Distributive Justice and Legal Regulation of Social Security
The building of social security models should be based on the principles of justice that are predetermined and recognized by society. Chaotic reforms without a common vision of the system in accordance with the principles of justice lead to complication, closeness of systems and a sense of insecurity. Since social security is primarily a matter of access to benefits, the state should clearly define the criteria of distributive justice: to whom, to what extent, at whose expense. Public opinion polls sometimes demonstrate that the existing mechanisms of redistribution do not correspond to the idea of justice in society. Throughout the 20th century, the systems were built and improved on the basis of the principle of solidarity of generations, insured, sick and healthy… Currently, due to the crisis of existing models, for many reasons, the old ones are being rethought and new construction options are being tested. They range from extremely liberal, with minimization of social guarantees, to the introduction of a universal basic income. In the Russian Federation, after experiments in pension provision and the introduction of a funded element, which did not show its effectiveness and caused the rejection of society, in 2020 the state fixed the principle of generational solidarity in the Basic Law of the country as the basis for building pension systems. It is equally important to ensure distributive justice in such a resource-intensive and individually unpredictable area as medical care. It is necessary to ensure that the system meets the expectations of citizens in an area where the principle of merit-based provision (meritocratic principle) does not always work. At the same time, the key point is the choice of the organizational and legal form of social security. Despite the opinion expressed about greater compliance with the principles of fairness of the budget model of medical care, it is concluded that there is a need for a broad discussion of reforming the healthcare system with the involvement of experts, the professional community of doctors, patient organizations, etc.