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: 

Managed-Care: 

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. 

Single-Payer: 

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.

Fee-for-Service: 

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 1980s 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 Better

Outline for Chapter 11 :

Munson, Ronald. INTERVENTION AND REFLECTION . 6th ED.,Belmont, California: Wadsworth Publishing Company, 2000.

RIGHT TO HEALTH CARE

SOCIAL CONTEXT:

CRISIS:

Costs are increasing- greater than rate of inflation

Failure to deliver decent and minimal for ALL who need it!

Medical Successes

25 -50 million of 260 million in the USA are not covered by any insurance

Underinsured- small companies, self insured

Children

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:

.org/

http://www.aflcio_healthcare/curing_fix.htm

http://www.uhcanohio.org/archives/uo_uninsured.html

http://www.meps.ahrq.gov/Papers/HL13_01-0023/HL13.HTM

http://www.statecoverage.net/who.htm

http://www.ncpa.org/pi/health/pd012699c.html

http://www.theatlantic.com/unbound/polipro/pp9808.htm

url?s describing viewpoints:

http://www.usc.edu/student-affairs/dt/V142/N10/03-america.10v.html

http://www.cthealthpolicy.org/consumers/items21-32.htm

http://www.inside.mc.duke.edu/archives/2001/010604/1.html

http://www.nursingworld.org/mods/mod3/cemcfull.htm

Need a National Health Insurance Plan

a. Single Payer Plan- Government pays the providers

Advantages:

universal coverage

portability of insurance

accessibility

comprehensiveness

controlling costs

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

Criticisms:

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

Advantages:

universal coverage

portability of insurance

accessibility

comprehensiveness

controlling costs

high quality of care

Criticisms:

select from an approved list of physicians

gatekeepers requireed

provider groups may reduce quality of care\undertreatment

undertesting

delay in referring to specialists

increased administrative costs

c. Managed Care - HMO-

Advantages:

reduced costs

Criticisms:

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

Incremental Solutions

Subsidies

Standard benefits

Insurance Regulations

Expand Medicare

Patient's Bill of Rights

for managed care

Abuses of Managed Care

management

approved drugs

gag clauses

capitation

bonuses

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

cost

number of people to be helped

how long a person would remain healthy

CASE PRESENTATION: Employer Mandated Health Insurance

Hawaiian Example

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

Proceed to the next section of the chapter by clicking here> next section.

Copyright Philip A. Pecorino 2002. All Rights reserved.

Web Surfer's Caveat: These are class notes, intended to comment on readings and amplify class discussion. They should be read as such. They are not intended for publication or general distribution.

Return to:                 Table of Contents for the Online Textbook