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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
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The Milbank Quarterly’s multidisciplinary approach and commitment to applying the best empirical research to practical policymaking offers in-depth assessments of the social, economic, political, historical, legal, and ethical dimensions of health and health care policy.