Bioethicists Weigh In On the Healthcare Reform Vote (updated)

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."

Tom Murray, President and CEO of the Hastings Center:

 "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."

Hilde Lindemann, Professor of Philosophy and Immediate Past President of the ASBH says: 

"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."  

Amen to that. 

[Cross-posted on IEET's blog]

The “third tier” in US health care?

It’s a sickening situation. Physicians’ incomes are under attack: think lower reimbursements, higher costs for malpractice premiums and the like, greater business costs, claims processing hassles, and deadbeats.

What’s a poor doctor to do? One possible cure is the concept of Concierge Care.

Concierge Care (or Boutique Medicine, or Platinum Practices, one name hasn’t stuck) could offer a patient such privileges as 24-hour phone or pager access to the doctor, house calls, and guarantee of an appointment with your chosen doctor the same day you call.

The cost: a fixed annual fee that could range beyond $20,000 a year, depending on the services provided, and the patient’s age and health.

I’m not quite old enough to remember the days when doctors offered all the above and a lot more to everyone, for a lot less.

So there it is: to the other tiered services available in the US (UPS for the rich, the post office for everyone else; private schools for the rich, public schools for everyone else) we can now add a three-tiered “health” care system: no coverage at all for 45 million people, inadequate medical services for most of the rest of us, and Concierge Care for the lucky, wealthy few.

We're Number Two? The State of US Healthcare

According an article in Scientific American this week, Canada has good or better health care than the U.S. despite spending half what the U.S. does on health care:

"Whether it is American senior citizens driving into Canada in order to buy cheap prescription drugs or Canadians coming to the U.S. for surgery in order to avoid long wait times, the relative merits of these two nations' health care systems are often cast in terms of anecdotes. Both systems are beset by ballooning costs and, especially with a presidential election on the horizon, calls for reform, but a recent study could put ammunition in the hands of people who believe it is time the U.S. ceased to be the only developed nation without universal health coverage.

Gordon H. Guyatt, a professor of epidemiology and biostatistics at McMaster University in Hamilton, Ontario, who coined the term "evidence-based medicine," collaborated with 16 of his colleagues in an exhaustive survey of existing studies on the outcomes of various medical procedures in both the U.S. and Canada. Their work appears in the inaugural issue of the new Canadian journal Open Medicine, and comes at a time when many in Canada are debating whether or not to move that country's single-payer system toward for-profit delivery of care. The ultimate conclusion of the study is that the Canadian medical system is as good as the U.S. version, at least when measured by a single metric—the rate at which patients in either system died.

"Other people knew that Canadians live two to two and a half years longer than Americans," says Steffie Woolhandler, an author on the paper and an associate professor of medicine at Harvard Medical School, citing a phenomenon that many attribute to differences in lifestyle between the two countries. "But what was not known was once you got sick, was the quality of care equivalent in the two countries."

To read, click here.