Friday, October 27, 2006

Universal Health Care Ethics

One of the largest health problems facing the nation today is access to medical care. With around 50 million people uninsured, our country struggles with providing health care to many individuals. Because the scope of this problem penetrates all facets of life, it needs to be tackled at many different levels. Deciding our values as a society about health care requires answering difficult ethical questions. The means by which we begin to create and implement a national health care system necessitate that we define what those values are. Addressing the challenges of providing national health care is inherently part of the discussion around this dilemma.
One initial question that must be asked is: How responsible is an individual for the status of their health? Factors that contribute to one’s health include their environment, genetics, socioeconomic status, behavior, and the actual health care obtained. Because of the variability of these factors for each person and the unpredictable nature of individual health, responsibility should ultimately be shared among families, communities and society. It is known that approximately 10% of the population accrues 70% of total health care costs. The financial burden this poses on individuals with acute, chronic, or terminal illness is substantial. Do we want to live in a society where access to health care is determined by socioeconomic status? Aside from social responsibility, we have personal interest in creating a system where the burdens of this financial risk are spread across the population; our health circumstances are just as uncertain as everyone else’s.
The costs of health care are significantly rising at an unsustainable rate. Maintaining a healthier population not only benefits the individuals but also the payers (insurance companies, employers, government) of the expenses. How do we incorporate individual responsibility into the equation? What financial contribution should individuals make? Should it be experience based; should individuals pay premiums based on their health care history? Or should the payments be based on a community rating, where everyone pays the same regardless of their health status? Or should it solely be based on ability to pay, a tax financed system? How do we promote healthier lifestyles while recognizing the injustices that exist? It is less likely that someone living in poverty would have access to a fitness center. This person may also live in an unsafe area, making it difficult to take walks after work. This person may not be able to afford healthier foods, relying on foods with less nutritional quality to feed him or herself. The more we recognize the barriers that exist, the more responsibility we feel to help create a system that provides for everyone.
Even once we recognize that universal health care is essential, there are more questions to be answered. How would we go about implementing universal health care? What role should government play? The current structure allows for minimal governmental regulation and relies highly on free-market economics to regulate the system. Increasing governmental regulation would inevitably decrease our choice (as it has been observed in countries where it has been implemented such as Canada). We must decide that we value access for all over choice for those privileged enough to have this conversation.
Increasing access of information to individuals, determining what values as a society we have, implementing a system that insures health care to all individuals, and deciding how to finance this system are significant challenges regarding this issue. However, recognizing that access to health care is an ethical issue is a critical step in the process.

For more information: http://www.everybodyinnobodyout.org/FAQ/fqIndResp.htm

3 comments:

bob koepp said...

In addition to addressing the question of how to implement universal health care, a more basic issue is what sort of healthcare is to be made universally available. It would appear that there is a virtually inexhaustible demand for "healthcare," even when the connection to health and disease is tenuous at best. Witness the energies expended by marketeers to "invent" new diseases and create demand for products and services that are conveniently "waiting in the wings."

bob koepp said...

In addition to addressing the question of how to implement universal health care, a more basic issue is what sort of healthcare is to be made universally available. It would appear that there is a virtually inexhaustible demand for "healthcare," even when the connection to health and disease is tenuous at best. Witness the energies expended by marketeers to "invent" new diseases and create demand for products and services that are conveniently "waiting in the wings."

Kevin T. Keith said...

You identify some important considerations impinging on societal health patterns, relative ease of access to healthcare, and the logistics of designing and implementing a global healthcare system.

I would differ, at least tentatively, from the general thrust of your piece, however, which seems to be that the questions raised by these issues must be resolved before that system can be designed or before we can choose the basic shape (single-payer, privately-insured, market-based, etc.) we want it to have.

In fact, I would suggest that many of the major value choices that shape these questions can be resolved - not easily or without controversy, but at least in principle - without reference to the minutiae of health patterns or social justice factors. In fact, arguably, the introduction of such facts, even when relevant, is often in service of politically-motivated attempts to force a final resolution into one direction or another, where ideally those large-scale values choices would be made more fairly by reference to broad social values and not the need of particular social groups (which often devolves into nothing more than so much influence-peddling, a process perhaps less likely than not to put resources where they are most needed).

What I mean by that is that if, as a society, we make the values-based commitment to providing healthcare to all members of society without regard to circumstance, then it doesn't matter whether illness comes from "personal responsibility", genetics, or social circumstance. If, on the other hand, we choose to abandon the neediest to a for-profit healthcare market, such factors are equally irrelevant. If we decide instead to ration healthcare partly on the basis of one's "guilt" for one's ill health, then the question of "responsibility" does become relevant, but only after the large-scale decision about distribution practices has been made. Similar comments, I think, can be made about many other aspects of global healthcare policy-setting: the devil is in the details, but only in ways that become relevant after we have decided what kinds of resources are to be distributed and in what ways - not as a factor in making that decision in the first place.

Details can be important in large-scale policy-setting, of couse; particularly in respect of considerations of justice. If social inequality is responsible for, say, inner-city asthma epidemics, lack of access to contraception, or lack of mental health care, then perhaps some compensatory scheme has to be built into large-scale policy planning. But even in that case, such detailed planning is an adjustment to, not the reason for, the overall system we choose to adopt.

In short, global-level questions about what kind of healthcare system we want, what quantitative level of resources we are willing to devote to it, who may take advantage of it, who will have authority to determine what privileges it grants, and on what grounds those decisions are made, are all best approached as questions of social value-setting. That may not be an appetizing thought, given the trends of recent years, but it at least obviates a tacit admission that the system cannot be built until every factual question can be answered. It also pushes the debate over whether to change our system onto the value-based grounds of the obvious inadequacy of the current system to meet basic and profound human needs - and off of loaded questions about costs and efficiency, which are details, not values. That, I think, is a good thing.