1.1 Social Theory and Public Policy in Health Care
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Prohibiting smoking in public places exemplifies the social theory of the common good, because the mandate is meant to benefit everyone.
Health is both an individual consideration and a community concern. In other words, an individual makes decisions that directly affect him or herself, and a society makes decisions that affect and manage the society itself. For example, a person may choose to smoke cigarettes, thereby damaging his or her own lungs. However, this action also has an impact on those around the smoker because secondhand smoke has been shown to be a valid health concern. Thus, society may create public policy, or laws, that outlaw smoking in public places with the intent of ensuring that one person’s decision to smoke does not harm others.
A law that bans smoking in public places is based on the social theory of the common good, meaning it is intended to help everybody. The concept of the common good focuses on creating a benefit for the most members of a community. Sometimes the common good is juxtaposed with the social theory of individual rights, which is based on protecting personal freedoms. Public controversy often ensues when the common good is perceived to infringe on such individual rights. For example, social theory centered on the common good led to the creation of public policy in the form of a law banning smoking in public places, which results in heated debate among lawmakers and citizens. One side argues that such laws are necessary to protect society; the opposition argues that personal freedom should not be inhibited by the collective citizenry. The United States Bill of Rights is the primary protector of individual liberties in the United States. The argument that personal freedom should not be inhibited by the collective citizenry is primarily based on three amendments:
The Ninth Amendment states, “The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people.”
The Tenth Amendment further protects individual liberties by stating, “The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.”
The Fourteenth Amendment states, “All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they reside. No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.”
However, the argument in favor of passing legislation to promote the common good is based directly on the preamble to the Constitution:
“We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America” (Constitution of the United States of America and the Bill of Rights, 1787).
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Pareto’s principle explains why the common good and individual fairness often conflict. In many cases, a small group of people do most of the work, which the majority then benefits from.
The Constitution and amendments then go on to describe Congress’s power to legislate.
Which option is the fair choice? That question plagues American health policy. America dogmatically strives for justice and fairness for all citizens. Social theorists and policymakers alike refer to the Pareto principle when the common good and individual rights are directly at odds. The Pareto principle is the theory that 80% of the outcome is caused by 20% of the effort (Juran, 1994). This is often seen in community involvement situations wherein a handful of people do most of the work while the majority does very little. In social theory, the Pareto principle is often translated to mean that fairness for all does not necessarily create fairness for every individual and that some instances occur wherein fairness for all has negative effects on the common good (Kaplow & Shavell, 2000). Take the case of a communist society wherein all resources are combined then doled out equally among people, regardless of how much each person contributed. Ensuring food for all citizens benefits the common good, but a farmer who worked hard all year to fill the pantry may end up without enough to feed his family for the winter because others were less industrious, so his equal share becomes less than what he worked for.
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