Beyond Justice and Moralism: Modernity and Solidarity in the Health Care System

Abstract

Most welfare states have been in a period of attempted reconstruction and retrenchment for the past twenty years. In health care, the direction of reforms has been largely similar in most countries: to reduce the package of public services and to increase the private contributions of beneficiaries. The concept of solidarity has been utilised by nearly all of the proponents in the debates on such reforms. It appears to refer to two interrelated connotations: a benevolent attitude towards weaker groups in society and a commitment to fair or even egalitarian distribution of health care services. The poblem with the first connotation is that a deeply a-symmetrical concept of social relations may be disguised by the declaration of good intentions. The problem with the second connotation is that it appears to be identical with a concept that is much more common in the Anglo-Saxon world and that has been analysed and debated much more thoroughly than solidarity: justice. Why bother with the concept of solidarity in issues of health care reconstruction, if the only thing it appears to add to the concept of justice is some variation upon the equally well-worn concept of benevolence? Another problem with this use of the concept of solidarity is that it appears to be a notion that is mostly invoked for merely defensive purposes: the concept serves to tell us which groups and services should not be tampered with. However laudable this may be, this would place the concept outside the frontline of debates on possibilities to adapt the health care system to changing circumstances, without limiting this reconstruction to cutbacks and private payments.