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How Devolution Upsets Distributive Justice

Program in Ethics & Health Harvard University Boston MA, USA, shlomi_segall{at}hms.harvard.edu

Philippe Van Parijs suggests that in culturally divided societies health care systems (and perhaps other welfare services) should be divided along regional lines. He argues that since members of homogenous societies have relatively similar needs and tastes, it is easier for them to agree on a rather comprehensive distributive scheme. This proposed reform of health care, Van Parijs argues, would be consistent with distributive justice rather than undermine it. Against Van Parijs, the paper demonstrates that this policy of devolution upsets distributive justice. Devolution does so by shifting the pattern of distribution (across communities) from distribution according to need, to distribution of equal shares. The paper also argues that devolution is likely to weaken solidarity across the polity as a whole, which further undermines the attainment of distributive justice. The paper concludes that far from catering to culturally driven differences in medical preferences, distributive justice (in fact) permits disregard of such differences, and warrants enforcing a unitary pattern of consumption of medical goods (and other welfare services) across the citizenry, thus retaining a unified health care (and correspondingly, welfare) system.

Key Words: devolution • health care • justice • solidarity • Van Parijs

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