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dc.creatorDaniels, Normanen
dc.date.accessioned2015-05-05T18:30:27Zen
dc.date.available2015-05-05T18:30:27Zen
dc.date.created1990en
dc.date.issued1990en
dc.identifier10.2307/3350192en
dc.identifier.bibliographicCitationMilbank Quarterly. 1990; 68(4): 497-525.en
dc.identifier.issn0887-378Xen
dc.identifier.urihttp://worldcatlibraries.org/registry/gateway?version=1.0&url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&atitle=Insurability+and+the+HIV+Epidemic:+Ethical+Issues+In+underwriting&title=Milbank+Quarterly.++&volume=68&issue=4&pages=497-525&date=1990&au=Daniels,+Normanen
dc.identifier.urihttp://dx.doi.org/10.2307/3350192en
dc.identifier.urihttp://hdl.handle.net/10822/736170en
dc.description.abstractThe HIV epidemic has focused criticism on standard underwriting practices that exclude people with AIDS or at high risk for it from insurance coverage. Insurers have denied the charge that these practices are unfair, claiming instead that whatever is actuarially fair is fair or just. This defense will not work unless we assume that individuals are entitled to gain advantages and deserve losses merely as a result of their health status. That assumption is highly controversial at the level of theory and is inconsistent with many of our moral beliefs and practices, including our insurance practices. We should reject the insurers' argument. Justice in health care requires that we protect equality of opportunity, and that implies sharing the burden of protecting people against health risks. In a just health-care system, whether mixed or purely public, the insurance scheme is in systematic terms actuarially unfair, for its overall social function must be to guarantee access to appropriate care. This does not mean that in our system insurers are ignoring their obligation to provide access to coverage. The obligation to assure access is primarily a social one, and the failures of access in our system are the result of public failures to meet those obligations. In a just but mixed system, there would be an explicit division of responsibility among public and private insurance schemes. In our mixed but unjust system, both legislators and insurers cynically pretend that the uninsured are the responsibility of the other. The attempt to treat actuarial fairness as a moral notion thus disguises what is really at issue, namely, the risk to insurers of adverse selection and the economic advantages of standard underwriting practices. Standard underwriting practices will be fair only if they are part of a just system, not if they simply are actuarially fair. The failure of the argument from actuarial fairness means that we must face an issue private insurers had hoped to avoid if we are to defend standard underwriting practices at all. In view of the clear risk that a mixed system will fail to assure access to care, the burden falls on defenders of a mixed system. They must show us that its social benefits outweigh its social costs, and that it is possible to have a mixed system that is not only just, but also superior to a compulsory, universal insurance scheme.en
dc.formatArticleen
dc.languageenen
dc.sourceBRL:KIE/34977en
dc.subjectAidsen
dc.subjectAids Serodiagnosisen
dc.subjectBiomedical Technologiesen
dc.subjectCommon Gooden
dc.subjectCosts and Benefitsen
dc.subjectDiscriminationen
dc.subjectEconomicsen
dc.subjectEthicsen
dc.subjectFinancial Supporten
dc.subjectFreedomen
dc.subjectGovernmenten
dc.subjectHealthen
dc.subjectHealth Careen
dc.subjectHealth Care Deliveryen
dc.subjectHealth Facilitiesen
dc.subjectHealth Insuranceen
dc.subjectHealth Maintenance Organizationsen
dc.subjectHealth Statusen
dc.subjectHIV Seropositivityen
dc.subjectHomosexualsen
dc.subjectIndustryen
dc.subjectInstitutional Ethicsen
dc.subjectInsuranceen
dc.subjectInsurance Coverageen
dc.subjectIllnessen
dc.subjectJusticeen
dc.subjectMass Screeningen
dc.subjectMoral Policyen
dc.subjectNational Health Insuranceen
dc.subjectObligations of Societyen
dc.subjectOrganizationsen
dc.subjectPolicy Analysisen
dc.subjectProperty Rightsen
dc.subjectPublic Policyen
dc.subjectPropertyen
dc.subjectRegulationen
dc.subjectResource Allocationen
dc.subjectRightsen
dc.subjectRisken
dc.subjectSelection for Treatmenten
dc.subjectSelf Induced Illnessen
dc.subjectSocial Discriminationen
dc.subjectStatisticsen
dc.titleInsurability and the HIV Epidemic: Ethical Issues in Underwritingen
dc.provenanceDigital citation created by the National Reference Center for Bioethics Literature at Georgetown University for the BIOETHICSLINE database, part of the Kennedy Institute of Ethics' Bioethics Information Retrieval Project funded by the United States National Library of Medicine.en
dc.provenanceDigital citation migrated from OpenText LiveLink Discovery Server database named NBIO hosted by the Bioethics Research Library to the DSpace collection BioethicsLine hosted by Georgetown University.en


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