A system that treats suffering should not refuse it because the cause is visible

The argument

A second argument offered for this position concerns what health systems already agree to fund. Proponents note that a good deal of covered treatment does not address a threat to life or a measurable physiological failure. Pain is treated because it is unbearable, not because it is dangerous. Infertility treatment, vision correction and much dental work are provided in various systems because the conditions they address interfere with how a person lives rather than with whether they live. The principle at work, on this reading, is that medicine relieves burdens, and a burden counts because of its weight rather than its location. The argument is that appearance imposes a burden of the same kind, and does so through other people. Proponents argue that how someone looks affects how they are spoken to, hired, promoted, approached and believed, which makes the consequence social rather than imagined, and no less real for that. They stress that this does not require any claim that appearance should matter. It is precisely because it should not, and does anyway, that the person who carries the cost is not the person responsible for it, which is the structure of a burden rather than a preference. Holders of the view add a practical point. Refusing coverage does not reduce the number of operations performed, it changes who performs them and on whom. Those who can pay proceed, those who cannot either go without or seek the cheapest available provider, and a market serving the latter is harder to regulate, since the procedures take place outside the system that would otherwise record and supervise them. Proponents argue that a system which declines to fund these operations still ends up treating their complications, and that bringing them inside is the safer as well as the fairer arrangement.

Premises

Counter-arguments

Opponents argue that the first premise cuts the other way, since the treatments listed address conditions nobody chose, which is exactly the feature in dispute. They also object that accepting a social burden as grounds for medical funding has no stopping point, because almost any disadvantage operates through the responses of others, and a health system is not the institution for correcting how people treat one another. On the safety argument, critics reply that the same reasoning would justify funding anything people might otherwise obtain badly, and that regulating providers and advertising addresses the risk directly without committing a pooled fund to paying for the procedures.

Rejecting the premises

[Rejecting P1] The treatments listed all address conditions the patient did not choose, which is the very feature in dispute, so the premise does not establish the parity it claims. [Rejecting P2] Almost any disadvantage operates through the responses of other people, so accepting a social burden as grounds for medical funding leaves the criterion without a limit. [Rejecting P3] Regulating providers and advertising addresses the risk of unsupervised procedures directly, without committing a pooled fund to paying for them.