Generational Equity and Social Insurance
Journal of Medicine and Philosophy. 1988 Feb; 13(1): 31-56.
In recent years, critics have argued that, when inter-generational transfer programs such as Medicare are judged by the standard of "generational equity," these programs are seen to be unfair. It is argued that, under a pay-as-you-go system, future generations are committed to burdens without their consent; that claims are not contractually guaranteed; that early entrants reap windfalls gains; that successive cohorts are tempted to provide insupportably high benefit levels; and, finally, that fluctuations leave future generations at unacceptable risk. Attempts have been make to defend social insurance programs by means of a "lifespan prudential model" of age-group resource allocation, but this defense does not adequately take account of uncertainties and inequities faced by historical birth cohorts. A deeper defense must acknowledge an element of risk-sharing and solidarity while trying to limit inequities within reasonable bounds.
Age Factors; Aged; Children; Contracts; Consent; Economics; Freedom; Future Generations; Government; Government Financing; Health; Health Care; Health Care Delivery; Health Insurance; Insurance; Justice; Moral Obligations; Moral Policy; Obligations of Society; Patient Care; Public Policy; Resource Allocation; Rights; Risk; Socioeconomic Factors;
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