Posted on 08/05/2008 8:52:49 PM PDT by neverdem
A presidential committee explored the ethics of health system reform and plans to release a report later this year.
Chicago -- A panel appointed by President Bush that met here in June appears set to endorse some form of societal obligation to provide health care access to all.
The meeting was part of the President's Council on Bioethics initiative examining the ethical underpinnings of approaches to reforming the nation's health system and covering the estimated 47 million uninsured Americans. A report is likely to be issued after the November election.
Bush established the council in November 2001 to advise him after his decision to deny federal funds for research using newly created human embryonic stem cells met with fierce opposition. The council's first chair, Leon Kass, MD, PhD, primarily focused the group's attention on the ethical implications of scientific advancements such as cloning and assisted reproductive technology.
But in remarks before the panel in June, current chair Edmund D. Pellegrino, MD, made clear that he believes health system reform also has ethical dimensions. "What kind of society do we want to be?" he asked. "Are our values reflected in the way we've authorized and delivered this element of the flourishing of human beings?"
In an interview, Dr. Pellegrino said the goal of the council is not to recommend any political party's plan but to lay out in "an orderly, systematic and critical way" the ethical implications of various approaches on access to care, medical innovation, and individual freedom and responsibility.
"We will not be lecturing people on what's right and wrong," said Dr. Pellegrino, a spry 88-year-old widely recognized as a father of bioethics and the founding editor of the Journal of Medicine and Philosophy.
Despite Dr. Pellegrino's view, there was plenty of pushback from members of the conservative-leaning council.
Health system reform is "a black hole -- once you get in it, you never get out," said Gilbert Meilaender, PhD, professor of Christian ethics at Valparaiso University in Indiana. "The more we try to fully elaborate all the principles that might be involved in reforming the health care system, the more hopeless and black hole-ish things get."
Carl E. Schneider, JD, a bioethicist at the University of Michigan, agreed, saying the council -- composed primarily of physicians, ethicists and legal scholars with little expertise in economics or health policy -- was out of its depth. The reform plans are "all based on data and empirical evidence that we are entirely incompetent to evaluate," he said.
Meilaender said the council might be able to argue that providing care to those who cannot afford it is a "moral imperative." A majority of the council seemed to agree that society has a duty to provide everyone with access to health care.
A draft of the council's report notes "growing support for the claim that the problem of the uninsured is a moral problem for a prosperous society that strives to provide some measure of equality of opportunity."
The major split, the report said, comes when discussion moves to "how best to solve this problem." That division was reflected in panelists who spoke before the council on behalf of options such as a Massachusetts-style, individual health insurance mandate and a more market-oriented approach.
Steffie Woolhandler, MD, MPH, argued that the single-payer model prevails around the world in countries that provide better access to care at lower cost than the U.S. system. "I think single payer is the only morally acceptable reform choice, because it's the only effective one on the table," said Dr. Woolhandler, a primary care doctor who co-founded Physicians for a National Health Program in 1986. "If we're concerned about the 18,000 deaths a year due to uninsurance, then we are morally obligated to go with a plan that has been shown to work."
Other panelists were reluctant to declare their proposals morally superior, and there was no apparent consensus among council members about which proposal would best improve access to care.
Laurie Zoloth, PhD, director of the Center for Bioethics, Science and Society at Northwestern University's Feinberg School of Medicine, Chicago, attended the council meeting as an observer. She believes, based on panelists' discussions, that the panel will issue a report endorsing the principle of universal access to care. She said the statement would mean a lot coming from a panel appointed by Bush.
"The more people who say universal health care is a moral imperative, the better our society is," she said.
Last fall, the AMA's Ethical Force Program published an essay in the Hastings Center Report outlining a consensus framework for reform proposals. According to the report, reforms should ensure that everyone has adequate health care benefits established through an ethical process in a system that is financially sustainable over time and makes clear the responsibilities of doctors, patients, payers and society.
At its June Annual Meeting, the AMA House of Delegates adopted policy seeking to replace the tax deduction for employer-provided health insurance with tax credits and an exemption for health insurance spending from state and federal payroll taxes. Expanding coverage for the uninsured also tops the AMA's legislative agenda.
*sigh*
Can’t we just go bomb some more brown people and ignore this crap till after the election? (shameless Carlin thievery)
Then it would only be fair to also designate universal access to legal care. It shouldn’t be only for those who can afford it and for those who are grievously injured to avail themselves of a competent tort attorney to recover monies for any injuries sustained at the hands of a mistake-prone physician. Ethically speaking, of course.
"The more people who say universal health care is a moral imperative, the better our society is," she said.
OMG....doesn't this idiot understand that this country already HAS UNIVERSAL HEALTH CARE??????
btt
SEVEN years to come to the conclusion that we need socialized medicine.
Nice work if you can get it.
Where did this estimate come from? Does it include 30 million illegal aliens? If not, how many Illegal aliens DOES it include? Don't tell me that it's STILL 12 million.
A panel appointed by President Bush that met here in June appears set to endorse some form of societal obligation to provide health care access to all...and let's charge it to the American Bar Association.
Health system reform is “a black hole ...
Racist! Racist! Racist!!!
It should be called a “White hole...” (/sarcasm)
The key is how it's achieved. Do we use market mechanisms and incentives, or do we do it with socialized medicine?
It’s just like all the rest of socialism/communism/etc. It looks great on paper. Then you try it.
How does the Swiss system work?
Well, Obama is clean, blue lipped, big eared ,and skinny.
McCain is old, band aid headed, stiff, and mealy mouthed.
What has that got to do with anything?
Right, because the systems in the UK and Canada are doing so well.
The biggest problem these folks have when they look at the other countries that have single payer programs is that those societies that are doing it somewhat successfully are not the same type as ours. They typically are very homogenous, and don't have the same type of societal problems that we have, simply because we have so many cultures, and each culture has its own customs, ideas about medicine, etc.
Changing the system to enable each family to purchase its own health insurance, NOT necessarily tied to their employment, and having the govt. help those families who may have difficulty affording health insurance is the better way to go.
This coverage mandate eliminates the irresponisble, uninsured free riders who greatly inflate healthcare costs for the rest of us. It also eliminates the adverse selection problem, which also significantly contributes to the high cost of individual coverage in the US.
There is no favorable tax treatment of health insurance. You buy it with after-tax dollars. Hence there is no incentive to overinsure, as people do in the US. In addition, there is no favorable treatment of health insurance paid for by employers, so everyone buys his or her own insurance in a highly competitive market, so the insane practice of tying health insurance to employment doesn't exist there. This makes their labor markets more flexible.
Because of the high deductibles and copays, people there have an incentive to shop around for the lowest prices, unlike in the US. The lack of shopping here gives providers a degree of monopoly power they don't have in Switzerland. Also unlike in the US, people there have an incentive not to ask for procedures that aren't truly medically necessary. This not only reduces wasteful spending on unnecessary procedures, but it also reduces the need for costly monitoring and approval processes that insurance companies in the US are forced to conduct, greatly reducing administrative expenses.
In addition, because everyone has an individual, rather than group, policy, health care providers have to cater to individuals, rather than groups. Thus they don't have the price discrimination problem so endemic to our system, wherein group providers negotiate sweetheart rates with hospitals, who in turn gouge individuals to make up for it.
There is a sliding subsidy for the poor to buy private insurance (which I think is a political necessity in a modern democracy), but the vast majority of the population can afford it on its own.
Fascinating—thanks much!
Have to say, that sounds like the most reasonable universal-care system I’ve heard of yet.
I’m not in favor of government mandates for anything, but a system like this seems to be the only political alternative to an insane single-payer UK or Canada-type disaster.
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