As the readers of this blog know, both myself and several of our bloggers have posted about universal health care coverage many, many times as an ethical and moral imperative. In the last year, my hopes (along with many other bioethicists, I'm sure ) of attaining universal coverage have gone up, down and sideways, like a roller-coaster ride, exhilarating and frightening, with emotions ranging from inspiration to resignation. Now that the US House of Representative has finally passed a health reform bill, I've requested several bioethicists (and friends of the WBP) to share their thoughts on the ethical implications of the passage of this bill:
Art Caplan of UPenn: "The passage of this bill, flaws and all, represents the elimination of the single greatest failure in American health care -- a lack of universal insurance coverage. With this legislation in place America can finally say after decades of failure that it has honored its responsibility to create equal opportunity for every citizen."
"I liked Nancy Pelosi’s comment that being female will no longer be considered a preexisting condition.
As I tried to say in my essay in the Connecting American Values to Health Reform collection, and reiterated in my Perspective in the New England Journal of Medicine, any serious and responsible health reform had to include universal participation along with means for insuring that we could be good stewards of our finite health care resources.
The “universal participation” piece was not fully accomplished, but very significant progress was made. Already today, however, news reports say that it will be under attack in several states. We will have to see whether it survives.
Perhaps the least appreciated aspect of the legislation is the set of strategies to make stewardship a reality (most commentators lump it under “cost containment”). Ezra Klein offers a very useful, brief summary here."
Ruth Faden, Executive Director of Johns Hopkins Berman Institute of Bioethics and Philip Franklin Wagley Professor in Biomedical Ethics says: "This historic legislation for the first time enshrines a national commitment to guarantee that all of us in this country have meaningful access to appropriate medical care. As a consequence, our society is now more just. Our people have a greater prospect of securing for themselves and their families not only more health, but also more of everything that is essential to human well-being, including personal security, respect and self determination."
"Can one be happy and angry at the same time? The passage of the health care reform package is cause for rejoicing: it helps the poor and dispossessed—a disproportionate number of whom are women and children--gain access to health care. But it was achieved at the cost of both parties’ affirming in very loud tones that if a woman is pregnant unwillingly, she has recourse to abortion only if she can pay for it privately. That so much of the rhetoric surrounding reform was given over to underscoring what has been the case since the Hyde Amendment was passed many years ago, leaves me furiously frustrated."
I am waiting for several other bioethicists to respond to my inquiries, and will post them upon receipt.
As for my own feelings and thoughts, I think Nancy Giles of CBS Sunday Morning said it best:
"So I'm a progressive, and I don't consider this bill, or Dennis Kucinich (D-Ohio), or anyone who supports this legislation to be "selling out" because it doesn't go far enough. The bottom line is 30 million more people will get health care coverage, and that will save lives now. Voting "yes" gets a foot in the door.
Change takes serious effort, but progress happens. The fight for women's rights didn't end when we got the right to vote in 1920; the Lily Ledbetter Fair Pay Act signed just last year was another move toward true gender equality. Civil rights didn't end with the Emancipation Proclamation or the Voting Rights Act of 1964.
HR 4872 is a crucial first step, and can be amended and improved, but doing nothing is not an option. Health care should be a basic human right. And no one should be uninsured, or underinsured, or go broke paying their medical bills in the richest country in the world."
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