Is our Health Care System Ethically Flawed?

The Supreme Court announced this week that it will hear another case challenging the Affordable Care Act; this time the focus is on the tax credits that many Americans have received in order to afford health care insurance. And the Republican party leaders have again proclaimed their desire to repeal “Obamacare.”  The focus on health care in this nation is divisive between those who want the health care industry to be unregulated and governed by the free market and those who want health care to be regulated, if not administered, by the government.

I, like many Americans, have very strong opinions on this matter. So, it’s time for me to remind you of the disclaimer at the bottom of the right sidebar of this blog: “The ideas expressed here are my own personal opinions …”

There are some things that cannot or should not be left to the free market. Many of them are things that relate to the basic wellbeing of people. According to the Universal Declaration of Human Rights, everyone has the right to medical care [Article 25 (1)]. Health care is what some economists call a “merit good,” that is, it is something that should be universally accessible and provided for not only the wellbeing of an individual, but also the wellbeing of society as a whole. It should be provided on the basis of need, not on the ability to pay. The free market premise is that those who can pay more have access to goods and commodities that are in demand. It’s not a bad system for items like a new iPad or a more powerful motorcycle, but it is ethically flawed in providing services for people who are sick, disabled, or injured.   I am convinced that it is fundamentally immoral to profit off the misfortune of others.  While the ethics of profit based health care were not directly discussed, the premise that profit driven health care is not economically wise is supported in this week’s lecture and course material for The Age of Sustainable Development.

We don’t have a totally free market health care system in the USA.  There is, of course, governmentally provided health care for those covered by medicare, medicaid, veterans and other city or state run medical plans.  The Affordable Care Act introduced regulations to 1) keep young adults on their parents’ health care insurance until the age of 26, 2) eliminate lifetime caps on insurance and 3) require insurance companies to cover people despite pre-existing conditions.  In addition, it is requiring transparency regarding the actual costs of procedures which can vary drastically not only between different care providers but different patients at the same office, lab or hospital.  A major strategy of the ACA, however, was to keep a market based system as illustrated with the state and federal insurance marketplaces.

Despite the argument that a free market economy will ultimately keep costs down, the United States spends nearly twice as much on health care, per person, than other developed nations.  The cost of a hospital stay is two to three times as much as Canada or European countries such as France or Germany.  And, we pay our physicians approximately twice what doctors make in Canada, Germany, France or Australia.  Despite the astronomically high spending in the US, we are no healthier than these other countries.

Why are our costs so high?  Those of us who have been following the health care debate know that there are multiple causes.  First of which is that Americans are not only paying the costs of a procedure or a medication, but we are paying for the huge profit margins of  pharmaceutical corporations, insurance companies, hospitals, labs, and other service providers.  The health care industry is one of the biggest lobbies of government.  The healthcare lobby is bigger than oil and bigger than the military industrial complex.  It is second only to wall street and the financial market.  The healthcare lobby spends $5 billion per year on lobbying for deregulation and in contributions to campaign financing.

Other reasons for the increased cost of  health care in the US has to do with the the way we bill for procedures as opposed to person or diagnosis.  Because of this, too, we have a great deal of waste in the system.  Doctors will prescribe sometimes unneeded procedures in order to increase their profit.  I am not suggesting that doctors are intentionally manipulating the system for personal gain, but I believe there is a natural consequence to a system in which we bill based on a specific procedure or test.

While I am personally in favor of a single-payer universal health care system, I understand that we are not ready for that politically.  In the meantime, let’s support the legislation that concerns the way hospitals and doctors bill patients.  We should be sure that the costs are transparent so that they are more equalized and controlled. Let’s work to create a nation in which all people have access to preventive care at little or no out of pocket cost.  Contraceptive care should also be freely available because it will decrease the fertility rate which utlimately reduces poverty and creates a more sustainable economy.

Most Americans are concerned about their own increased medical costs.  In the Presbyterian Church, the cost of health insurance is fast becoming cost prohibitive.  New options are being offered by our Board of Pensions next year to help relieve some of the expense for some congregations, but the community/shared nature of providing this basic human right is at risk.  Universal health care is an issue, I believe, our church should be actively promoting.  We have a strong history of advocating for and providing care to the sick, as we were reminded by the “Presbyterian” hospitals in the news.

So, let’s discuss the justice issues.  And let’s discuss the ethical and moral issues of our American health care system.  Does the free market system guarantee access to excellent health care for all Americans?  What can we do to better promote health care for all?

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