather than what one would call a moral or natural law argument. In fact we would argue that they reject any moral argument and any economic based argument and seek a politically correct extreme left wing argument as stated by Rawls. Now the propose several systems which we summarize I their own words as follows: "…Lottery Allocation:.. lottery has been used, sometimes with explicit judicial and legislative endorsement, in military conscription, immigration, education, and distribution of vaccines… First-come, first-served: Within health care, many people endorse a first-come, firstserved distribution of beds in intensive care units or organs for transplant. The American Thoracic Society defends this principle as “a natural lottery—an egalitarian approach for fair [intensive care unit] resource allocation.” Others believe it promotes fair Page 165
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