All is Fair in Budgeting and Recession

Many of us are well aware that the United States is in the process of evaluating our health care delivery system and the services that we offer to those who do not have access to health care.  However, even more of us are probably familiar with the constant news stream of budget cuts and individual states struggling to make ends meet.  It seems as of lately that not only are the American people struggling to find new and innovative ways to budget, but so is our government.  This past week, major news came when Arizona announced that their Medicaid system was going to stop financing organ transplants.  Here you can read the story of  Francisco Felix, who was lucky enough to find a liver donor.  However, when the state announced they would no longer fund his transplant, and the efforts at raising money for the transplant failed, Felix was back at where he began, without a liver and this time without any hopes of ever receiving one.

These sudden changes in state medicaid systems have had dramatic impacts on those who rely on government services.  Arizona is not the only state to make such cuts as Washington and California have both proposed state budget cuts to their medicaid programs.  The topic of medicaid budget cuts brought me back to so many class discussions where we brought up the idea of what is fair?  As many people brought up the idea of fairness usually depends on who is getting the benefit of the doubt.  However, in this case it is clearly low-income people who are bearing the weight of these budget cuts.

In Rawl’s theories he acknowledges that there will be differences, but if there are differences they should favor those who are worst off.  These differences showcased in our health system show the exact opposite of Rawl’s ideas, with systems that aid the  poor seeing budget cuts first.  We have discussed that Rawlsian ideas are very idealistic, and maybe not the most realistic theories to apply to life, but is their fairness in his difference principle?

We also discussed the idea that those who are advantaged, and usually the decision makers, should idealistically be making decisions in the best interest of the disadvantaged.  In this case, this is not happening either.  Is their some element to the equation that we are missing, such as logistics and financing, which make the execution of a fair and just approach to healthcare delivery nearly impossible?


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