Health, Justice, and Fairness

In this study I will endeavor to show that the American system of health care violates any conception of distributive justice understood as equality of opportunity. This system fails to provide equal access through a lack of universal insurance, a consumer driven conception of quality, and a system wide focus on cost control, leaving millions of Americans exposed to the ravages of disease. However, if health is understood as an antecedent for one's ability to function across a number of categories that have been objectively deemed as vital to engage in a life that is fully human than the commitment our nation has to the protection of fair equality of opportunity, established by our adoption of a Rawlsian conception of justice, necessitates a revision of our nation's conception of quality to encapsulate health outcomes as well as the advent of a system of universal coverage. Quality care will come to be understood as care that returns to the patient the ability to function across those categories of functioning that illness has jeopardized, and this conception of quality will precipitate system wide reform geared at the creation of positive health outcomes. This paper will articulate this argument by reconstructing and synthesizing precepts from the contemporary philosophical sources and then applying these to the practical workings of our healthcare system, while concurrently demonstrating that a system of distributive justice is compatible with the creation of a universal system of healthcare.

Does Mental Illness Affect Consumer Direction of Community-Based Care? Lessons From the Arkansas Cash and Counseling Program

Purpose: Previous research from the Cash and Counseling Demonstration and Evaluation (CCDE) in Arkansas, New Jersey, and Florida suggests that giving consumers control over their personal care greatly increases their satisfaction and improves their outlook on life. Still, some argue that consumerdirected care may not be appropriate for consumers with intellectual disabilities or mental health diagnoses. This study examined how Cash and Counseling— a new option allowing consumers to manage an individualized budget equivalent to what agencies would have spent on their care—changes the way consumers with mental health diagnoses meet their personal care needs and how that affects their wellbeing. Design and Methods: Using the Arkansas CCDE baseline and the 9-month follow-up data for individuals in the treatment and control groups, we compared and contrasted the experience of elderly consumers with and without mental health diagnoses utilizing logit regression. Results: After examining several outcome measures, including satisfaction with care arrangements and the paid caregiver’s reliability and schedule, unmet needs, and satisfaction with the relationship with paid caregivers, this study found evidence that, from the perspective of consumers, the Cash and Counseling program works well for participants with mental health diagnoses. Implications: Considering the growing need for long-term-care services and the limited resources available, a consumer-directed option makes sense, and it can be a valuable alternative for persons with mental health needs.