Market Justice and Social Justice: How They Conflict, Complement and Reform Healthcare

Abstract

Market justice asserts that in a free market economy, market forces can achieve a fair distribution of healthcare among individuals who have the freedom to purchase the healthcare services they value. In market justice, healthcare is rationed by the willingness and ability of people to pay for healthcare. Alternatively, social justice asserts that it is the responsibility of society to ensure equitable distribution of healthcare services provided through a central agency. In social justice, healthcare is rationed through supply-side rationing, in which the government limits the availability of certain healthcare services by deciding how they will be dispersed. These two types of approaches complement each other in our current healthcare system. Private, employer-provided health insurance, which mainly applies to middle class Americans, is driven by market justice, as this group has the ability to pay for healthcare often through the employer. Publicly financed programs like Medicare, Medicaid, and workers’ compensation, covers groups who are unable to pay for healthcare, and are based on social justice. Market justice conflicts with social justice in that it emphasizes individual wellbeing rather than collective wellbeing. Market justice reform aims at market efficiency, high quality, and low costs with greater share in the market. Social justice reform aims to rid healthcare of discriminatory systems that can affect society as a whole.

According to Stephen Krau (2015), the goal of justice in the healthcare system “can be considered that persons with the same medical conditions should have availability of the same treatment options.” Market justice and social justice are two models within the healthcare system, with differing approaches that potentially are divisive for many Americans on how our healthcare system should function. This paper will outline the ways that market justice and social justice complement each other, conflict in healthcare delivery, and contribute to the probability of healthcare reform.

Market Justice

Market justice subscribes to the idea that in a free-market economy, market forces can achieve a fair distribution of healthcare among people. However, not all people are guaranteed distribution of healthcare. Market justice relies on people’s willingness and ability to pay as a basis for healthcare services. Therefore, people have the freedom to purchase the healthcare goods and services that they value. People pay for these goods and services through their own financial means that they have acquired through their own “legitimate efforts” (Shi and Singh, 2015). Most goods and services within a free market are acquired similarly. Thus, it stands that providing people healthcare that they have not earned through their own financial efforts is not just. As a result, the production of healthcare is determined by the quantity and cost that consumers are willing to pay. Consequently, those who are not able to pay or who are uninsured will have great difficulty acquiring healthcare (Shi and Singh, 2015). In other words, this system “allows for inequality as long as [it is a] result of a fair market system” (Matthews, 2006). Supporters of market justice believe in the logic of supply and demand within the healthcare system, arguing that minimal government intervention leads to “optimal outcomes of healthcare sources” (Matthews, 2006).

Market justice operates on a multitude of free-market assumptions. First, healthcare functions as any other economic good or service, rendering it subject to market forces of supply and demand. Second, individuals are held responsible for their own economic and financial achievements. When individuals pursue their own best interests (i.e. purchasing healthcare services), society as a whole benefits. Third, people tend to make rational decisions in their choice to purchase healthcare services that promote individual health. Fourth, people informed by physicians know what is best for their own health, implying that people place a great deal of trust in their physicians. Lastly, a free market, rather than the government, can distribute healthcare efficiently and equitably (Shi and Singh, 2015).

Social Justice

In social justice, it is the responsibility of society to ensure equitable distribution of healthcare. This equitable distribution of healthcare is achieved by letting a “central agency,” usually the government, distribute and produce healthcare. Within social justice, healthcare is regarded as a social good that should be financed by all citizens regardless of the healthcare recipient’s ability to pay. It is considered unjust in this system to let an individual go without healthcare services because of the individual’s inability to pay (Shi and Singh, 2015). In other words, social justice says that “basic needs such as: income, housing, and healthcare should be given to all citizens as part of their fundamental rights” (Matthews, 2016).

As with market justice, social justice grants a multitude of assumptions. First, healthcare is different from all other goods and services and should be regarded as its own entity. Secondly, there is a shared responsibility for health. Individuals are not held solely responsible for their bad health, because they are not in control of outside factors like economic inequalities, unemployment, lack of sanitation, or poor air quality. Furthermore, society has an obligation to do what is best for everyone. A single individual in bad health could affect everyone, as that individual could be carrying a deadly infection that presents a threat to society as a whole. Therefore, it is the responsibility of society to eliminate the problem by finding a cure, because in doing so, all people benefit. Finally, the government, instead of the free market, can best decide how much healthcare should be produced and distributed so that it is available to all citizens (Shi and Singh, 2015).

How Market Justice and Social Justice Complement Each Other

Despite the multitude of differences between market justice and social justice, the two complement each other. For example, private, employer provided health insurance, which mainly applies to middle class Americans, is driven by market justice, as this group has the ability to pay for healthcare, because the employer is willing to provide. Publicly-financed programs like Medicare, Medicaid, and workers’ compensation, which cover disabled, elderly, and low-income groups, are based on social justice. The inability of these groups to pay for their own coverage is financed by society (Shi and Singh, 2015).

According to John Derrick, there are five areas in which market justice and social justice complement each other: equality, time, freedom, and fundamental rights. With regard to equality, Derrick (2017) says, “Both social justice and market justice emphasize equality and fair treatment of individuals in a society, even though each philosophy envisions different means for achieving this goal.” Social justice aims to treat all members of society rich or poor, healthy or ill, equally. Market justice gives every individual equal opportunity to participate in the exchange of healthcare goods and services. With regard to time, Derrick (2017) says, “Both market justice and social justice take time for their effects to be fully realized.” Within social justice, individuals must understand the needs of all members of society, a feat which takes times to fully ascertain. Similarly, market justice requires time for the forces of supply and demand to be felt (Derrick, 2017).

Market justice and social justice complement each other in their common goal of freedom, which Derrick (2017) says, “Social justice and market justice hold that freedom of action and freedom of choice need to exist.” Social justice purports that individuals in society can choose what is best for them collectively, while market justice maintains that individuals can freely participate in the exchange of goods and services “as governed by free market forces” (Derrick, 2017). Furthermore, market justice and social justice uphold fundamental human rights. Social justice holds that basic needs like healthcare are fundamental rights, whereas market justice holds that in a free society people have the right to choose the healthcare services they will acquire.

How Market Justice and Social Justice Conflict in Healthcare Delivery

Market justice and social justice conflict as models of health delivery, because they emphasize different aspects of healthcare. In market justice, it is the responsibility of the individual to maintain health, and therefore benefits are based on the individual’s ability to purchase healthcare. Social justice, however, says that health is a collective responsibility in which everyone is entitled to basic benefits. Therefore, market justice values individual wellbeing with little obligation to collective health, while social justice emphasizes the acquisition of community wellbeing over individual health.

A key difference in market justice versus social justice is that market justice focuses on the individual rather than the collective population when determining who is responsible for health. It adheres to private solutions rather than government solutions to health problems. These principles work well when allocating economic goods, as long as their unequal distribution does not affect society at large. Market justice does, however, fail to take into consideration human concerns like crime, homelessness, and illiteracy which threaten that stability of society (Shi and Singh, 2015).

For social justice, community wellbeing is at its best when discrimination on the basis of “Race/ethnicity, skin, color, religion, or nationality; socioeconomic resources or position…; gender, sexual orientation, gender identity, age, geography, disability, illness, political or other affiliation; or other characteristics associated with marginalization” does not exist (Krau, 2015). According to the American Public Health Association, “more than 30 percent of direct medical costs faced by blacks, Hispanics, and Asian Americans can be tied to health inequities….[T]hese populations are often sicker when they do find a source of care and incur higher medical costs” (APHA, 2019). Social justice aims to eliminate statistics like this so that community health is equitable across all populations. Market justice is more concerned with the effect that these discriminatory phenomena have on the individual rather than the whole population. Furthermore, market justice and social justice conflict when “a significant number of uninsured still cannot afford health insurance and do not meet the eligibility criteria for Medicaid, Medicare, or other public programs” (Shi and Singh, 2015). Due to these differences, it is difficult for social justice and market justice to be equal participants in the healthcare system; one must be more prevalent than the other.

Healthcare Rationing

In market justice, healthcare rationing is called demand-side rationing or price-side rationing. In this type of rationing, quantity and type of healthcare services consumed by people are rationed by prices and ability to pay (Shi and Singh 2015). In social justice, healthcare rationing is called planned rationing or supply-side rationing. Because no country can afford an unlimited amount of healthcare for citizens, the government must limit the availability of certain healthcare services by deciding how they will be dispersed. Basic services will be available to everyone, but who will be allowed access and how they will be allowed access to certain services like technology for example will be determined by the government.

Since the introduction of Medicare and Medicaid in 1965, the government has been moving towards social justice. In fact, the Affordable Care Act was spurred by this shift. Currently, the government finances a little less than half the healthcare services in the United States. Furthermore, the government exercises its control over the system by governing insurance, payment to providers, access to new drugs, availability of procedures, medical research funding, and mandating information (Shi and Singh, 2015).

What Market Justice Means for Reform

Policy analysts James Capretta and Kevin Dayaratna believe that because consumers act rationally when presented with market signals in healthcare, there is great probability of reform in the future. Market reform will present itself in a few ways. According to Capretta and Dayaratna, “Reform plans should be evaluated based not only on how they affect federal spending and taxation but also how they affect private health insurance premiums and insurance coverage rates” (2013). However, caps on spending could have a potentially negative effect on quality. When spending is hindered, Capretta and Dayaratna worry that quality healthcare will be less of a priority. Additionally, they express concern that a market-based approach to healthcare reform would “rely on defined contribution systems to support insurance purchases by consumers, which have far more potential to control costs” (Capretta and Dayaratna, 2013). Consumers tend to look for high values at low costs when it comes to spending their own money on healthcare. It follows, then, that the more involved consumers are when paying for their healthcare, the more transparent the prices will be. Ultimately, however, reform in “market-driven health system would work as one would expect it to—driving out waste and inefficiency and rewarding high quality and lower costs with greater market share” (Capretta and Dayaratna, 2013).

What Social Justice Means for Reform

Social justice calls for a very different type of reform as compared to market justice. Reform in social justice will take into account social determinants of health like racism, sexism, and xenophobia, as they influence health just as drastically as biological factors do (Westerhaus et al, 2017). According to an article written by the founders of the Social Medicine Consortium, discriminatory systems create stress and interfere with access to healthy, safe, and affordable food and housing as well as fair paying jobs. It is the role of the community, then, to rid healthcare of structural violence—”the idea that structures of a society can inflict damage on the health of poor communities” (Westerhaus et al, 2017). Consequently, social justice reform would provide a “preferential option”—healthcare services beyond the surplus—to the those who cannot afford healthcare or who feel discriminated against by healthcare. In an article written by the founders of the Social Medicine Consortium, reform would mean “the disruption and transformation of the way we train health professionals in the US and around the world to more honestly incorporate learning about the social and structural determinants of health so these professionals are prepared and able to make a preferential option for the poor” (Westerhaus et al, 2017).

Market justice and social justice theories add to an already complex healthcare system. Knowing the difference in the two and understanding how they exist in the current healthcare system helps to determine what Americans value in healthcare. As a result, market justice may be more prevalent than social justice in healthcare or vice versa, depending on what Americans prefer at the time and the political climate. Despite market justice and social justice complexities, however, it is possible for the two systems to concurrently and successfully exist in healthcare delivery, as they do today. However, there is room for reform in both models to better complement each other by providing quality healthcare for all Americans, whether through private or employer provided insurance or government programs.

References

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• Derrick, J. (2019, February 11). Similarities in Social Justice & Market Justice. Retrieved from https://bizfluent.com/info-11404225-similarities-social-justice-market-justice.html
• Difference between Market Justice and Social Justice. Retrieved from https://lawaspect.com/difference-market-justice-social-justice/
• Shi, L., & Singh, D.
  
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