Liberal Arts and Management Program | Justice and Business of Healthcare
L216 | 26614 | Shapshay, Sandra


Most people agree that the health care system in the U.S. is in
crisis: The costs of health care are rising sharply and many
citizens lack health insurance (by latest figures approximately 45
million Americans, among whom number 9 million children). Is it just
that health care is largely distributed in the U.S. by ability to
pay?  Is healthcare a special kind of good that shouldn’t be
distributed in the same manner as toaster ovens and iPods?The first
part of this course will examine several theories of justice
(Rawlsian, libertarian, socialist-egalitarian) and their
implications in debates on the following topics: Is there a moral
right to health care?  If so, is this a universal human right?  What
sort of healthcare system (the Canadian single-payer health
insurance system, the U.S. more market-based system, the Public
Health Service of England, etc.) is a just one?  In trying to answer
these questions, we will compare several health care systems and
will explore real-world cases of health care reform efforts:  From
the 1965 Social Security Act which brought about Medicare and
Medicaid, to the creation of the universal single-payer system
called Medicare in Canada, the Clinton Administration’s efforts in
the early 1990s, the Oregon Rationing Plan of 1994, to the 2006 bill
intended to guarantee nearly universal access in Massachusetts.The
second part of the course will investigate the “business of babies”
and questions of justice that arise in the context of reproductive
medicine.  First, we will investigate the business of infertility
medicine, including surrogate motherhood, egg and sperm ‘donation’,
and the lack of significant regulation of infertility clinics in the
U.S.  Second, we will address how new genetic information and
technologies are being used for would-be parents to select the sex
and genetic traits of the child they wish to produce.  For a
significant price, would-be parents can now use pre-implantation
genetic diagnosis and embryo selection (widespread use of which is
dramatized in Andrew Niccol’s 1997 film Gattaca, which we will
screen during the semester) to avoid having a child with a
significant predisposition to a genetic disease and to select for
desirable genetic traits.  If such technologies are available only
to the wealthy, will this lead to a “genobility” that further
exacerbates societal inequalities?  What, if anything, is wrong with
choosing our children?