I haven’t yet read the Senate Republicans’ draft health care bill, just out today. Until I do I’m not going to comment about it directly.
The matter is a bioethics concern solely from the perspective of justice, really. What is the wisest, most just policy? And here one is forced, I think, into a fairly utilitarian assessment of what approach provides the best outcome for the country overall? In that, we can allow for a “priority concern” for pool or relatively poor folks, allowing a weighting of factors in their favor. In fact, I’m all for that.
But two thoughts. First, I and others tend to argue that we should reform Medicare and Medicaid and not just leave them as they are, because to do so is to ratify their demise into bankruptcy or unaffordability. That argument is open to two charges: that it assumes that forecasts of rapid demise are reliable, and that preserving the programs, in a sustainable form, favors future generations at the expense of the current ones. On the latter, to wit: Most people would agree that “my” (i.e., someone’s in general) duty to people close to them (like spouse, children) is greater than to a stranger. But can we not say the same thing about generations? Isn’t our duty to people already among us greater than, say, our envisioned duty to our grandchildren and great-grandchildren, even if they are ours and not someone else’s? I suppose that one might argue that.