2AC – Perm

O’Neill 20 – Lecturer in Moral & Political Philosophy in the Department of Politics at the University of York.

Martin O’Neill, “Power, Predistribution, and Social Justice,” Philosophy, vol. 95, no. 1, January 2020, pp. 76-78, https://www.cambridge.org/core/journals/philosophy/article/power-predistribution-and-social-justice/02449FCC840979032236220D38D11A4F.

Imagine a society in which healthcare benefits are provided in a haphazard way by an inefficient system of private insurance, with many people’s access to even a minimally decent level of healthcare provision being tied to their employment status. Imagine that in such a society, against all previous expectations, a democratic socialist candidate is elected to the presidency, and that one of his or her first policy priorities is to create a national health system that ensures that all workers have access to an excellent level of universally available healthcare, provided free at the point of use through direct public provision, funded by general taxation. What would be the implications enacting this kind of policy? Well, obviously something would have to happen to the tax system in order to fund this new system, and the new system would bring benefits to many individuals who were comparatively disadvantaged by the previous system No doubt there would be some general efficiency gains in moving from a splintered private market to a coherent public system of healthcare provision, and so there would be a certain amount of ‘levelling up’, and the removal of the deadweight loss associated with the rent-seeking private bureaucracies associated with the previous system. What there would also be, in terms of direct effects, would be a de facto economic transfer from those who were especially advantaged by the old system (e.g. by the unreasonable suppression of top rates of taxation) towards those relatively disadvantaged individuals who would be most advantaged by the new system.

But something else would happen as well, which would directly parallel what would happen when Ukania moved towards a more Rhenish or Nordic model of employment relationships. The bargaining power of labour would go up. When workers’ access to healthcare depended directly on their employment status, and where employers had a role as gatekeepers in terms of access to more adequate and attractive health insurance plans, workers obviously had a direct incentive against ‘rocking the boat’ in their workplace, given that the effective costs of even a short period of unemployment could be so high. By contrast, after the enactment of our imagined National Health Service – or Medicare for All – in USania, the costs of exiting from a bad employment relationship would be much lower for workers, and hence their bargaining power against their employers would go up, in much the same kind of way as if a change had been made more directly to the regulation of that employment relationship.

The tax-funded provision of public services is not of interest to progressives or egalitarians only because it is directly a way of benefitting everyone at a cost that falls disproportionately on those who have more, but also because of second-round effects that the provision of public services can have in terms of the structure and distribution of power in economic relationships within that society. The public provision of services such as healthcare, education, and childcare, or even provision of goods such as public transportation and public parks,27 creates the background conditions against which different groups and different sectional interests fight their corner and negotiate their economic relationships. Public provision is not just a way of undertaking a transfer against the backdrop of a market with a particular kind of shape and structure, it is also at the same time a means of shaping markets, and changing the relative bargaining power of different groups of market actors. Therefore, if predistribution is centrally about the role of government in what we might call ‘market-shaping’, then there is not a relevant contrast to be drawn with a different kind of activity (imagined presumably as purely redistributive) that government undertakes when it goes in for the provision of public services funded by taxation. Public service provision is in general both about transferring benefits, per se, but also about shaping the background within which market transactions take place, and therefore it is misleading rather than illuminating to draw a sharp contrast, at the levels of types of policy, between policies that have a redistributive role and those that have a ‘market-shaping’ role.

A pessimistic diagnosis at this point is that the idea of predistribution as presented in Hacker’s revised and more promising formulation ends up trading on a merely shallow distinction between different kinds of government action. If it turns out that precisely what is interesting about the predistributive effects of changes in labour regulation can also be seen at work in the classically ‘redistributive’ provision of public services, then we apparently do not have a way of dividing government policies that affect economic outcomes neatly into the two categories of ‘redistribution’ and ‘predistribution’. Advocates of predistribution as the proper zone of focus for progressive or egalitarian politics, in distinction to the previous focus on redistribution, might therefore be seen as relying upon a superficial conceptual distinction that does not illuminate a deeper contrast in how policies function.

Combining the two is key to progressive policy goals

O’Neill 20 – Lecturer in Moral & Political Philosophy in the Department of Politics at the University of York.

Martin O’Neill, “Power, Predistribution, and Social Justice,” Philosophy, vol. 95, no. 1, January 2020, pp. 88-89, https://www.cambridge.org/core/journals/philosophy/article/power-predistribution-and-social-justice/02449FCC840979032236220D38D11A4F.

It is a familiar objection directed at advocates of a political focus on predistribution, that even effective policies of predistribution would not eradicate the need for forms of redistribution, both in the form of direct cash transfers, and in the form of indirect transfers through the provision of public services funded through taxation. Obviously, the advocate of predistribution should have no argument with this objection, not least because, as we have seen in sections 4–6 above, such redistributive policies frequently have a distinctively predistributive justification. Moving away from the Hacker-type view that sees predistribution as a kind of policy as opposed to a kind of aim or goal, or valuable effect, helps to forestall this kind of unilluminating disagreement between advocates of predistribution and their opponents. Moreover, it should be no part of advocating predistributive public policies to think that there might not also be a justification for transfers or public service provision that was based on purely redistributive considerations – i.e. because one person or group is in need, or suffering some absolute level of privation, and the transfer from a relatively advantaged person or group would rectify this. After all, our concerns as egalitarians are complex, combining consideration of both how well each individual fares, and of the nature of the social relations between individuals.43 There may also be cases where purely redistributive aims could be most efficiently enacted by means of the kinds of policy mechanisms associated with predistribution. In many cases, the same policies might be favoured by progressives and egalitarians for both their redistributive and predistributive effects, operating at once but by means of distinct mechanisms. None of these cases would constitute an objection to either our characterisation of the idea of predistribution, or to the claim that progressive or egalitarian politics should treat predistribution as a central priority.

Universal health care is a strategic lever that forces the broader expansion of the social safety net – forcing the government to pay for health care costs requires improvements in other relevant arenas, like housing, education, and environment.

Rudiger 16 – Anja Rudiger, Ph.D. in Political Theory from the University of Kiel, former Director of Programs at the National Economic & Social Rights Initiative (“Human Rights and the Political Economy of Universal Health Care,” Health and Human Rights, Vol. 18, No. 2, pgs. 67-78, https://www.hhrjournal.org/2016/12/human-rights-and-the-political-economy-of-universal-health-care-designing-equitable-financing/)

This focus on equity coincided with the Occupy movement’s protests against rising inequality, which catalyzed an ongoing debate in US politics about the largest concentration of wealth since the 1930s and the greatest income inequality since the late 1970s.19 Regressive health care financing is a significant contributor to economic inequality, producing an inverse correlation between household income and household health care spending.20 Conversely, a redistributive universal health care system in the United States would deliver significant financial relief to lower- and middle-income families.21 Providing health care as a public good could also pave the way for a broader paradigm shift toward universal public programs, replacing the threadbare safety net of means-tested benefits. Health care could function as a strategic lever for building a more equitable society through the universal provision of the goods and services needed to exercise economic and social rights. In turn, increased equity would further improve health outcomes.22 It follows that health reform goals should reflect the direct correlation between health and equity by measuring not only health but also equity indicators.

This broader equity vision characterizes the HCHR campaign’s approach to financing, which aims to disrupt the vicious circle of inequity and poor health fueled by unequal access to care based on income, wealth, and employment. International health systems research confirms that commercialized health systems with significant private sector involvement both impede access to care and deepen inequities.23 The market-based insurance system in the United States demonstrates that private pre-payment schemes are neither intended nor equipped to guarantee equity in access to and payment for care. Any redistributive potential of pre-payment is lost when the insurance business model incentivizes access restrictions by means of cost-sharing, narrow provider networks, and prior authorization processes, and when even a slightly more progressive premium structure for low-income policyholders, as mandated by the ACA, requires the channeling of sizable public subsidies to private insurance companies.