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I. AFTER THE SOCIAL-DEMOCRATIC STATE: HEALTH CARE FINANCING REVISITED

Health care systems are currently challenged by an insufficiency of funds and a lack of clarity about which moral principles should give them structure. People generally want the best of basic care. In addition, most polities promise their citizens equal care, but few wish to pay for this care. As a result, such policies are not possible: all citizens cannot have equal access to the best of basic care. Nor is it clear why equality of access is morally required.

In part, the problems turn on facts of the matter. As populations age, there is an increasing percent of persons who are ill and/or no longer working. There is also a decreasing percentage of the population who are young and who through tax and insurance payments can pay for the health care of the unemployed. This state of affairs is accentuated by an ever-growing percentage of the population, the fragile old, who are high consumers of health care. The result is that there are insufficient funds to provide all with the best of basic care. This fiscal limitation is expressed in funding crises for health care systems and for the social-democratic state as a whole. The social-democratic state had counted on there being ever more young workers to pay for the health care of the unemployed ill. This hope has proven false. There are ever increasing indications of the unsustainability of the social welfare state.

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