Chapter 17 : A Claim of a Right to Health Care
|Section 3. Presentation of Issues.|
Summary by James Rowe, QCC, 2005
As social animals, it generally behooves humanity to seek ways whereby we might assure the well-being of even our most well off to a certain level. In modern society, current economic pressures have exerted upon all countries new problems in dealing with the crucial aspect of how we may do just that. Befuddling the matter, economic considerations are usually paramount, sometimes even eclipsing the ethical concerns, and owing to the vastly complicated nature of economics, this imposes upon us a plethora of conflicting issues to somehow resolve in the manner best suited to the needs and views of our individual countries and, more broadly, the world itself. Difficulty of anything, however, has never been an excuse not to tackle it, specifically when it impacts the lives of million each year, and thus mankind has devoted considerable intellectual pursuit towards finding the greatest potential end. That many partial solutions have been conceived and implemented all ready speaks leaps and bounds for our capacity to handle the issue, if only partially, and perhaps one day we shall see this matter resolved completely, specifically as few, if any, consider an improvement in overall medical quality a morally improper thing to be realized.
The three main solutions proposed and/or implemented in one country or another, are as followed:
This system, found extensively in the United States, is the practice of insurance – either government or private – which delineates which doctors, treatments, surgeries, one might access, as well as what hospitals one can visit, in order to assure that costs remain reasonable via limiting things to that which are necessary. Although often derided as too restrictive, Managed-Care has a proven track record and does tend to keep costs down for a period, if not forever, as well as providing good care at a reasonable price. HMOs practice a type of managed care.
The single-payer system, such as that which is used by Canada, is a means whereby the government, supported by taxation (often heavy), provides universally for its citizen under what becomes an arm of the government. Doctors and hospitals may or may not be nationalized and in theory, the medical bureaucracy is controlled by the people and works for the people. In recent years, questions as to the efficiency of this system in getting treatment to those who need it fast enough, as well as to whether medical breakthroughs and increases in technology can still progress under this system, has raised questions as to whether it is proper to continue supporting these systems, although their success in giving quality healthcare to practically everyone is incapable of being ignored.
Widely becoming a rarity, the fee-for-service plan essentially is one whereby one goes to a doctor and the insurance company, so long as the procedure is covered, pays for most, if not all, of what the doctor has charged one. Companies employed this system as a benefit to their workers extensively in the United States up until the 1980’s when the switch to Managed Care systems (mostly HMOs) took the place of this system. Since many of the problems of health care are not resolved under these systems, although they are effective for those who have it, it is generally not considered best for adoption on a wide-scale level anymore.
READ: More may not be BetterOutline for Chapter 11 : Munson, Ronald. INTERVENTION AND REFLECTION . 6th ED.,Belmont, California: Wadsworth Publishing Company, 2000.
RIGHT TO HEALTH CARE
Costs are increasing- greater than rate of inflation
Failure to deliver decent and minimal for ALL who need it!
25 -50 million of 260 million in the USA are not covered by any insurance
Underinsured- small companies, self insured
Case Description: The topic is about how 40 million people in the U.S. don?t have health care coverage. Out of those 40 million there are 10 million children that are uninsured. It?s a huge problem in our country that is seeking reform.
url?s describing case:
url?s describing viewpoints:
Need a National Health Insurance Plan
a. Single Payer Plan- Government pays the providers
portability of insurance
high quality of care
reduces overhead expenses
preserves freedom to choose physician
breaks control of private insurers and managed care companies
emphasis on primary care
emphasis on prevention
too radical change for the USA
government deeply involved in health care
long delays likely
explicit rationing likely
reduction of the rate of medical advance
b. Managed Competition
portability of insurance
high quality of care
select from an approved list of physicians
provider groups may reduce quality of care\undertreatment
delay in referring to specialists
increased administrative costs
c. Managed Care - HMO-
Monetary savings may be illusory with patients contributing more money
restricts patents' access to physicians and to treatments
restricts access to specialists
restricts physician's choice of therapies
Patient's Bill of Rights
for managed care
Abuses of Managed Care
cost reduction by inconvenience
investor owned - for profit managed care companies
Rights - emergency care, access to specialists, appeals, minimum standard of care, right to sue
CASE PRESENTATION: The Canadian System: Troubled but still a model?
Increased access and delay and decrease in quality
CASE PRESENTATION: Drawing the Line in Oregon: Rationing Health care
Ranking of medical services according to a formula based on three factors
number of people to be helped
how long a person would remain healthy
CASE PRESENTATION: Employer Mandated Health Insurance
Employers are required to provide for coverage
Claim Rights - serve as ground for other people's duties
Legal Rights-claim rights with legal remedies if the duty is not performed
Statutory Rights - claim rights that are explicitly recognized in legal statutes or laws- impose duties on certain classes of people under certain conditions
Moral Rights-- one that is stated in or derived from a principle in a Moral Theory
moral rights are claim rights which impose a moral duty
Political Rights: required by political commitments , e.g. the Constitution
Claim of a Right to Health Care is not legally recognized in USA .
The justification for such a right would be based on legal, social and moral principles. Principles that express the aims and commitments of the society.
AGAINST the Right to Health Care:
A. MEDICAL INDIVIDUALISM: a right to health care would violate the rights of health care providers to decide to whom they provide their services
B. Health Care is only one social good and there are others such as education, transportation, housing, legal aid etc.. There must be a limit. It is impossible to satisfy all claims.
Response to the two objections:
A. There exists a conflict in rights as with patients right to service and health care providers right to decide to whom to provide not just restrictions on the rights of providers
B. There may exist the possibility of a right to a minimum of health care and NOT a right to equal health care
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© Copyright Philip A. Pecorino 2002. All Rights reserved.
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