The Legitimacy Problem and Fair Process

Norman Daniels and James E. Sabin

in Setting Limits Fairly

Published in print March 2002 | ISBN: 9780195149364
Published online September 2009 | e-ISBN: 9780199865123 | DOI:
The Legitimacy Problem and Fair Process

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This chapter substantiates the claim that we need an account of fair process, showing that commonly advocated alternative accounts of fairness and legitimacy cannot work, at least when taken by themselves. It briefly reviews and rejects four distinct alternatives. The market alternative—called “market accountability”—insists that there is no special problem of fairness or legitimacy, provided that we make available a market for insurance in which people legitimize the limits health plans employ by choosing—buying—the plan. The Philosopher's Alternative says that the principles of justice, or some middle-level principles, give us clear enough answers to questions about distributive fairness to determine if fair outcomes are present. The Majority Rule solution suggests that we resolve disputes about limits the way we resolve many policy disputes, through direct or indirect democratic processes that ultimately rely on voting. The fourth alternative—the Public Attitudes approach—relies not on voting but on scientifically surveying the public to find out its moral views on limits. All these alternatives contain valuable clues to, or elements of, a plausible solution to the legitimacy problem, but taken by themselves, they are inadequate. Because these solutions fail by themselves, we need the account of fair process that is proposed in Chapter 4.

Keywords: health care; market accountability; distributive principles; majority rule; fair process

Chapter.  8151 words. 

Subjects: Public Health and Epidemiology

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