By David K. Johnson, Ph.D., King’s College
Elysium is set in the future when the Earth has become so overpopulated that the wealthiest have abandoned it to live in a utopian space station called Elysium. Elysium has a healthcare system, Med-Bays, capable of curing all diseases and reversing aging. The inhabitants of Earth often make desperate attempts to reach Elysium to use one of the Med-Bays, only to be shot down or deported.
Problem of Healthcare System in a Capitalist Society
What the film describes is not unlike what capitalism has produced in America. When healthcare is treated as a commodity, it becomes expensive because it’s highly valued and requires expertise. This necessarily limits access.
Insurance programs can increase access, but not everyone can access them either. And in a way, they made things worse. Insurance companies asking for discounts on bulk goods and services forced hospitals to jack up their prices; consequently, Americans often pay up to 1300 percent more for healthcare services compared to what it costs the hospital to provide them.
One fundamental reason capitalism can’t reduce costs for healthcare like it does for other goods is because people can’t really compare shops when it comes to healthcare. When your health is concerned, you usually have to go to whichever provider is nearest for whatever services you need. But without competition, there’s no incentive for providers to lower prices or improve services.
Imagine if fire stations were for-profit entities. If your house caught fire, you’d just be forced to use whichever station was closest and pay whatever price they demanded. It’s for this reason that fire-fighting services are government-funded, and it’s for similar reasons that most developed nations provide healthcare services for all their citizens through a taxpayer-funded single-payer system.
This is a transcript from the video series Sci-Phi: Science Fiction as Philosophy. Watch it now, on Wondrium.
What Would You Want If You Didn’t Know Who You Were?
Arguably, the philosopher who’d be most opposed to unequal access to healthcare is John Rawls. In his book A Theory of Justice, Rawls argues that one can discover what principles would govern a just society by determining what people would agree upon if they were about to be placed in a society without knowing what position in society they would hold.
So again, consider Elysium. Only those on the space station have access to the Med-Bays; everyone else is left to fend for themselves. This is not the kind of society you would want to enter without the knowledge of where you’d be living.
You’d instead demand everyone have equal access to the Med-Bays—and, indeed, the movie ends with ships full of Med-Bays being dispatched to Earth’s surface. Rawls would demand exactly this, and for the same reason, he would favor a single-payer healthcare system for Americans.
Learn more about American capitalism.
Principles of Justice Drawn Up by Rawls
The general conclusion that Rawls drew was that if you had a collection of people about to be placed in a society without knowledge of who they’d be, they would agree that two principles of justice should rule their society: first, everyone should have an equal amount of liberty, as long as that liberty was compatible with everyone else’s, and second, the economic and social inequalities that exist should be “arranged so that they are both (a) reasonably expected to be to everyone’s advantage and (b) attached to positions and offices open to all.”
What does that mean? The first principle is clear enough. Everyone should have the liberty to do whatever they want, as long as what they want to do doesn’t limit the liberty of others. But the second principle is conceptually more difficult. Rawls wasn’t a communist; he recognized that capitalism was necessary to drive innovation and lower prices. Thus social inequalities are inevitable—there will be well-paid jobs and poorly paid jobs.
But in order for society to be fair, Rawls argues, it has to be possible for anyone to acquire one of the better-paying jobs—at least if they were sufficiently qualified and hard working. So there must be laws against discriminatory hiring practices and efforts to ensure equal access to quality education.
But, for the sake of fairness, these inequalities also have to work to everyone’s advantage; in other words, the fact that some people make more money has to be beneficial to society as a whole.
Learn more about the Handmaid’s Tale: feminism and religion.
Inequalities for the Sake of Society
Rawls didn’t think this could be accomplished by simply giving the rich more money and letting it trickle down the economic ladder to produce economic growth. If that actually worked, Rawls would’ve been fine with it, but it doesn’t.
As most economists will tell you, low taxes for higher earners have never grown the economy. Indeed, the greatest middle-class growth in America happened during and after World War II, when the tax rate for the highest earners was greater than 90 percent.
The best example of a social inequality that works to everyone’s advantage is medical doctors being highly paid. Because of the education, work, and risk involved, doctors need to be paid more to incentivize people to become doctors. But because society is better off when it has medical doctors, the fact that they get paid more works to everyone’s advantage.
Rawls is suggesting that all social inequalities should work essentially like this; they should only exist because they are necessary to make society better. This means that no one should be paid more than is necessary for the betterment of society.
Common Questions about Elysium and the Public Healthcare System
The main problem is people can’t compare prices between different healthcare systems. They usually go to the nearest facility, and rightfully so. As long as there’s no comparison, the costs can’t come down in competition.
In the movie Elysium, only those on the space station have access to the Med-Bays; everyone else is left to fend for themselves.
Medical doctors are high earners in the healthcare system and this encourages more people to become doctors, which is beneficial for society.
