Uwe Reinhardt of Princeton discusses how various views of distributive justice have influenced the design of the American healthcare system. According to Reinhardt, American policymaking is plagued by dysfunctional federal government, increased political polarization, and lack of management acumen in government. The U.S., he says, is far less egalitarian than it used to be. Income inequality is way up. For health reform, he says, the major question is: To what extent will upper income families pay higher taxes to subsidize healthcare for the lower third? Private charity, Reinhardt says, is not capable of closing the gap. The solution, he argues, will depend on which view of distributive ethics wins out in the public debate: the view that healthcare is a public service, or the view that healthcare is a private consumption good to be secured by individuals.

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