Reforming Health Care in The US: A Tutorial (Part 2)

By on September 23, 2012

When the next round of reforms in Health Care comes again after the 2012 election, Americans need to be better prepared to sift through the rhetoric. It is hard to believe voters will be as uninformed as they were in 2009. That does not mean however that they cannot make a big mistake on the next round. They need to be vigilant, thoughtful and informed.

Cost will head head the list of problems. There is little agreement how to address this growing problem. And, as usual every interest group in America will start piling on, confusing the folks at home without a scorecard. Doctors, hospitals, patient advocate groups, pharmaceutical reps, trial lawyers, insurance companies, medical schools and teaching hospitals, lobbyists, conservative talking heads and liberal talking heads will all be jockeying for the last word. Trouble is there may not even be agreement within the groups themselves. Breast cancer advocates will likely not say much for those with epilepsy. Surgeons will want different things than psychiatrists. Pfizer may want something different than GlaxoSmithKline, and the insurance companies will all be reaching for a bigger piece of the pie. It could get very noisy in the committee rooms of Washington come 2013.

One nice feature of the next round might be an ethical basis for discussion. Health care policy people have four measures of ethical concern useful as a yardstick for future proposals. They apply here.

One is Beneficence, who does this help? Does it help? Who benefits? Second is Non-maleficence  —  the cardinal rule of medicine: first do no harm. Is anyone damaged by this proposal? Who will be disadvantaged? Third is Justice. Is this legal and lawful? Is this fair to all parties concerned? Is it open and even-handed? Fourth is Respect/Autonomy  — does this show respect to all interested parties? How does this play out for individuals trying to service their own needs? Have all interested parties been heard?

This is still a fair approach to assessing future reform. It may even reduce the number of future shouting matches and skirmishes in the cloakrooms of Congress and bars along K Street.

At the core of it all, is the question “Is Health Care a Right or a Privilege in these United States?” Something we have not asked ourselves out loud.

Stay tuned for the fireworks.

Tom Godfrey

About Tom Godfrey

2 comments on “Reforming Health Care in The US: A Tutorial (Part 2)

  1. I really would like to ponder on the last paragraph. ” “Is Health Care a Right or a Privilege in these United States?” “. Depends on how you define “right” and “privilege”. Having a right, an inalienable right, has nothing to do with responsibility. Yes, you have a right to health care, we all have that. There is no law impeding you from going to a clinic, hospital or a facility for your health issues. But… you also have responsibility to pay for it – I’m not even going to get into the responsibility of maintaining one’s own health. I get the sense that when many refer to the “right” to health care, they mean free health care. There is NOTHING free in the world, especially not freedom – in any sense.
    Privilege of health care is another matter. This word is more applicable to the current healthcare system. Privileged health care goes into the tier system – the haves and have-not of society. Currently, economics impede access to healthcare for many and they see this as being denied the right to healthcare.
    Let’s take two polar opposites. We are each wholly and completely responsible for our health care. No money, no service. The other opposite is a complete state funded healthcare system and you can not get anything more. The janitor and CEO of a company get the same access – call it what you wish. Where does the ideological conflict start? It starts with the founding bases of this country – individual freedoms. There is a culture that we have constitutionally guaranteed individual freedoms. We can act accordingly so long as it does not impede another’s and no one is allowed to impede ours. I am going to spare you a protracted discussion on outdated ideas. This was founded in 1787, we are now 2012. The interdependency has gone from neighborly farms to earth is once again flat. There needs to be a paradigm shift in how we view independence. It should be interdependence.
    When all the entities mentioned attempt to iron out their piece of the pie, they should remember that the pie is finite. We can no longer live as an island seeking just our individual gains and rights. To the many I would say, you have a right to get health care and you always have had this. To the privileged I would say, it is the right thing to assure that all have access to health care. Eventually, we all stand to gain. Above all, we must have an educated populace for any of this to be understood and succeed.

    • TGodfrey on said:

      There is a noted author of the mid-twentieth century Carl Lotus Becker who wrote a book about freedom and responsibility in the American way of life. He argued for all the freedoms we enjoy in life here, we have equal responsibilities that go along with them. He made the point that we did not always honor them. I was tremendously impressed with his writing when I was in college. I think his argument applies today. We do not have a right to free care. We should have the freedom to access care that we need, and the responsibility to use it wisely and support it. It is a privilege to get great care, but it should not be the purview of the privileged. We need to talk about our responsibilities as well as our rights if we are to have access to good care. I don’t hear that going on. Dr. Deramerian is right on about our interdependence as a people. Our failure to work together in recent years has created problems for us. It has frustrated needed reform. If we can’t pull together after tomorrow’s election, we will see them get far worse.

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