Jennifer Prah Ruger, an associate professor Yale University at the Schools of Public Health, says in her book "Health and Social Justice" an important perspective lacking in the healthcare reform debate is that of the ethical underpinnings of the healthcare system and health policy.
The Affordable Care Act requires that non-exempt taxpayers purchase a minimum level of health insurance or pay a penalty, but this healthcare mandate has been challenged in U.S. District Courts and U.S. Circuit Courts of Appeal.
In a brief for petitioners in the U.S. Supreme Court, the U.S. Department of Health and Human Services says the individual mandate is a legitimate use of Congress' commerce and taxing powers because healthcare markets have near universal participation and the minimum coverage provision is needed to regulate the way individuals pay for their participation.
The federal brief cites Ruger's article in which she argued health risks are uncertain in timing, magnitude and frequency, making it difficult to predict when healthcare services will be needed and how much coverage will be necessary.
This uncertainty, Ruger argued, increases individual and community vulnerability, and economic and health insecurity. Universal health insurance is morally justified, she maintained, because it reduces, mitigates and copes with risks of ill health and the resulting economic insecurity.
"State and federal laws -- reflecting deeply rooted societal values -- have required emergency rooms to stabilize patients," Ruger said. "The uninsured thus participate actively in the market for healthcare services, even if they cannot pay in full."