How Ought Health Care Be Allocated? Two Proposals

Two thinkers have crafted visions of how they believe health-care resources ought to be allocated if there were universal health-care coverage in the United States. One is The Ends of Human Life (1994), in which Ezekiel Emanuel proposes to base resource allocation on community preferences. More recently, Charlene Galarneau has written Communities of Health Care Justice (2016), partly in response to Emanuel's earlier work. Both thinkers center their visions of just health care on communities, albeit differently structured from one another. This essay examines the similarities and differences in their proposals for resource allocation and addresses questions that arise from their proposals, such as: What are the advantages of their community-based approaches compared with more universal, nationalized options? What might prevent communities from excluding certain individuals from active participation? And finally, does positing active engagement in a community, all by itself, guarantee that justice and fairness will be served? The essay concludes that although community allocation of health services has some desirable elements, allocating resources in a centralized, national manner would be more efficient, practical, and more likely to prevent bias and discrimination against those at the margins of their communities.