How devolution upsets distributive justice

Journal of Moral Philosophy

Volumn 4, Issue 2, 2007, Pages 257-272

  Segall, Shlomi ^a  

^a HARVARD UNIVERSITY   (United States)

Author keywords

Devolution; Health care; Justice; Solidarity; Van Parijs

Indexed keywords

EID: 64249088354     PISSN: 17404681     EISSN: 17455243     Source Type: Journal    
DOI: 10.1177/1740468107079269     Document Type: Article

References (45)

1. Philippe Van Parijs, 'Just Health Care in a Pluri-National Country', in Sudhir Anand, Fabienne Peter and Amartya Sen (eds.), Public Health, Ethics, and Equity (Oxford: Oxford University Press, 2004), p. 164
2. I am happy to use here David Miller's characterization of the group in question as 'a set of people with a distinct set of cultural values and a shared language, who recognize their cultural kinship with one another, and engage in practices that set them apart from outsiders' (David Miller, Citizenship and National Identity [Oxford: Polity, 2000], p. 127)
3. Van Parijs's argument may appear to amount to that of subsidiarity. 'The "principle of subsidiarity" regulates authority within a political order, directing that powers or tasks should rest with the lower-level sub-units of that order unless allocating them to a higher-level central unit would ensure higher comparative efficiency or effectiveness in achieving them' (Andreas Føllesdal, 'Subsidiarity', Journal of Political Philosophy 6.2 [1998], pp. 190-218 at p. 190)
4. See also Hans M. Sass, 'The New Triad: Responsibility, Solidarity and Subsidiarity', Journal of Medicine and Philosophy 20.6 (1995), pp. 587-94 at p. 591
5. In the EU, the principle of subsidiarity is responsible for, among other things, keeping the provision of health care with the member states (a policy that has recently come under challenge). See Panos Kanavos and Martin McKee, 'Cross-Border Issues in the Provision of Health Services: Are We Moving Towards a European Health Care Policy?' 'Journal of Health Services Research and Policy 5.4 (2000), pp. 231-36
6. I leave the issue of subsidiarity aside here, as it seems to be concerned not so much with justice as with the values of self-determination, republican liberty, autonomy, and efficiency. See John Finnis, Natural Law and Natural Rights (Oxford: Clarendon Press, 1980), p. 146
7. Van Parijs, 'Just Health Care in a Pluri-National Country', p. 176
8. His proposal is made with the particular case of Belgium in mind, but is universal in its appeal. A similar initiative was recently adopted in Quebec. In September 2004 the Canadian Health Accord included a special communiqué that exempted Quebec from some of the federal provisions. The exemption allowed for the government of Quebec to apply its own wait-time reduction plan and introduce its independent strategies for family and community care reform, home care, drug access strategies, health promotion and chronic illness prevention. http://www.hc-sc.gc.ca/english/hca2003/fmm/quebec-bk.html, accessed 6 May 2005
9. Donald L. Horowitz, 'Constitutional Design: An Oxymoron?' Nomos 42 (2000), pp. 253-84
10. Harry Beran makes a similar comparison with regard to secession. 'More Theory of Secession: A Response to Birch', Political Studies 36.2 (1988), pp. 316-23, esp. 318-19
11. Unless one community is systematically discriminated against (rather than simply suffering from the other community's expensive medical tastes). So unless secession is likely to correct a severe case of ethnic discrimination, or unless the different communities are irreconcilably divided, secession should be resisted. This is admittedly a higher threshold than the one proposed by liberal nationalists, for whom it seems to be sufficient simply to have 'two communities whose collective identities are radically at odds with one another'. Miller, Citizenship and National Identity, p. 123
12. See Shlomi Segall, 'Unconditional Welfare Benefits and the Principle of Reciprocity', Politics, Philosophy, and Economics 4.3 (2005), pp. 331-54, esp. 341-44
13. Distribution according to need may take various forms, and primarily the following two. The 'need principle' can refer to distribution in proportion to need, where the system equalizes the proportion of needs met. Alternatively, the system may prioritize those whose needs are greatest. In the latter case the equalisandum is the needs themselves, rather than the proportion of needs met. For a discussion of this distinction see David Miller, Principles of Social Justice (Cambridge, MA: Harvard University Press, 1999), pp. 213-21. What I have to say below applies to both interpretations of the need principle
14. See Norman Daniels, Just Health Care (Cambridge: Cambridge University Press, 1985), p. 11
15. See also Thomas Scanlon, 'Preference and Urgency', Journal of Philosophy 72.19 (1975), pp. 655-69
16. For my purposes I am happy to use Daniels's understanding of medical needs as 'impairment to normal species functioning'. Daniels, Just Health Care, p. 32
17. Norman Daniels, 'Justice and Health Care', in Donald VanDeVeer and Tom Regan (eds.), Health Care Ethics (Philadelphia: Temple University Press, 1987), pp. 302-306
18. Or to take the case of Belgium more specifically, the stereotype is that the prudent Flemings' idea of 'living well' is household decoration, whereas the more light-hearted Walloons' idea of living well is manifested through parades and feasting. See Kenneth D. McRae, Conflict and Compromise in Multilingual Societies: Belgium (Waterloo, Ontario: Wilfred Laurier University Press, 1986), p. 91
19. A theme touched upon in Chinua Achebe's classic novel, Things Fall Apart (Oxford: Heinemann, 1986), p. 5
20. I acknowledge here the ambiguity of whether or not fertility treatment answers a medical need. We may say that although it does not, strictly speaking, answer a medical need, fertility treatment is a medical procedure that is needed for pursuing what for most people is a normal life plan. See Daniels, Just Health Care, pp. 42-48
21. Daniels, 'Justice and Health Care', p. 305
22. As noted above I leave aside here the important question of to what extent can membership in a community with special medical needs itself be considered an expensive taste. I have noted that Nigerian society should treat the Ibo speech impediment as a greater need (than occurrences of that impediment in other ethnic groups). But one may say that in this case membership in Ibo culture itself becomes an expensive taste. It would follow that society need not treat that condition when it can simply require Ibo members who have a speech impediment to switch to another cultural group. Of course, a familiar reply to this type of suggestion is that it would be wrong to treat cultural membership as a choice that could easily be revised. See Will Kymlicka, Multicultural Citizenship: A Liberal Theory of Minority Rights (Oxford: Clarendon Press, 1995)
23. Cf. Brian Barry, Culture and Equality: An Egalitarian Critique of Multiculturalism (Cambridge, MA: Harvard University Press, 2001). Since I cannot take on this important and complex issue within the confines of this paper, let me then say that culturally-determined medical needs ought to be respected in cases where it would be unfair to ask individuals to give up their cultural membership
24. Cf. Miller, Principles of Social Justice, pp. 212-13
25. To put this differently, to say that needs are to a large extent socially determined is not to say that needs are identified by society (as Michael Walzer erroneously, I think, suggests [Spheres of Justice: A Defence of Pluralism and Equality (Oxford: Blackwell, 1983), p. 65])
26. See Shlomi Segall, 'Bringing the Middle Classes Back in: An Egalitarian Case for (Truly) Universal Public Services', Ethics and Economics 2.1 (2004), pp. 1-7
27. William R. Morgan and Jack Sawyer, 'Equality, Equity, and Procedural Justice in Social Exchange', Social Psychology Quarterly 42.2 (1979), pp. 71-75
28. Gerold Mikula and Thomas Schwinger, 'Intermember Relations and Reward Allocation: Theoretical Considerations of Affects', in H. Brandstatter, J.H. Davis and H. Schuler (eds.), Dynamics of Group Decisions (London: Sage, 1978), pp. 229-50
29. Morton Deutsch, 'The Effects of Co-operation and Competition Upon Group Process', in D. Cartwright and A. Zander (eds.), Group Dynamics (New York: Harper & Row, 1968)
30. Ivan D. Steiner, Group Process and Productivity (New York: Academic Press, 1972)
31. Morton Deutsch, Distributive Justice: A Social-Psychological Perspective (New Haven, CN: Yale University Press, 1985), p. 158
32. Further references to this conclusion are made in the review article by Karen S. Cook and Karen A. Hegtvedt, 'Distributive Justice, Equity, and Equality', Annual Review of Sociology 9 (1983), pp. 217-41, at p. 223
33. David Miller, On Nationality (Oxford: Clarendon Press, 1995)
34. Principles of Social Justice, ch. 2
35. Citizenship and National Identity, p. 32
36. One typical objection I do not confront here says that we need not be concerned with the weakening of solidarity on a national level as it can easily be replaced by solidarity sustained by communities of a sub-national level. See Michael Keating, 'Social Inclusion, Devolution and Policy Divergence', The Political Quarterly 74.4 (2003), pp. 429-38, at p. 430
37. It seems to me, though, that the benefits of solidarity are only readily available to the community of the level in which it is produced. Thus, it is only solidarity at the level of the political community that can strengthen those bonds crucial for the type of compromises and sacrifices needed when pursuing distributive justice. (See Andrew Mason, Community, Solidarity and Belonging: Levels of Community and their Normative Significance [Cambridge: Cambridge University Press, 2000], p. 61.) It is the case, therefore, that the strengthening of Scottish solidarity, say, does not necessarily benefit the pursuit of distributive justice across Britain, and may actually hinder it
38. The Barnett Formula in Britain is not based on the changing needs of the respective regions, and thus cannot respond to shifting demands for health care expenditure. See Scott L. Greer, 'The Fragile Divergence Machine: Citizenship, Policy Divergence, and Devolution', a paper presented at The PSA Conference, Leeds University, April 2005, p. 20
39. (forthcoming in A. Trench [ed.], Devolution and Power in the UK [Manchester: Manchester University Press, 2006])
40. See Theda Skocpol, Social Policy in the United States: Future Possibilities in Historical Perspective (Princeton, NJ: Princeton University Press, 1995), ch. 8
41. It may be objected here that unitary systems also suffer from power bargaining over communal differences in needs. The reason being that within a unitary system, members of one community may refuse to recognize certain needs, or refuse to recognize certain conditions as constituting a more urgent need for members of the other community. That, admittedly, may still be the case, but the crucial advantage of the unitary system is that, to a large extent, this type of decision is taken out of the hands of politicians and constitutional lawyers and into the hands of doctors and health care administrators. More generally, many pre-devolution unifying features of health care in the different regions are likely to disappear post-devolution as devolution leads, willy-nilly, to great divergence in health policy. See Greer, 'The Fragile Divergence Machine'
42. The confusion results from my conforming to the way in which 'thin' and 'thick' are conventionally used. See Michael Walzer, Thick and Thin: Moral Argument at Home and Abroad (Notre Dame, IN, and London: Notre Dame University Press, 1994)
43. Or as a critic of the special ('asymmetrical') provisions to the Quebec health care system succinctly put it: 'it's hard to argue that Quebeckers have distinct diabetes and asymmetrical aortas'. http://members.shaw.ca/nspector3/ globe13.htm
44. For more on 'packing' and 'un-packing', see my 'Bringing the Middle Classes Back in'
45. On the justness of institutions as depending also on the conduct of the individual actors, see G.A. Cohen, 'Where the Action is: On the Site of Distributive Justice', Philosophy and Public Affairs 26.1 (1997), pp. 3-30