Allocating Scarce Medical Resources: Roman Catholic Perspectives

By H. Tristram Engelhardt Jr.; Mark J. Cherry | Go to book overview

Equal Care as the Best of Care:
A Personalist Approach

Paul T. Schotsmans

Problems of macroallocation in health care have become increasingly important. Awareness and confrontation with such problems has come much later in nations with a very large social insurance system. This is certainly the case for my native country, Belgium, and may explain the strong reactions of unbelief and even severe critique on health care allocation experiments like those in Oregon in the United States. Some Belgian commentators even consider the Oregon experiment radically unethical (Hallet 1994, 24–25). There is quite a lot of misunderstanding about the social health care system of the democratic European countries by U.S. observers. The fact that some of diem classify the Western European health care system as “socialist” may illustrate a strong misunderstanding of the ethical foundations of the European health care systems (McCarrick and Darragh 1997). At the same time, many Europeans refer to the American system as radically unjust for the reason that it excludes millions of people outside of a national system of solidarity. They are convinced that the American health care system places too much emphasis on individualism (McCarrick and Darragh 1997, 82). For Europeans, this observation is even more surprising in light of the so-called “promised land” myths surrounding the U.S. welfare state (Kilner 1995, 1071).

This very general introduction seeks to clarify why I seriously object to statements by Engelhardt in his introduction to this volume, such as:

Much public policy has been framed in terms of a disingenuous commitment to
providing all citizens equally with all the care from which they could benefit. Such
an approach to health care policymaking is at best deceptive and at worst involves a
corruptive false consciousness, which makes forthright health care policymaking
impossible. It is not possible to provide all with (1) the best of care, (2) equal care,
(3) physician and patient choice, while (4) still containing costs. One must compro-
mise on one or more points. If resources are not unlimited, then one must limit
choice and provide a basic package but not the best of care. And if one is not to im-
pose intrusive governmental restraints, one must accept numerous forms of in-
equalities. (6)

-125-

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