What makes a good society?

Paul Starr • APRIL 2, 2014

Paul Starr of Princeton University proposes a model for thinking about the debate on healthcare. This model consists of essentially two opposing views on what constitutes fairness in healthcare. According to Starr, one view approves of "actuarial fairness," and the other approves of "shared responsibility." Starr argues that it is a unique characteristic of politics in the United States that the latter of these two views is equated with a loss of individual freedom. He says that resistance to the shared responsibility view puts us in an "American Health Policy Trap" in which people become overly protective of a system that is unnecessarily expensive, out of a fear of embracing something new and foreign. Starr calls it a terrible prospect that efforts to implement a federal system of universal coverage might fail due to these deeply held ethical beliefs.

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