Death Panels and Difference Principles: A Rawlsian Analysis of the Affordable Care Act

When the Patient Protection and Affordable Care Act (ACA) was signed into law in March 2010, it was supposed to usher in a new era of health care in the United States. From both Democrats and Republicans, we heard that it was going to change the way that Americans think of health insurance—depending on whom one talked to the ACA would finally create a just system of health care in America or usher in a Brave New World of socialized medicine and government takeovers. As the Affordable Care Act begins implementing its signature proposal this year, the so-called individual mandate, its provisions are starting to look more and more like reality. This paper will focus on the ethical ramifications of the Affordable Care Act— specifically, I will examine how the different provisions included in the Affordable Care Act may or may not be justified under the liberal egalitarian system of justice created by John Rawls in the classic book, A Theory of Justice (later referred to as Theory). In my examination, I will extensively use insights from Norman Daniels’ 2008 book, Just Health, which applies Rawls’ system of justice to health and establishes a series of benchmarks for measuring the justness of health sector reforms. Indeed, the discussion and critique of Daniels’ theory forms another main focus of this paper, for it allows for a broader and more nuanced discussion of what comprises health justice.Bachelor of Art