Insurability and the HIV Epidemic: Ethical Issues in Underwriting

Many insurers claim that it is actuarially unfair, to people at low medical risk, if persons at high risk for HIV infection and other serious diseases are not excluded from insurance pools. Underwriters of health insurance, however, err when they treat the concept of actuarial fairness as if it were an obvious requirement of social fairness. Policy makers often advocate departing from actuarially fair practices when diverse matters of social justice are involved. No health-insurance system will be just unless it explicitly divides responsibility between the public and insurers for guaranteeing access, an action American society has thus far failed to take.

Author(s): Norman Daniels

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Volume 68, Issue 4 (pages 497–525)
Published in 1990