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Wharton Professor Robert Hughes advocates for universal health care

December 16, 2020

Topics: Quote of the Day

Interview of Robert Hughes, professor of business ethics and legal studies at Wharton
The Wharton School of the University of Pennsylvania, Knowledge@Wharton, December 8, 2020

Nothing quite exposes the inequalities that exist in American society more than the health care system. It’s a complex combination of private insurance, public programs and politics that drives up costs, creating significant barriers to lifesaving medical treatment for large segments of the population. In America, access to quality health care often depends on income, employment and status.

Robert Hughes, professor of business ethics and legal studies at Wharton, is an advocate for universal health care coverage. Drawing deeply on his research in philosophy, Hughes believes that equal access to medical care is beneficial for both liberty and social stability. Health, he says, should not be tied to wealth.

“I think it’s very disturbing that people have to go to GoFundMe in order to get their medical treatments paid for. It creates a power imbalance,” he said, referring to the crowdsourcing platform used to help raise money for patient bills. “That’s why I say that truly universal health care would be good for people’s liberty. Because you’re not really free if you’re depending on charity, especially discretionary charity like the kind you see on GoFundMe, for a basic need like health care.”

The ACA, commonly referred to as Obamacare, brought the U.S. closer to providing universal health care through subsidized private health insurance, but Hughes said there’s still a wide gap. He believes policymakers should ensure that everyone has coverage and access to the same needed treatments.

The professor argued the case for universal health care in a paper titled “Egalitarian Provision of Necessary Medical Treatment,” which was published last year in the Journal of Ethics. (The author-accepted version is here.) He examined the health care systems of the U.K., Australia and Canada, concluding that Canada’s single-payer system is the most advantageous for the U.S.

“I don’t understand why there’s so much resistance to the idea of truly universal health insurance in the United States, given that this is something that other industrial countries just do,” Hughes said.

He acknowledged that the U.S. doesn’t have the “political will” to change a system that’s been entrenched since the end of World War II, when employers began offering health insurance to their workers instead of higher wages.

Link includes 12 minute podcast:

Egalitarian Provision of Necessary Medical Treatment

By Robert C. Hughes
The Journal of Ethics, October 31, 2019


Considerations of autonomy and independence, properly understood, support strictly egalitarian provision of necessary medical treatment. If the financially better-off can purchase access to necessary medical treatments that the financially less well-off cannot purchase without help, then their discretionary power to give or to withhold monetary gifts indirectly gives them the power to make life-and-death or sickness-and-health decisions for others. To prevent private citizens from having this objectionable form of power, government must ensure that citizens’ finances do not affect their access to medical treatments that significantly prolong life, relieve suffering, or cure or mitigate disabilities. Government should ensure this even if doing so involves leveling down and even if it is unclear whether egalitarian provision of necessary treatment would provide better care to the poor than a less egalitarian health care system would.

The Journal of Ethics: Abstract

Author’s pre-copyedit version of the full article:


By Don McCanne, M.D.

Robert Hughes’ position on universal health care is one that is certainly familiar to supporters of single payer Medicare for All. What is unique here is that Hughes is a professor of business ethics and legal studies at the University of Pennsylvania’s Wharton School, which some believe is a center of conservative thought at an otherwise liberal university.

His views on egalitarian provision of necessary medical treatment should provoke thought. Does care need to be egalitarian (equal for all), or can it ethically be equitable (merely fair for all)? Should “leveling down” be applied to services for the affluent so that they do not exceed services for the poor? If leveling down is applied only to unnecessary services then can’t a wealthy nation like the United States afford to provide all necessary services for everyone? If so, then would it be ethical to avoid leveling down unnecessary health services that might be desired by the affluent as long as they were not financed by the government? But then how would you silo unnecessary services?

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About the Commentator, Don McCanne

Don McCanne is a retired family practitioner who dedicated the 2nd phase of his career to speaking and writing extensively on single payer and related issues. He served as Physicians for a National Health Program president in 2002 and 2003, then as Senior Health Policy Fellow. For two decades, Don wrote "Quote of the Day", a daily health policy update which inspired HJM.

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