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Health and Social Justice$
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Jennifer Prah Ruger

Print publication date: 2009

Print ISBN-13: 9780199559978

Published to Oxford Scholarship Online: February 2010

DOI: 10.1093/acprof:oso/9780199559978.001.0001

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Political and Moral Legitimacy: A Normative Theory of Health Policy Decision‐Making

Political and Moral Legitimacy: A Normative Theory of Health Policy Decision‐Making

(p.205) 9 Political and Moral Legitimacy: A Normative Theory of Health Policy Decision‐Making
Health and Social Justice

Jennifer Prah Ruger (Contributor Webpage)

Oxford University Press

Many countries, including the United States, lack consensus about the core ethical principles concerning health and health care, beyond a market‐based approach to resource allocation. This chapter offers a normative theory for analyzing health policy decisions and recognizes that norms need fundamental restructuring to address existing health problems. Substantive normative principles (moral legitimacy) should be introduced into deliberative democratic process (political legitimacy) for a comprehensive, integrative theory of health and social justice. The chapter reviews the role of moral values in motivating citizens' support for public policies, and explores differences between social agreement frameworks such as incompletely theorized agreements (ITAs) and overlapping consensus and more traditional political bargaining models. ITA analysis of the American Clinton health care reform attempts reveals agreement on the mid‐level concept of universal coverage, but disagreement on both high‐ and low‐level principles. The chapter concludes that high‐level principle (e.g. health for all) or low‐level principle (e.g. willingness to pay for other's and future selves' health insurance) agreement, arising from internalization of shared public moral norms, might lead to more stable support for reform.

Keywords:   moral legitimacy, political legitimacy, incompletely theorized agreements, overlapping consensus, Clinton Administration, health care reform, universal coverage, public moral norms, norm internalization, moral values, health reform, health policy

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