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Arbitration & Mediation

: Settle It Now Negotiation Blog

The Prisoners' Dilemma, Rawls' Theory of Justice and the Healthcare Debate

By Victoria Pynchon

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Healthcare Napkins All

Napkin Presentation thanks to John-Folk Williams at Cross-Collaborate

Cheyney Ryan, a philosophy professor at the University of Oregon, contributed a short but extremely useful article to the must-have Negotiator's Fieldbook entitled Rawls on Negotiating Justice. John Rawls, Ryan explains, is the seminal philosopher of justice in the 20th century. "From the start," writes Ryan,

Rawls asked us to think of justice as a matter of agreement. He suggested that we think of the principles guiding a just society as the ones that individuals would agree to -- with the crucial proviso that they do not know where they themselves would end up in society, on the top or the bottom. They would thus act from behind a "veil of ignorance . . . Given this constraint, no individual could tailor the principles of justice to his or her special talents or circumstances, which is why Rawls called this approach "justice as fairness." Rawls suggested that the principles that would be agreed to would be ones that were deeply committed ot basic human rights and had a strong presumption in favor of economic equality. Inequalities would only be tolerated if they most greatly benefited the least well off.

According to Ryan, Rawls later concluded that the reciprocity inherent in bargained-for resolutions and a negotiated mutual advantage were insufficient to ensure justice. "The question to ask of principles of justice," Rawls asserted, was,

what were the most reasonable ones for people to agree to given the nature of our society and the nature of who we are? Justice, thus reconceived, lost the harsh individualism that Rawls' earlier theory seemed to possess. The stress on reasonableness meant that people taking others into account was an essential part of what justice was all about. His theory also moved away from his earlier hyper-abstraction, insofar as we talk of what is "reasonable" invariably refers not to some hypotheitcal persons with hypotheical aims but to real people -- in this case, us, here and now.

So this is what I'd like to ask my readers to do about the health care debate right after the jump.

It's a thought experiment. I don't want to urge you to think about it the way I do. I don't want you to think about it as a progressive, a liberal, a Republican, a Democrat or an Independent. I don't want you to think about it as an insurance executive or even as a taxpayer. I don't want you to think about the probable effect of the pending Bills on the economy (unless you're an economist with the credentials to do this). Here's what I want you to do and I want you to ask your friends and neighbors and congresspeople and senators and your insurance broker and chamber of commerce and PTA and Bar Associations to do:

Blind yourself to your socio-economic status, if only just temporarily. If it helps, think of someone who is as far distant from your own place in society as possible. If you are an insurance coverage attorney with a nice house in a good neighborhood with quality schools and a good health care plan, I want you to imagine yourself a pregnant teenager who has no father and whose mother works as a cashier at a local hardware store that cannot afford to purchase group health insurance. She is under-insured, having purchased the only plan she could afford. She was diagnosed with breast cancer just last week.

If you are unemployed and your COBRA benefits are running out, I want you to imagine yourself a United States Senator with responsibility for insuring that all Americans have access to quality health care while at the same time answering to the folks back home who are afraid the cost will show itself in increased taxes; the quality of care will plummet; and, the insurance industry will be hobbled, decreasing the benefit of private insurance plans to those who have them now.

Ready?

Now do what Rawls asks. Acting behind a veil of ignorance about your place in the social order, craft a principled means of providing Americans with healthcare (government-funded, privately offered or a combination of both) that is a fair and reasonable means for achieving the greatest good for the greatest number. If that seems daunting, shrink your world to the size of a tropical island like the ones the survivors of the TV series Lost live on. And if you've never seen Lost, just think of a society on an island cut off from communication with the rest of the world with about 100 people -- 50 in one "camp" and 50 in another -- with a single physician able to serve everyone's needs. Here are some season previews that will help you get the Lost idea.