Please read section 2of the textbook and listen to this lecture. An assignment is posted for this lecture.
ALLOCATION, SOCIAL JUSTICE, AND HEALTH POLICY ALLOCATION, SOCIAL JUSTICE, AND HEALTH POLICY Read all sections of part 2 in thetextbook ETHICAL ISSUES FOR HEALTH CARE MANAGERS SOCIAL VALUES AND PUBLIC POLICY US is a mix of people from different places who often maintain deep ties to a diverse mix of cultural values, American experiment is predicated on a basic respect for the freedom of individuals to forge their own identity, build their own communities, and use their distinctive gifts and perspectives to create something new. Values include emphasize individual liberty, autonomy, ingenuity, and industriousness Person’s ability to enjoy or take advantage of these values is deeply influenced by their health status. Healthy = freedom from health care needs problems For unhealthy with catastrophic disease or severe disability survival and quality of life is achieved through costly and intrusive application of intensive high-technology medical care. These inequalities in life prospects are exacerbated by social and economic inequalities that include unequal access to even basic health services. SOCIAL VALUES AND PUBLIC POLICY Values questions raised by health care policy include: How can we treat every citizen as the moral equal of every other if we permit some to suffer and die based on available resources? How can we protect liberty and the pursuit of happiness if some people never have the opportunity to develop and apply their talents and abilities because they suffer from the debilitating effects of sickness, injury, or disease? Should taxation to be used to fund universal access to the health system based on the need to protect community members against threats to individual safety, security, and autonomy posed by sickness, injury, and infectious disease. SOCIAL VALUES AND PUBLIC POLICY Competing Positions : Threats to health are the same as threats to national security -National security requires state action Provision of health services can be left to the private activities of individuals, social groups, and charitable organizations. Taxation is an encroachment on the liberty and autonomy of those whose financial resources are taken in order to provide health benefits to others. All Americans have effective access to meaningful health services provided by private markets, competitive forces, and charitable giving rather than government mandated programs. Lack of coherent and effective health policy because we disagree about what some of our most basic values require of us at the level of policy and practice. SOCIAL VALUES AND PUBLIC POLICY Examples of attempts to address disparities in health care access: Health Insurance (non-profit and for profit) Government Programs Medicare, Medicaid CHAPS Veterans and Military Health care Affordable Care Act Native American Health Care Programs SOCIAL VALUES AND PUBLIC POLICY Section 2 of the textbook examines some of the hard choices forced upon society by the confluence of an ever-expanding demand for health care, high-cost technology, and the rise of managed care and other cost-constraining strategies. When goods and resources are scarce, and not everyone can receive as much of a good as they need, society must face though questions about how to ration goods or services fairly. In the current pandemic this issue has already come to light. Issues of priority setting and allocating scarce resources are a fundamental component of every health care system but worsen during a health care crisis SOCIAL VALUES AND PUBLIC POLICY FACTORS THAT INFUENCE HEALTH CARE STATUS A person’s health is determined by many factors that are beyond their control including: inherited genetic traits maternal and paternal health habits which are highly correlated with: the level of maternal education, socioeconomic status, environmental factors such as: the presence of toxins, neighborhood ecological issues such as dirty water The presence or absence of many of these factors plays a crucial role in determining which life choices will remain open to an individual. Despite having an employer-based health insurance system, Many working Americans remain uninsured. Many are unable to afford routine medical care that would prevent a medical crisis, Americans who fall prey to accidents or medical emergencies cannot be turned away from emergency medical care. The inability of the uninsured to pay for their care forces many into bankruptcy, Creates stealth tax on the insured who face higher health costs in order to make up for the difference. FACTORS THAT INFUENCE HEALTH CARE STATUS Question raised: Whether social inequalities in health are unjust or merely unfortunate—a failure of charity or a violation of rights—and how these inequalities should be addressed. The President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research report An Ethical Framework for Access to Health Care. FACTORS THAT INFUENCE HEALTH CARE STATUS An Ethical Framework for Access to Health Care Report: Health problems can significantly affect the range of social opportunities that are open to an individual. Health problems and the restrictions on opportunity that they produce are often undeserved. Factors that cause health problems are often difficult to predict and to prevent, Factors that cause illness are widely but unevenly distributed in society, Their effects on individuals are often costly to ameliorate. Ethical arguments for society’s role in health of the individual An Ethical Framework for Access to Health Care Report: The president’s commission views health care as being different from other consumer goods because It is crucially related to one’s level of well-being, helping ward off pain, suffering, and premature death Like education, health care is necessary to achieve equal opportunity in society. The commission insists that this social obligation is not unlimited -it must be discharged with an eye to the costs and burdens to society in meeting it. Ethical arguments for society’s role in health of the individual Norman Daniels - “Equal Opportunity and Health Care.”: Health needs are special in that they relate to our ability to function as normal members of our biological species. Lack of equal opportunity due to illness is not “merely unfortunate” in any society that is committed to providing equal opportunity to its members it is unjust therefore, people deprived of adequate health care in our society are treated unjustly. Ethical arguments for society’s role in health of the individual Robert M. Sade - “Foundational Ethics of the Health Care System: The Moral and Practical Superiority of Free Market Reforms Rejects theories of health care justice. The role of legitimate government is to protect the security of individuals, their property, and their rights to be free from outside interference in making contracts and transacting freely with others. A unavoidable consequences of a free society is that people form competing and often incompatible views about the good life including the importance of health and its maintenance relative to other life projects and plans. Ethical arguments for society’s role in health of the individual Robert M. Sade - “Foundational Ethics of the Health Care System: The Moral and Practical Superiority of Free Market Reforms Not taxing people in order to fund a vision of health care that they do not accept. Allowing people to engage freely in a market for health services so they can buy the kind and amount of insurance or health services that reflect their preferences about risk and the importance of health and health care relative to other goods and goals. Sade’s rejection of a right to health care is also grounded in his rejection of the assumption, common to both Daniels and the President’s Commission, that health care is a major determinant of most people’s health status. Health status determinants are life choices relating to how active or sedentary they are, what they eat, where they live, how fast they drive, and what kind of risks they take. Ethical arguments for society’s role in health of the individual Paul T. Menzel- “The Realistic Moral Right to a Basic Mini- mum of Accessible Health Care” Deeply held commitments and existing social policies entail the existence of an actionable moral right to health care. Defends reforms, such as the ACA’s individual mandate Not as creating a new right -enabling society to more coherently and efficiently honor a right that it already recognizes in a disorganized and uncoordinated way. Ethical arguments for society’s role in health of the individual Paul T. Menzel- “The Realistic Moral Right to a Basic Mini- mum of Accessible Health Care” Americans have broadly rejected the idea that it is permissible to deny emergency medical care to those who are unable to pay through the Emergency Medical Treatment and Labor Act (EMTALA) which states that hospitals are legally forbidden to refuse to provide emergency care to patients regardless of their ability to pay. Effectively turns health care into a public good Ethical arguments for society’s role in health of the individual Paul T. Menzel- “The Realistic Moral Right to a Basic Mini- mum of Accessible Health Care” In order to avoid unfair free riding it is necessary to spread the burden of funding this public good more evenly across the population that benefits from its consumption. This means requiring people to spend their own resources to purchase insurance and providing financial assistance to those who cannot afford insurance. Ethical arguments for society’s role in health of the individual Both Menzel and Sade regard the current health system in the U.S. as an incoherent mess. Both agree that this incoherence could be rectified by embracing the libertarian formula outlined by Sade and allowing those who cannot afford medical care to suffer and die of preventable causes. Menzel thinks that we have already rejected such an approach in policy and in law. Both support a mandate for universal participation in health insurance coverage that will make possible universal access to a more sensible package of basic medical care. Ethical arguments for society’s role in health of the individual Ichiro Kawachi - “Why the United States Is Not Number One in Health Lack of access to social determinants of health that explains why the United States compares so poorly to other developed countries on key health measures. U.S. expenditures account for about half of all the money spent on medical care across the globe. The world’s wealthiest nation does not have the best health outcomes. Kawachi argues that three factors that are commonly cited as causing these shortcomings do not reflect reality Ethical arguments for society’s role in health of the individual Ichiro Kawachi - “Why the United States Is Not Number One in Health Argues that it is difficult to lay blame at the feet of individuals for their poor health behaviors: Many such behaviors are initiated in childhood, These behaviors can be seen as responses to environmental factors that are overrepresented in poor and minority neighborhoods. Lack of access to universal health care cannot explain the poor performance of the United States on important health measures but may improve it. Root cause of poor outcomes is the high degree of social inequality that characterizes the United States. Ethical arguments for society’s role in health of the individual ALLOCATING SCARCE RESOURCES Even if we can reach consensus that there is a right to health care, we must still learn to assign