Unequal by Design: Health Care, Distributive Justice, and the American Political Process

This chapter focuses on the impact of politics on health care and distributive justice in the United States. More specifically, it argues that health inequities in the United States arise from the fundamental constitutional and political structure of the country's political system. That system does not make inequities inevitable, but it certainly makes ameliorating or eliminating them much more difficult than is the case in any other affluent society. The chapter also suggests that the absence of a national health care provider or health insurance system in the United States, which leaves about one third of the population without reliable payment for medical treatment, is a consequence of the constitution and political system. Finally, it examines the political economy of Medicare to highlight the politics of national health insurance in the United States.