The just distribution of health care resources: An analysis of the Oregon health plan

Shonna Mulkey, Fordham University


In the United States the cost of health care has been escalating at an alarming rate over the past two decades while access to basic health care for the poor and uninsured has continued to decline. This dilemma has led many to explore the concept of health care rationing as a moral alternative to the present system. In an attempt to provide care to a larger number of its citizens, the state of Oregon proposed an explicit rationing scheme. This scheme significantly increased access to care by providing a basic package of health benefits to all Oregonians. However, to help finance this benefit the total number of health services provided under Medicaid were reduced. Some believe this proposal represents a more just form of health care allocation since, in considering the total health needs of the population, it rejects the strict, often irrational, categorical approach that exists in the current system. The current system is commonly justified by a resort to the language of individual rights. However, critics of the Oregon proposal argue that it rations health care to the poor, the very people it claims to help. The Oregon debate concerns the issue of justice and whether the prevailing liberal theories of justice apply to health care. This analysis leads me to conclude that none of these theories alone provides a moral grounding with which to adequately address the health care dilemma. The moral stalemate that exists revolves around the issue of values and the difficulty of prioritizing complex needs and demands in a political milieu that both eschews values and possesses a minimal concept of the common good. However, in spite of these conceptual limitations, the Oregon Plan attempts to achieve a consensus regarding health values through its emphasis on the political process of public deliberation. In this respect, it provides an example of a successful attempt to utilize liberal political principles and move beyond the current moral stalemate.

Subject Area

Political science|Public administration

Recommended Citation

Mulkey, Shonna, "The just distribution of health care resources: An analysis of the Oregon health plan" (1995). ETD Collection for Fordham University. AAI9530031.