Benchmarks of Fairness for Health Care Reform

These benchmarks of fairness represent the first time that a concept in moral philosophy has been transposed into a usable policy tool for scoring alternative proposals. The authors show how concerned members of the public and policy makers can use the benchmarks by actually scoring four major proposals for health care reform that exemplify the most prevalent ideas of the 1990s in state and national debates. The authors pay particular attention to the problems of fairness in reforms that rely on competition. Although some reform ideas fare much better that others, all are found weak in establishing open, democratic procedures for deciding the limits of care. They also assess the current changes brought on by the rapid growth of managed care systems since the collapse of national reform.