The concept of what justice is, and how to best obtain it, has been widely debated over the Twentieth Century. Many opposing schools of thought have emerged. In his essay titled, “A Theory of Justice”, John Rawls poses an important question. How do we convince those who are well off, to consider those that are struggling? In examining this question, Rawls makes a substantial case for the Welfare State. This argument still resonates today as the debate over Universal Healthcare rages on.
Rawls begins with a simple and profound idea, a social contract. In creating this contract, all people would assume an equal position. Having no idea what fortunes may be gained in life, if one would be intelligent or born into wealth or born into poverty, everyone would agree on the most fair and equal terms. A social situation would evolve from this social contract to create a just and fair society. Rawls contends that people are self-interested. Using the “original position” of equality ensures that the contract deals fairly with the least advantaged of society.
Once the social contract has been agreed upon, Rawls claims that society must agree to a “division of social benefits” (Rawls 458). To keep this process fair and just, he sets up three major areas of distribution. The first area is the most important and should always take precedence over the other areas. The first area of social benefits to be divided are liberties and rights. This includes freedoms such as freedom of speech, thought and liberty of conscience. The second area of distribution is opportunity for gaining positions of authority in organizations. This does not mean that the positions have to be distributed equally, just that everyone is awarded the opportunity to obtain these positions. The third area is distribution of income and wealth. Equality of income is not necessary, but a threshold needs to be established to ensure the basic needs of everyone. In a declining situation, the least advantaged are the first to suffer. For this reason, the above areas need to be distributed in such a way that no one is worse off, in order to better a position of another person. Any change needs to better the position of everyone.
Many political arguments can be hard to relate to, but Rawls theory of justice is not one of them. The theory of “Justice as Fairness” as presented by Rawls is clear and easy to understand. He has chosen a hypothetical situation that is easy to imagine oneself in. Anyone that has ever played the lottery or tried their hand at a slot machine can understand the concept of gambling with their life. Life is uncertain and no matter how you look at it, it’s unfair. A person can be born into a multitude of circumstances. These circumstances can positively or negatively affect the growth and advancement of an individual. Talent, looks, and strength are not distributed equally. Intelligence is not distributed equally either. Not everyone can have the mind of an Einstein or the ability of Beethoven. Few people are born into wealthy families, but many are born into poverty. The fact that Rawls asks the people of society to decide on a social contract under a “veil of ignorance” is brilliant. (Rawls 458). Not knowing what circumstances one may be thrown into causes an individual to seek the highest level of fairness for everyone.
Once a social contract is agreed upon it seems natural that the rules and laws of society should be based upon it. This would ensure that the values of justice the society has agreed upon would become the values that people would live by. Cooperation would exist, because the basis for society had been agreed upon. Hypothetically, most conflicts could be resolved by going back to the basic principles of the social contract.
While Rawls’ organization of distribution of social benefits is scattered within the essay, the principle behind it is efficient. The most important area, that of rights and freedoms, cannot be infringed upon by any other area of distribution. If basic rights and freedoms are guaranteed, it lays a framework for new concerns in society to be dealt with. The guarantee of rights and freedoms allows an individual to better themselves. This is important for society as a whole to prosper and grow. Rights and freedoms can cover a broad array of issues: fair and safe working conditions, fair wages, safe living environment, education, and health. Without one or more of these, a person cannot fully function and reach a point of self-actualization.
The second area, that deals with the opportunity for gaining positions of authority, is important for safeguarding the freedoms that are established with the social contract. The opportunity for advancement is a powerful incentive. Individuals work harder when presented with greater opportunity, which would benefit the economy and society. If everyone has the opportunity for a position of authority, these positions would ideally be filled by members from all different parts of society. This would create a diverse working environment and would benefit the whole.
The third area of distribution, that of income and wealth is well thought out. Rawls is clear that this area cannot be completely equal. If it was, incentive to work hard would be lost. People need a reason to work hard, and self-interest is effective. Because self-interest can easily turn to complete greed, society must ensure that a basic level of needs are met for everyone. Unfortunately, in our society, people do not always look out for their fellow man. This last area of distribution assures that no one will starve or lack shelter or other basic necessities. The position of one cannot be changed or improved without improving the position of all. No individual should suffer for the betterment of another.
The overall value of the passage can be measured by the usefulness of the argument today. Many of the points raised by Rawls can be applied to the current debate over Universal Healthcare. “On this fundamental issue, the United States is the odd man out among the world’s advanced, free-market democracies. All the other industrialized democracies guarantee health care for everybody-young or old, sick or well, rich or poor, native or immigrant. The U.S.A., the world’s richest and most powerful nation, is the only advanced country that has never made a commitment to provide medical care to everyone who needs it.” (Reid 2). Rawls’ ideas suggest that he would consider healthcare a basic need that all should be entitled to. Using Rawls “veil of ignorance” there is no question whether or not we should pass Universal Healthcare. If everyone in the United States was placed in the “state of nature” in regard to health, Universal Healthcare would be a given. Health is like any other area that can be left to fortune. No one knows who will be struck with cancer or diabetes. Anyone can be injured in a car accident. “A French physician, Dr. Valerie Newman, explained it this way: “You Americans say that everybody is equal,” she said. “But this is not so. Some are beautiful, some aren’t. Some are brilliant, some aren’t. But when we get sick-then, yes: everybody is equal. That is something we can deal with on an equal basis. This rule seems so basic to the French: we should all have the same access to care when it comes to life and death.” (Reid 3). If everyone involved in the healthcare debate were to begin on equal footing, no one would risk lack of access.
When healthcare is unavailable to a portion of the population, it makes matters of health unequal. This relates to Rawls division of social benefits. We will begin with the first area, rights and liberties. The European Union’s Charter of Fundamental Rights includes: “Everyone has the right of access to preventive health care and the right to benefit from medical treatment under the conditions established by national laws and practices. A high level of human health protection shall be ensured in the definition and implementation of all Union policies and activities.” (Article 35 Official Journal of the European Communities). In the United States, our citizens pride themselves on the many rights and liberties they are guaranteed under the Constitution, but the right to healthcare is not one of them. If we assume that an unhealthy work environment infringes on our rights, then we must also assume that the unfair distribution of healthcare infringes on our rights. As American’s, we have fought for a fair and just system, it seems natural that healthcare would be the next step.
The second area of division of social benefits is the opportunity for gaining positions of authority. This relates to the healthcare debate because without access to healthcare, a person who suffers from a chronic condition is at a disadvantage in the workplace. Someone dealing with an untreated illness is not able to pursue the opportunities they might otherwise. They are unable to reach their full potential.
In America today, healthcare is doled out according to who can afford to pay for it. This system is contrary to Rawls’ third area of distribution of wealth and income. Rawls advocated for a threshold of basic needs to be met when inequality of wealth occurs. In the healthcare system today there is a great inequality. Those who can afford it get the best care available. Those who cannot afford it, in many cases, die of treatable illnesses. “According to government and private studies, about 22,000 of our fellow Americans die each year of treatable diseases because they lack insurance and can’t afford a doctor. This generally happens to people with a chronic illness who have too much money to qualify for Medicaid, but too little to pay for the drugs and treatment they need to stay alive. Among the rich nations, this happens only in America. Likewise, the U.S. is the only developed country where medical bankruptcies can happen.” (Reid 2). This discrepancy based on wealth and income is contrary to Rawls’ idea of distribution. He believed there should be “equality in the assignment of basic rights and duties” (Rawls 460). He also felt that, “social and economic inequalities, for example inequalities of wealth and authority, are just only if they result in compensating benefits for everyone, and in particular for the least advantaged members of society.” (Rawls 460). The healthcare system, as it is now, leaves many without any access to care, there are no compensating benefits for everyone.
There is a great similarity between Rawls’ theory of “Justice as Fairness” and the case in favor of Universal Healthcare. Both hope to promote consideration. There is a moral element to both arguments, that questions if we are responsible for each other. There is also a self-interested aspect to the argument, individuals always want to know what they will gain from a change. Universal Healthcare is a change that would benefit all, and that is a change John Rawls would agree with.
Article 35. Charter of Fundamental Rights of the European Union Online. Official Journal of the European Communities. 18 December 2000.
Rawls, John. “A Theory of Justice”. The Great Political Theories, Volume 2. Ed: Michael Curtis. Avon Books, New York: 1981. (264).
Reid, T.R. “No Country for Sick Men.” Newsweek 12 September 2009: 1-5. Newsweek Online. Web. 19 November 2009.