The musical Rent, about a community of people living with AIDS, begins with the song “Seasons of Love.” This song asks the simple question: how do you measure a year in the life? This question is also applied to the ethical issues surrounding healthcare costs. Politicians, ethicists, and doctors must ask themselves this question all of the time when analyzing the ethics behind health. Is a human life worth less than extra profit for private insurance or pharmaceutical companies who raise the prices of medicine and care? Is a year of one person’s life worth more than a public park that could be funded with the same money? These questions and many more will be addressed, analyzed, and answered on this webpage.
Before we dive deep into ethical questions we must first understand the basics of healthcare. Some countries, such as Britain with the NHS, have government funded and provided healthcare. This allows every citizen to be on the same healthcare plan and makes healthcare free or considerably less expensive because the government covers the cost of medicine and treatment. In the United States, we have private health insurance. Citizens are usually provided insurance through their employer. This insurance covers the cost of the majority of treatments and medicine. This model of health coverage creates many issues.
PROBLEMS WITH PRIVATE HEALTH INSURANCE:
The first major issue with the private insurance model is that often the most vulnerable members of the population are left without healthcare. Since insurance is often obtained through employment, those that or unemployed or who have jobs with poor benefits are left without insurance. This means that the poorest members of the population are left to cover the cost of their healthcare entirely by themselves while the more fortunate have ways to defer the cost of their care. Since most people have insurance, hospitals will often charge high prices for medicine, forcing uninsured patients to also pay the raised price. addition, most insurance does not cover all cost. Companies will cover the cost of certain treatments or medicines up to a certain point leaving the rest for the patient to pay as a “copayment.” Different insurance companies cover different amounts of the cost of each medicine. This means that doctors have no way of knowing how much a prescription will cost each patient. Sometimes a patient faces major financial troubles overpaying for medicine when their doctor could have prescribed a cheaper, alternative method. Issues in this arena have created a “price transparency” movement with sites like fairhealth,org laying out the cost of different medicines under a variety of insurance plans. There is also the issue that medicine has become big business. Cancer drugs made $25 billion in 2006. Congress has long been dealing with the issue of how much to regulate the pharmaceutical companies when they jack up the prices of relatively easy to make drugs, which brings up the question how much is a human life worth in comparison to extra profit?
PRIVATE NEED VERSUS PUBLIC GOOD:
One of the biggest questions when it comes to the affordability and feasibility of a public healthcare system is the idea of the “opportunity cost,” or all of the things that the government could be doing with the money it uses to fund healthcare. One major issue is that when the government becomes a healthcare provider they become ethically obligated to ensure that every person has equal access to care, but the high cost of one patient’s care might cause them to ration someone else’s. Specific medicine can be easily recreated by other companies and sold at a low price, so to incentivize the creation of new medicines governments will sometimes give certain companies a monopoly in a certain drug. This allows that company to raise the price incredibly high. When governments are also the provider of healthcare they then have to pay for this medicine. A cancer treatment can cost up to $10,000 dollars per cycle for a provider. People against healthcare argue that this money spent on one person could be used to help the entire community, through the creation of parks or funding of schools. They claim that the private market should be used for private individual needs and can function without public funds. It is true that healthcare coverage diverts a large amount of money away from other projects. The cost of public healthcare in California alone would be $400 billion, more than double the state’s budget. To cover this cost the state would have to raise taxes, making many citizens unhappy. So, healthcare becomes an issue of private need versus the public good. In order for the government to save on individual they have to sacrifice some of the public happiness. To answer the question of whether a country should have healthcare the question of what is more important: individual happiness maximized or collective happiness maximized must be answered first.
- Universal healthcare allows for everyone to receive treatment without worrying about financial hardship, keeping people from not getting treatment to help their family say financially afloat.
- It keeps everyone healthier, providing the most benefit to the largest amount of people
- The poorest populations often face the highest risks and need the most health services.
- Based on the justice principle of responsibility: the richest parts of the population help the poorest parts through taxes
- The UN has declared health a fundamental human right.
- Health helps people be more productive and allows children less time being sick or caring for sick so they can learn at school.
- UN considers universal healthcare a key part of sustainable development and poverty reduction.
- The government doesn’t have enough money to cover everyone’s medical costs, this could create in some people not getting the medicines they need, which could be more detrimental than financial troubles.
- The government would also put in price controls, which would cause the supply of drugs to decrease and lead to shortages of life-saving drugs.
- People would be unable to choose their insurance plan, preventing them from being covered by a plan that would benefit their individual healthcare needs the most.
- The government can’t make decisions about what would best benefit every individual person in the country.
The United States has aimed to have a more public healthcare system previously – most notably with Barack Obama’s Affordable Care Act (ACA), popularly known as Obamacare. Obama’s efforts were vehemently opposed by the right. While debates continue online, on TV, and in real life about the validity of ACA nobody really stops to address what it is.
Obama’s goal for Obamacare was to make healthcare more accessible and to cut the cost of healthcare in general. Currently, the United States has two programs Medicare and Medicaid which provide healthcare for the elderly and incredibly poor, respectively. These two programs take up a massive amount of the federal budget, and Obama was hoping to cut costs by standardizing the entire healthcare system. One program the ACA provided was online exchanges, where people could compare insurance plans to see which ones worked best for their financial and physical situations. In addition, it mandates that all plans contain ten “essential health benefits.” In addition, it provides services to help people enroll in healthcare plans, allows for more people to be covered by Medicaid, and made it easier for small business owners to provide insurance for their employees. While the Affordable Care Act did not create socialized healthcare, it introduced more government presence in the private insurance industry and aimed to make it easier for more marginalized groups ( the disabled or chronically ill, poor, and elderly) to get on a health insurance plan. The Trump administration is currently working to dismantle ACA.
This is an interview with my mom, a biology professor, and breast cancer survivor, about her experiences with private and public healthcare systems.
THE BIOETHICAL PRINCIPLES:
Autonomy: Autonomy is a principle that can be used in arguments to support and reject public health care. Supporters of a public healthcare system would say that people are able to make their decisions about their own body free from the influence of others when they don’t have the opportunity for treatment. They cannot make the choices that they feel would be suit their treatment, because the financial burden of being uninsured outweighs their health needs. If the government provides healthcare for everyone, people would make healthcare decisions purely based on what is best for their body instead of making decisions that are mainly financial. However, the opposite side would argue that private health insurance is necessary for autonomy because it is more individualized. Since the government has fewer funds and more people on insurance than private companies, often everyone gets the same type of healthcare and medicine for conditions, even if they could benefit from a more customized treatment. The private sector allows for more customization, allowing every patient to pick the treatment that they feel is exactly right for them. If the government provided a more standardized form of healthcare patients would feel that the governments are making poor decisions for them, thus violating their autonomy.
Nonmaleficence: The principle of nonmaleficence states that they cannot willingly cause harm to the patient and must do everything in their power to prevent harm. A bioethical question to ask from this information is if financial harm is included in the harm that doctors must prevent. If it is, doctors would have to consider how much financial harm a potential healthcare treatment would provide. This puts doctors in private healthcare systems in a difficult situation: denying an uninsured patient access to treatment because the doctor knows the patient can’t afford it causes physical ruin, but giving them the treatment could cause an equal amount of financial ruin. Doctors in a public healthcare system don’t have to weigh these costs, because no patient has a high healthcare bill, and only needs to consider the costs and benefits as they relate to the health of the patient, which results in the doctor building the best possible treatment. However, the counterargument to this point could be that doctors can cause a smaller amount of harm in private healthcare systems because the government does not provide everything, and so the doctor might have more resources to do better and more cutting-edge treatments.
Beneficence: The principle of beneficence states that doctors must aim to provide the most benefit to their patients. An important bioethical question to ask relating to this principle would be: if the government, pharmaceutical corporations, and insurance companies are involved in providing healthcare are they bound to the same bioethical principles as the doctors who directly provide the care? If one believes that the answer is no, then the argument can be made that private healthcare systems and high costs for treatment are ethical because the companies that provide the access to care don’t have any obligation to provide the most benefit (physical or financial) to those they serve. However, if one says the answer is yes, then the private system doesn’t adhere to the principle of benefit. The system of private healthcare does not provide the most benefit to patients, because certain patients incur financial harm greater than the benefit of the healthcare because they carry the burden of paying for their care by themselves. Others don’t receive any health benefits because they refuse to get treatment for fears that it will bankrupt them. In addition, pharmaceutical corporations also don’t follow the principle of beneficence, because the high price for medicine does not give patients the most benefit, fairly priced medicine that results in a financial cost less than the physical benefit of the treatment would, but often medicine is so highly priced that this is not the case. Finally, if governments also have an ethical duty to abide by beneficence they have a duty to provide healthcare to all citizens so that they can ensure that all of the people they serve are getting the most benefit out of their treatment.
Justice: The justice principle states that everyone is entitled to equal and fair opportunities at healthcare. On the surface, this would support a government-funded healthcare system where everyone has the same insurance plan and receives the same care. However, there are different theories of justice that relate to the principle. For instance, one theory of justice is that power theory which states that it is just for people with more power or money to gain certain advantages because they worked to gain these advantages. Essentially, if someone achieved a status above the level that they started at with everyone else they are entitled to better benefits. If you buy into this theory of justice, then the private system of healthcare would be considered more just because it rewards people with jobs. Another theory is the responsibility theory or the idea that people with more have a responsibility to help those with less. This theory would support government-backed healthcare because taxpayers with higher incomes would be paying to support those who cannot afford to pay for healthcare. When it comes to justice, the principle can be used to support each different side of the healthcare debate depending on what theory is employed.
CONCLUSION: The issue of healthcare is a complicated and nuanced one. As one can see from the different arguments that can come from each bioethical principle, whether one believes a private or public healthcare system is more ethical depends largely on their own pre-existing ethical beliefs and interpretations of the bioethical principles. However, I truly think that after a bioethical analysis of different healthcare systems it is clear that government-funded healthcare is the more ethical option. The United Nations has a sustainability goal of good health and well being. This goal strives for everyone on the planet to live a healthy life. This goal cannot be achieved if access to basic healthcare is unavailable to large swaths of the population because they cannot afford it. Often the burden of healing patients is placed on doctors, they are the group that pledges to follow the principles of beneficence and nonmaleficence, but they cannot prevent harm and cause benefit without help from others in the healthcare industry. Doctors cannot help if the life-saving medicine they prescribe causes financial ruin, the only way they can fix this issue is if pharmaceutical companies pledge to decrease prices as much as possible. All members of the healthcare industry must be held to the same principles as doctors, so all can work together to provide the best care. All of the bioethical principles boil down to the UN sustainability goal of good health and well being. Beneficence and nonmaleficence prevent benefit and preventing harm. Justice promotes everyone from getting equal access to healthcare. Autonomy promotes a human’s right to make decisions about their body, which they cannot properly do with outside financial pressures. The principles show that is entitled to the best possible shot at a healthy life, but this cannot be achieved until governments ensure that their citizens are receiving the care they need.
Please take the poll linked here to share your opinions on high costs of healthcare in the United States: https://forms.gle/iUqk1tZfahBRTRg8A
CALL TO ACTION:
If this presentation motivated you to share your opinion on the high cost of healthcare I strongly suggest writing the congressperson in your district to let them know why public/private healthcare is important to you.