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Perspectives: Healthcare in the United States

Introduction:

Hello! I decided to research healthcare as it is a highly polarizing topic currently in the United States where I live. Being from Southern California in a very liberal school, I wasn’t exposed to many perspectives on healthcare. However, seeing how controversial a topic it was, I wanted to discover more about what values people hold highly compared to what stance that they take on the issue. I also wanted to learn more about how this debate came to be and what we need to do to fix this crisis. Personally, I believe that healthcare is a right and should be available for everyone, but I also know that I need more basis on healthcare in order to have a conclusive opinion. Really, this is about perspective. In order to come up with a system that most of the population is happy with, we need to take into account everyone’s point of view.

The History of Healthcare in the United States:

An example of older surgery. Long Island, Boston Harbor, MA.

The time that the American Medical Association (AMA) became a powerful national force incidentally was around the same time that doctors were no longer expected to provide free services to all hospital patients. The whole issue of healthcare began in the very beginning of the 1900s, also the time when surgery became more commonplace. The first protests for health insurance began in the 1910s, with progressive reformers gaining support, with opposition from physicians and other interest groups. However, as the United States entered the war in 1917, the reform effort was undermined. It was in the 1920s when reformers began to emphasize the cost of medical care instead of a loss of salary due to medical reasons. Also during the 1920s was when the cultural influence of the medical profession began to grow. Medical professionals’ incomes grew higher as well as the prestige associated with the job. In 1935, the Social Security Act was passed, omitting health insurance, and a push for health insurance within the Roosevelt Administration began, however, the politics began to be influenced by internal government conflicts. During the 1940s, prepaid group healthcare began but was seen as radical. President Truman also offered a national health program plan that would include all of American society, however, it was denounced by the AMA and called a Communist plot by a House subcommittee. It was in the 1950s when the attention turned to Korea and away from healthcare reform. At the time, America had a system of private insurance for those who could afford it, and welfare services for those who couldn’t. However, at the same time, federal responsibility for the sick and economically disadvantaged was established. Also during the 1950s, the price of hospital care doubled. As a result, those outside the workplace had extreme difficulty with affording insurance. To combat this, President Lyndon Johnson signed Medicare and Medicaid into law. During the 1970s, President Richard Nixon took further steps, renaming prepaid group health care plans as health maintenance organizations, providing federal endorsement, certification and assistance. Despite this, health care costs escalated, partially due to high Medicare expenditures, an inflation in the economy, expansion of hospital expenses and profits and large changes in medical care. American medicine was now seen as to be in crisis. Through the rest of the century, healthcare costs rose at double the rate of inflation, with multiple failed attempts at healthcare reform in the United States Congress. In 2010, the Affordable Care Act, or Obamacare was signed into law by President Barack Obama. This act increased coverage, but largely retained the structure of Medicare and Medicaid. However, insurers were forced to accept all applicants and charge equal rates, despite pre-existing conditions or sex. Currently, the Trump Administration has been attempting to repeal the Affordable Care Act, prompting many polarizing debates surrounding the issue. Healthcare remains an unsolved issue today.

Models of Healthcare Based On Different Ethical Lenses:

Is Healthcare a Right or a Privilege?: To some, a right means that there’s no difference between someone who’s earned and who hasn’t. There are many people who tend to lean conservative on the issue although healthcare could benefit them the most. Some people feel that the government needs to step back. Forcing people to pay for others oversteps the boundaries set in place for a democracy. Others feel that when they’ve worked their entire lives and others haven’t, not everyone deserves the same amount of help. However, healthcare is known for being a tricky subject, deservedly so. There are dozens of perspectives, most of which can be looked at and given a basis for understanding. Is healthcare like water? Something that we take for granted but we can’t live without? Should the government become more involved or less? For some, self-reliance, the ability to be independent, is drilled in from the beginning. For others, helping people no matter what stands as a value unrefuted. You get what you work for, the world will reward your effort. These sayings were made to comfort those who were treated unfairly. How are they supposed to react if they work hard their entire lives and see others boosted by a system without any effort? But then again, a right is defined as legal, social or ethical principles of freedom or entitlement. Healthcare fits that definition by simply providing the freedom of mental and physical security. Education is a right because we know that we need it for a future. Why shouldn’t health, the very basis of life be considered one as well? Healthcare depends on perspective. Who deserves it, who should pay, how it should happen, what it even is. The answers to these questions vary depending on who you are and in what position you’re in. In order to find a common ground, we must be willing to take into account other perspectives.

Equality vs. Equity: Let us suppose that there exists a society that values the belief it has a duty to guarantee equal access to health services to minimize health-based differences. However, just simply providing healthcare does not take into account the provision of healthcare in specific ways. If the society simple wants an equal opportunity of access, whether it is delivered privately or publically is irrelevant. Despite this, how would the cost of healthcare come into play? If all healthcare was the exact same price, this would still be unfair. Equal, yes, but fair, no. This is when equity comes into the picture. Giving something at the same price to everyone does not mean that society is equal. When people start off at different levels in the playing field, one low price to someone might mean an extremely high price to another. Should society therefore also decide to give each person a basic income to cover the cost of accessing healthcare? With this approach, if this income was considered no strings attached, people could choose what to spend it on. Pushing autonomy into the spotlight, people could choose to either spend their guaranteed income on healthcare or on other goods and services. While health-related differences may still exist, the society would have fulfilled its ethical duty to level the playing field by providing each person with sufficient resources. This system would rely on the individual people, not the society. Instead of structuring healthcare as a system for everyone at the same price, a need and use based system would prevent the misuse of funds. While saying that a country may advocate for universal healthcare, the society’s approach to attain that goal must remain consistent.

The Geisinger Health System in work.

Capitation: Some people who are opposed to free healthcare are the people providing the services: the doctors. Because much of medical care is paid on a fee-for-service basis, medical providers make more money the more patients they meet and the more procedures they perform. However, as a society, we don’t want a huge number of these services, as this means that we require all of those services. Frankly, most people don’t want to have to go see the doctor time after time after time or undergo procedures. They don’t want health services, they want to be healthy. However, if our population didn’t require as many services as we do now, not as many people get paid or as much. One payment model that encourages maintaining health is the capitation model, currently in use by the Geisinger Health System in Danville, Pennsylvania. After noticing that many of their diabetic patients live in areas with few supermarkets and an abundance of fast-food places, they began providing free and healthy groceries to their patients through a hospital pharmacy. Immediately, they noticed the average weight and blood pressure falling, with fewer diabetics requiring dialysis or eye surgery. The hospital also noticed a rise in profit, as the cost per patient for the food was two thousand dollars a year, while the savings from fewer procedures came out to more than twenty-four thousand dollars a year per patient. While one of the main battles among parties is who should pay for healthcare, the government or the private sector, we as a country need to look into the pricing of the healthcare services itself. Instead of health services, attempt for health.

 

The Effects of Universal Healthcare on Society:

Would Universal Healthcare Encourage Bad Health?: In order to avoid unwanted doctor visits and huge bills from insurance companies, many people make lifestyle changes in order to keep themselves as healthy as possible. Could it be that if healthcare becomes universal for everyone, people wouldn’t face the repercussions of lifestyle choices? Possibly, also possibly not. Having a successful system relies on the people who benefit from it. While some people may choose to abuse it, many others will choose not to. The fact remains that people can’t just rely on health services to save them. While medicine can be amazing, and we have incredible technologies available, there’s not a cure for everything. People don’t just want to go to the hospital and undergo treatment. Having treatment available if circumstances ever called upon them could either have two results: people may put less pressure on remaining healthy, or people will continue to attempt to stay healthy but have a peace of mind that there are options if anything did happen. However, there is a concern with how universal healthcare might be unfair to health-conscious citizens. Some diseases are heavily influenced by lifestyle. Is it fair that people who chose to smoke or drink in excessive amounts receive the same exact treatment as those who try all they can to stay healthy? There are some people who do things terrible for their health and make that decision consciously. However, lifestyle is also impacted by where you grew up, by what opportunities that were offered to you, by your economic status and by your race. Some people are raised in environments that aren’t conducive to eating organic and avoiding drugs. How should that be taken into account?

Would Providing Healthcare Benefit the Economy?: Economic historian Robert Fogel wrote a paper in 1993 demonstrating how improvements in health resulted in economic growth across the United Kingdom. He claimed that the health changes accounted for half of the economic advancement because of improvements in the quality and length of life. By boosting sanitation, the quality of food production and medical treatment, people were able to live longer and do more while living. Instead of immobilized by illness and disease, people were able to work harder and longer. Indeed, a Gallup poll found that overweight or obese workers and those with chronic health conditions in the United States miss around 450 million addition days of work a year compared to healthy workers, costing more than $153 billion per year because of lost productivity. A separate study published by the Milken Institute also found that diseases such as cancer, diabetes, stroke and other chronic diseases cost the United States $1.3 trillion per year. Poor health also negatively affects the education of students. Poor health leads to lower classroom attendance and negatively impacts the ability to learn, decreasing the quality and amount of education in societies.

 

More on Economy – How Would Universal Healthcare Affect Taxes?: While universal healthcare is often called “free” healthcare, in reality, that isn’t the case. Because universal healthcare would be government-run, it’s most likely that taxes would also be raised in order to compensate for the influx of patients and increase of treatments necessary. This issue often raises concern among people who can already afford healthcare, as they don’t find it fair that they would have to pay for someone else. Based on equality, there are multiple perspectives you could take on this topic. One, in order to provide everyone with equal opportunities, those who have the most should have a responsibility to help those who aren’t as privileged. Two, it’s neither equal nor fair for people to have to pay more than others when they have earned their money for themselves. Three, by lowering the gap between the elite and economically disadvantaged, everyone will benefit as society will function in a more productive manner.

More on Economy – How Would Universal Healthcare Affect Treatment Costs?: Right now, hospitals and medical professionals have a huge say over how much certain treatments cost. It is apparent that the United States has a very large issue when it comes to inflation of the price of medical services. Under a government-run, universal healthcare system, there would be much more regulation on the prices of treatments, hopefully reducing the prices of currently very expensive procedures. Because of this, a government-run system also has its advantages, as hospitals and insurance companies wouldn’t have as much power over the everyday person when it comes to the cost of necessary procedures.

How Would Universal Healthcare Affect the Quality of Treatment?: Right now, we are able to decide which doctor we go see. We can look them up and read reviews before choosing the one that we think will be best for our own treatment. However, under a universal healthcare system, there’s a possibility of doctors being allocated a set of patients that they must treat. This both undermines the very important doctor to patient relationship and leads to possibilities of doctors who aren’t suited for the necessary task. In order to trust a doctor, it’s important to know them at least a little. It’s always a comfort knowing that we have the option to try somewhere else if we feel necessary, however, that may not be a given under a universal healthcare system. In addition, one doctor may not know what a certain group of symptoms means while another will. If one doctor is randomly assigned a patient even though there’s a much better-suited doctor for them, there could either be a wrong diagnosis or a reference to another doctor, potentially delaying the time until treatment. This delay could lead to some serious outcomes, depending on the severity of the illness and the amount of time it actually takes. Another issue is how the doctor to patient ratio may be affected. If healthcare suddenly becomes a much more viable option for people, it’s most likely that they will go see medical professionals if needed. While many people today are dissuaded from the prospect of seeing the doctor or undergoing treatment because of its cost, if a universal healthcare system is put into place, that might not be an issue anymore. While more people having access to necessary treatments is a wonderful sounding idea, there could be an issue of there being too many patients for not enough doctors. An increase in patients might mean that the waiting time for tests or treatments could increase, leading to repercussions health wise. Doctors might also not have enough materials to treat everyone, causing chaos and confusion. However, like all of the other hypotheticals that come into mind, there’s no guarantee that something like this may happen. Despite that, we must always keep in mind the possibilities in order to be prepared for the worst outcome.

 

How Would Universal Healthcare Lead to Creative Destruction?: A concerning prospect when it comes to universal healthcare is the idea that it might lead to the suppression of innovation. In order for the government to afford all of the treatments necessary, it’s possible that they might force cuts on doctors and pharmaceutical companies for the most cost-effective system. This, in turn, could lead to both a lack of innovation and a lack of access to innovation already existing. If less focus is put on finding more cures and treatment options for harmful diseases, there could be a severe lack of progress in the medical innovation field. However, there is one thing to keep in mind. The biggest source of medical research funding in the entire world is the National Institutes of Health. This singular institution could be one of the reasons why the United States has had such success with medical breakthroughs, as there is no other institution that can match the National Institutes of Health in size. A system that supports universal healthcare wouldn’t change that fact, therefore medical innovation wouldn’t have to be hindered for the sake of affording treatments for everyone. While there is some reassurance in the National Institutes of Health, we must still remain cautious that we don’t completely swap medical care for medical innovation, as both are crucial for the development and health of society.

 

Conclusion: When I started this project, I knew that I believed that healthcare was a right that should be made available for everyone. Now, I still fundamentally believe that, but I also know more about why I believe what I believe. I still have questions, I still don’t have answers to everything, and I still know that I’m learning, but I have a little more knowledge about healthcare as a whole and the issues that surround it. I’ve always been a stubborn person, and I’m not ashamed of that, but I also know that I need to learn about perspective. One thing that I’ve learned while taking Bioethics is that every story has more than one, or even two, sides. In order to come up with a conclusive answer or solution, you have to look at the situation from every lens available. One position may correspond with one ethical principle and completely violate another. There is never one right answer, but tens or right answers based on how you frame it. Equality isn’t more important than individuality. Treating people with kindness isn’t more important than being fair. There aren’t clear answers or even clear distinctions about which is better because those values are a matter of personal opinion. Often, I’ve found that political views align with the values that we strive to uphold, which is why it’s so difficult to find a common ground that we all agree upon. It’s difficult to listen to others who you don’t agree with because their views can hurt people that you love and care about. It’s extremely hard to respect people who believe things that you find ridiculous. But what we do have to do is listen. We don’t have to value their opinion, but we have to value that they can have one that’s not our own. Maybe then, if we all try to listen to each other, we’ll get one small step closer towards progress.

 

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COMMENTS: 3
  1. April 26, 2018 by Ava.Carter Reply

    Wow, I loved your project. I think you do a phenomenal job at representing the many arguments for and against healthcare. I think healthcare is a highly contested and nuanced issue, so I’m glad you depicted it as such.

    • April 27, 2018 by Audrey Reply

      Thank you so much! I really appreciate the feedback.

  2. April 30, 2018 by CC Yin Reply

    Your project is great! Your topic is great because it’s very area specific and you include so much detail ( it actually looks like something someone could find in the New York Times) 🙂 Very professional and well done! I also really liked the poll and the videos!

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