America is a World Leader in Health Inequality ( 300 words) please use this link for the journal https://www.washingtonpost.com/news/wonk/wp/2017/06/05/america-is-a-world-leader-in-health-inequality/?
2-Use this thread to comment, question or dialogue about the latest ethical theory we’ve encountered! Is this a pragmatic melding of Principles and Consequences?
What do you think of his “Veil of Ignorance” and “Original Position”?
3-In Unit 1 we examined Dan Callahan’s connection of Health Care reform to our assumed set of Values (from his perspective of over 2 decades ago). Now that you read more on Canada in our text and other material in the Unit Assignment what do you think about the contrast with Canada and our other Western trading partners?
4-A “Right” to Health Care? Attachment
In response to the “Briefing Session” and other assigned readings, reflect on the following questions:
Do we have a “right” to Health Care?
What does it mean to have a “Right” to anything?
Even if there isn’t a Right per-se, is there an obligation by the profession to meet some sort of social goal of providing basic care to all Americans?
5-I don’t; think any one of the links for graphics alone is worthy of a post… but maybe you will prove me wrong!
Feel free to comment on a few of the links in the ‘bonus’ section in the Learning Unit that had links for graphs related to health care history and allocation.
Any comment on the local connections Philadelphia has to the History of Healthcare in the US? What about the one outstanding fact that the last link (with 21 graphs!) makes?
Please use this link:This map of global health care prices shows
Americans are getting ripped off:
And in the end — was this a helpful bonus?
Intervention and Reflection: Basic Issues in Bioethics, Concise Edition, 1e
Read about Rawls’ – Section VI: on p 489 through 493 AND ‘Major Moral Principles’ on p 505 through 510
Issues of Distributing Health Care Ch. 9 —
Read the “Briefing Session” and Read either the Case Presentation at the very beginning on “The Way It Was…” or the Social Context on “In Crisis Mode…”
Read at least ONE of the “Decision Scenarios” at the end of the chapter
Read this article, but ONLY SECTION V “Towards A Distributive Theory” (p 160 of the text or simply p 16 of the .pdf file):
How does the United States stack up against Canada in health care? Each Canadian province operates a tax-supported universal coverage plan. It’s estimated that such a system could save the United States more than $75 billion a year.
Note: This data is from the early ’90’s:
do you think that there would be the same difference today? GJP
Life expectancy —
U.S., 75.3 years;
Canada, 77.1 years.
Infant mortality —
U.S., 10.4 (per 100 live births);
Death from Heart disease —
U.S., 434 (per 10,000);
Health expenditure as percent of GNP —
Number of people per doctor —
U.S., 12.3 percent;
Canada, 8.7 percent.
Short-term hospital beds —
U.S., 4.05 (per 1,000);
Open heart surgery units —
Average physician income —
Canada, $115,000 (U.S.).
Average annual malpractice premium —
Health Care Reform: Dan Callahan & beyond
As a “follow-up” to your readings and reflections on The Claim to Health Care I’d like to make a few remarks of my own and follow through with additional information on Dan Callahan’s perspective.
The first observation is that whenever the question is framed as, “Do you have a Right to Health Care?” the responses tend very much to the affirmative. Yet people, especially those connected to the health care industry, realize that there is a disparity between what “is” and what “ought to be”. Health seems to be something so universally desired, but something that it is rare to achieve without the support services of the profession committed to its intrinsic moral value. Stories — tragedies, in some cases — of people ‘wrongly’ denied care abound. The sense of injustice seems more pronounced the closer and individual is to any particular situation. In part what one must do for philosophic reflection is to gain some distance from the particular and raise the question in a more general fashion. Hopefully the perspective gained informs and aids in a better understanding of the particular.
The first step is to re-examine the initial question; whether one has a right to health care depends on what it means to have a right to anything. If it is simply a legal question, the answer is easy: rights are those guarantees constitutionally inscribed. These range from the general (Life, Liberty and the Pursuit…) to the specific (Religion, the Press, Self-incrimination, Arms, etc.). In the legal context, in the United States there is no right to health care. We stand virtually alone in the Western industrialized world on this issue (as is the case with another contentious issue: capital punishment). There are a number of topics that Americans feel that they have a legal right to, but are surprised to learn that is not the case. For example, we do not have a constitutional guarantee of Privacy. True, privacy is protected by many state laws and by many legal precedents — it is said by a chief justice to be within the ‘penumbra’ (shadow) of other constitutional guarantees — but there is no explicit right to privacy.
Likewise, when we discuss the ‘right to health care’ as with the ‘right to work’ we are really referring to other constitutional guarantees. We have the right to not be discriminated against our pursuit for these goods, though we do not have a right to those goods per se. Further, in the U.S., those two goods just mentioned — health care and employment — are intricately interwoven. If one has a job and if that job offers health care benefits then perhaps access to affordable care is not a problem. If acquiring a good is not a problem, people tend to assume they are guaranteed that good. However, with those that work in the health care industry — people that usually have access to high quality care as a benefit of their employment — there is often an acute awareness of the limitations of the free-market system. There are nearly 40 million Americans without any health care coverage, the majority of whom are either “working poor” (those self-employed or working many part-time jobs to earn a living) or are children. As many have observed, these people tend to avoid preventative care and utilize health care services via the ER — something that is inefficient, avoidable, expensive, and something that is paid for either by those that are insured or through taxes.
According to some estimates, the benefits of granting universal access to primary health care service would save money and lower costs rather than raise them. This has already been borne-out by the relatively recent push for universal vaccinations for children. There is a movement to provide for a catastrophic health care fund, covering expenses for intricate, expensive long-term care and re-habilitation. This movement really first came into being as a result of the AIDS crisis; only when the spread of this disease threatened to bankrupt the system did the AMA accede to the need for certain costs to be borne by society as a whole. Even AIDS patients with health care insurance soon found that there were monetary limits to their coverage and that for many the only solution was to sell every asset, reduce total net worth to under $2000 and thereby qualify for Medicaid. There is not, however, any push for universal coverage on the scale that was considered, and defeated, in the early ’90’s.
While we do not have a right to a job, we do have a right to equal access to a job, as with housing or education, or even a loan. Anything less would be discrimination. We do not have a right to health or health care, but we do have a right to equal access to health care providers. But in a system in which employment is a key to remuneration for services otherwise not obtainable, it is not discrimination that is a barrier to admission.
Just after the rejection of the Clinton Health Care proposal in 1994 Dan Callahan gave a talk at Holy Family College in Philadelphia. I found his comments to be quite on-target, and worth sharing with my classes ever since. Basically he contends that any effective response to the crisis in health care demands a re-examination of assumed values. This current revolution in care (from fee-for-service to managed care) is really only one more in a series of revolutions (please think of the long history of medicine!). He began with a brief comparison/contrast with European and Canadian values with our own and then proceeded to identify five key values that are undergoing both re-thinking and re-tooling.
Our neighbors to our north and our “Old World” relatives have four key values that directly effect their approach to health care:
• Solidarity: it is understood that society has an obligation to aid its members. Note that hospital systems and insurance schemes have been in existence for hundreds of hears in some countries.
• Health Care is an unquestioned right. Period.
• Medicine is not perceived as an avenue to wealth.
• Government is usually considered to be a benign, even helpful force.
In contrast, U.S. values emphasize Freedom, (and consequently individualism and autonomy) and we tend to look upon government “as a joke.” Callahan was not arguing that we should simply adopt the values of other countries. He duly noted that those countries too have their difficulties balancing care and costs, and while their delivery is more broad-based, it can be cumbersome. Callahan said that our peer countries are looking to us and to our response to the crisis as a guide for re-tooling their own system.
Key Values in Transition:
Death –“let’s face it, you can’t beat it!”
(yet we pretend that we can — see his comments about a “natural” life span)
The paradox is that the present dilemma is a result of medical and biological success: Technology is the culprit in increasing the number of people over 65, and over 80 & 90, that are “expensively alive.” The most amount of our health care money goes to diseases that kill. “Americans are terrorized by their view of how they perceive ‘how they will die’.”
Note: Callahan is against Physician Assisted Suicide — holding that this question should not be addresses until care for the terminal is guaranteed.
Progress — we must re-think the ‘always get better’ paradigm. Callahan asserted that “if we stopped all new technology, there would be enough money to go around.” Arguing against “high-tech post facto Band-Aids”, he is in favor of preventative care, especially for the poor, for pre-natal care, family-child heath, etc.
Note: for example, the last decade saw a tremendous rise in the number of MRI services available. These “state of the art” facilities certainly have their value — but compare their cost with providing 10,000 pre-natal visits, and the fact that pre-natal care is one of the most significant factors in reducing neo-natal intensive care unit (NICU) utilization and cost.
Curing — we tend to emphasis this, as opposed to Caring. We need to make distinctions, and to balance the differences. Also, Callahan thought we ought to re-examine our priorities regarding acute vs. chronic care. “We have a great number of aged that are alive [but not cured] … that are sick, disabled and suffering…[and therefore are in need of care].” Since curing may not be possible, Callahan argues that maybe we can conquer the social aspects of disease.
Callahan is in favor of rigorous ICU admissions policies (re: triage)
Note: Callahan mentioned a survey that reported that people who had the “best” last year of their life died of….
What he meant was that qualitatively speaking, a life that ends suddenly and decisively with a heart attack is preferable to multiple system high-tech life support or surgery.
Health — we are fixated with it. Why are we the only nation that has newspaper and journal section devoted to the topic? (!) Are we any better off due to this focus? Do we exercise more than other nations? Are we less fat? Do we eat better? Sleep better? Smoke and drink less? NO.
Note: Callahan posed this question: “Health care costs are up 15%. Education costs are still at 5% — is it because our kids are smarter?”
Rationing: not whether, but how. (Back in ’94 accurately saw this coming).
While he admitted that the term “rationing” will ‘never sell’, he said de facto it is already here, at least according to economic statistics. His personal view is that, in any case, the government is the wrong agent for imposing limits!
Limits will be set. Costs will be offset by savings (cuts) in other programs. The only question is
I know it sounds as though he is proposing a simple trade-off of the expensive old for the majority young — but I feel that is an incorrect view of his intentions. If cuts must be made, limits must be placed, isn’t it better to limit “cure” for the aged since it is often of limited utility? Isn’t it better to do so while trading off an emphasis of “care” for those who benefit from it more than cure? There is ‘only so much of the pie’ to go around — does fair mean everyone gets an equal slice? Does it mean that some get more than others? Does it mean that some get nothing a certain times? Does it mean that some of us should relinquish our portion for the benefit of others?
Please do not include the questions, and also I would like to use the writer I used on my last assignment.