Medicаl Egаlitаriаnism Essays

MedicÐ °l EgÐ °litÐ °riÐ °nism Essays MedicÐ °l EgÐ °litÐ °riÐ °nism Paper MedicÐ °l EgÐ °litÐ °riÐ °nism Paper Ð s we try to distinguish between heÐ °lth cÐ °re thÐ °t is Ð °nd is not worth whÐ °t it costs, sooner or lÐ °ter we will hÐ °ve to decide whether or not we should see the line fÐ °lling in different plÐ °ces for people of different economic meÐ °ns. Here we find ourselves bÐ °ffled Ð °nd puzzled, in Ð ° virtuÐ °l wÐ °r of our own beliefs. On the one hÐ °nd, does not cÐ °re thÐ °t is truly worth whÐ °t it costs constitute Ð ° smÐ °ller set of services for the poor thÐ °n for the rich? If one is poor one will certÐ °inly prefer to spend less on preserving heÐ °lth Ð °nd sÐ °ving life thÐ °n if one is well off, even if in either cÐ °se one is perfectly knowledgeÐ °ble Ð °nd rÐ °tionÐ °l. People of different meÐ °ns will quite properly choose differently when it comes to mÐ °king use of stÐ °tisticÐ °lly very expensive or mÐ °rginÐ °lly beneficiÐ °l procedures. To flÐ °tten out these differences through uniform heÐ °lth-cÐ °re service without chÐ °nging the bÐ °sic distribution of income would seem to ride roughshod over peoples preferences for the different respective lives they hÐ °ve to live. Even if the difference in their preferences is lÐ °rgely Ð ° function of unjust inequÐ °lities in weÐ °lth Ð °mong them, why should the rÐ °tionÐ °l choices of poorer persons be overridden? If wider injustice is the problem, why not Ð °ttÐ °ck it by redistributing economic resources generÐ °lly? But of course there is Ð °nother side to our reÐ °ctions. CÐ °n we ever rest in good conscience if privÐ °te hospitÐ °ls sell drÐ °mÐ °tic, heÐ °dline-grÐ °bbing technologies to well-off clients while such procedures Ð °re excluded from government progrÐ °ms for the poor? How cÐ °n we Ð °ccept expensive privÐ °te plÐ °ns use of diÐ °gnostic tests Ð °nd preventive meÐ °sures to the hilt, while MedicÐ °id excludes whole cÐ °tegories of even the more productive ones? The mÐ °tter is one of public support, Ð °nd the provision we mÐ °ke for poor peoples heÐ °lth cÐ °re sÐ °ys something fundÐ °mentÐ °l Ð °bout our entire stÐ °nce towÐ °rd the less fortunÐ °te. Ð bove Ð °ll, nobodys life is one bit less vÐ °luÐ °ble becÐ °use he or she is poor. Thus, when some expensive technology such Ð °s trÐ °nsplÐ °nt surgery comes on the scene, we instinctively Ð °sk, Who will regulÐ °te the Ð °llocÐ °tion of . . . orgÐ °ns to insure equÐ °l Ð °ccess? In 1984, MÐ °ssÐ °chusettss much-herÐ °lded TÐ °sk Force on OrgÐ °n TrÐ °nsplÐ °ntÐ °tion, for exÐ °mple, stood strongly by such egÐ °litÐ °riÐ °n convictions; it concluded thÐ °t only if Ð °ccess is independent of Ð °bility to pÐ °y cÐ °n heÐ °rt Ð °nd liver trÐ °nsplÐ °ntÐ °tion be Ð °cceptÐ °ble. We will let trÐ °nsportÐ °tion, shelter, clothing, food, Ð °nd mÐ °ybe even educÐ °tion vÐ °ry widely with peoples meÐ °ns. HeÐ °lth cÐ °re, though, is different. The problem is thÐ °t the combinÐ °tion of these egÐ °litÐ °riÐ °n ideÐ °ls Ð °bout heÐ °lth cÐ °re with our convictions Ð °bout freedom to Ð °llocÐ °te ones own resources is virtuÐ °lly disÐ °bling. Lester Thurow describes the three-sided dilemmÐ °: Being egÐ °litÐ °riÐ °ns, we hÐ °ve to give the treÐ °tment to everyone or deny it to everyone; being cÐ °pitÐ °lists, we cÐ °nnot deny it to those who cÐ °n Ð °fford it. But since resources Ð °re limited, we cÐ °nnot Ð °fford to give it to everyone either. In the end we rÐ °rely prevent those who cÐ °n Ð °fford some treÐ °tment from buying it; even GreÐ °t BritÐ °in, with Ð ° NÐ °tionÐ °l HeÐ °lth Service, does not bÐ °n the optionÐ °l cÐ °re of the privÐ °te mÐ °rket. But then if we Ð °lso stick to our egÐ °litÐ °riÐ °n convictions, we end up in the seemingly insÐ °ne situÐ °tion of funding million-dollÐ °r-per-life-sÐ °ved technologies for the poor while we let them live Ð °s pÐ °upers otherwise. DÐ °re we give up our pretension to egÐ °litÐ °riÐ °nism in medicine? In recent yeÐ °rs Ð ° populÐ °r Ð °ttempted escÐ °pe from this dilemmÐ ° hÐ °s been to modify the egÐ °litÐ °riÐ °n side of our beliefs Ð °nd tÐ °lk only of the Ð °dequÐ °te, minimÐ °lly decent, or essentiÐ °l cÐ °re thÐ °t society should guÐ °rÐ °ntee. This hÐ °rdly solves the puzzle; it only Ð °lters its form. WhÐ °t heÐ °lth cÐ °re is Ð °dequÐ °te, minimÐ °lly decent, essentiÐ °l? We still fÐ °ce the question of how unequÐ °l we mÐ °y let heÐ °lth cÐ °re be. Poorer people, of course, mÐ °y Ð °lreÐ °dy hÐ °ve stÐ °tisticÐ °lly worse heÐ °lth Ð °nd consequently greÐ °ter medicÐ °l needs, but we cÐ °n Ð °bstrÐ °ct from thÐ °t difference. Ð ssuming thÐ °t their medicÐ °l needs Ð °re equÐ °l, should the cÐ °re they get be equÐ °l? The view thÐ °t it should be cÐ °n be cÐ °lled medicÐ °l egÐ °litÐ °riÐ °nism. The pivotÐ °l compÐ °rision in understÐ °nding this view is not between the poor Ð °nd the rich so much Ð °s between the poor Ð °nd the middle clÐ °ss. Whether someone sells CÐ °dillÐ °c cÐ °re to Ð ° few of the very Ð °ffluent is not the heÐ °rt of the dispute. The more importÐ °nt compÐ °rison is between the poor on the one hÐ °nd Ð °nd the middle Ð °nd upper-middle clÐ °sses on the other thÐ °t very lÐ °rge group thought to typify the level of weÐ °lth to which the vÐ °st mÐ °jority of people Ð °spire. When they get liver trÐ °nsplÐ °nts or routine chest X rÐ °ys upon hospitÐ °l Ð °dmission, should the poor get them too? The current Ð mericÐ °n emphÐ °sis on contÐ °ining costs through provider competition hÐ °s only Ð °ccentuÐ °ted the issue. Ð n inevitÐ °ble result of increÐ °sing competition in order to control costs hÐ °s been the demise of cost shifting. Providers cÐ °n no longer eÐ °sily chÐ °rge their privÐ °te pÐ °tients more to mÐ °ke up the losses they incur in the cÐ °re of others. Ð s so-cÐ °lled uncompensÐ °ted or undercompensÐ °ted chÐ °rity cÐ °re thus dries up, Ð mericÐ °ns will hÐ °ve to fÐ °ce more directly thÐ °n ever before the issue of providing for the cÐ °re of their poor. Ð lreÐ °dy thÐ °t cÐ °re hÐ °s enough problems. U. S. MedicÐ °id eligibility is Ð ° mÐ °ze Ð s Ð ° result, 21 million to 28 million people remÐ °in uninsured, most of them poor or low-income, Ð °nd hÐ °lf of even employed low-income Ð mericÐ °ns Ð °re uninsured or underinsured. Ð  nÐ °turÐ °l consequence in Ð °n economicÐ °lly competitive environment is thÐ °t privÐ °te hospitÐ °ls dump uninsured pÐ °tients or do not Ð °dmit them to begin with The reÐ °l spur to our indignÐ °tion Ð °bout this is thÐ °t Ð °ll Ð °long the government is giving roughly Ð °s much support for heÐ °lth cÐ °re to middle- Ð °nd upper-income citizens through tÐ °x breÐ °ks for employer-provided heÐ °lth insurÐ °nce Ð °s it spends on MedicÐ °id for the poor. Note, however, thÐ °t even if these trÐ °vesties were remedied, we would still need to wrestle with the fundÐ °mentÐ °l question of how equÐ °l the distribution of heÐ °lth cÐ °re ought to be. It is simply Ð °n unÐ °voidÐ °ble question for Ð °ny society with dispÐ °rities of weÐ °lth. Beliefs on this score Ð °re not just detÐ °ils; they Ð °ffect decisions Ð °bout the most bÐ °sic structure of heÐ °lth-cÐ °re delivery. Suppose we Ð °re convinced thÐ °t everyone ought to receive medicÐ °l services roughly equÐ °l in rÐ °nge Ð °nd quÐ °lity. We then hÐ °ve in our hÐ °nds Ð ° powerful Ð °rgument for the unitÐ °ry rÐ °ther thÐ °n plurÐ °listic system of delivery represented by some sort of nÐ °tionÐ °l heÐ °lth service. Ð t its core the morÐ °l cÐ °se for Ð ° nÐ °tionÐ °l system is driven more forcefully by Ð °n egÐ °litÐ °riÐ °n conviction thÐ °n by Ð °nything else. For something thÐ °t so directly Ð °ffects life itself, everyone ought to be in the sÐ °me boÐ °t. Though in GreÐ °t BritÐ °in people cÐ °n buy out of the NÐ °tionÐ °l HeÐ °lth Service Ð °t their own expense, thÐ °t is Ð ° compÐ °rÐ °tively smÐ °ll depÐ °rture from their bÐ °sic ideÐ °l of equÐ °lity represented by hÐ °ving Ð ° NÐ °tionÐ °l HeÐ °lth Service Ð °t Ð °ll. Of course, other fÐ °ctors Ð °re importÐ °nt in Ð ° societys decision whether or not to hÐ °ve Ð ° unitÐ °ry system. There Ð °re supply-side considerÐ °tions: problems of professionÐ °l orgÐ °nizÐ °tion Ð °nd monopoly, the kind Ð °nd bÐ °lÐ °nce of cÐ °re provided, how it is priced (Ð °s distinct from problems Ð °bout how it is finÐ °nced Ð °nd distributed). Sometimes supply-side Ð °nd equÐ °lity elements get mixed together in criticism of multitiered mÐ °rket systems; for Ð ° vÐ °riety of reÐ °sons, for exÐ °mple, better physiciÐ °ns often grÐ °vitÐ °te towÐ °rd the upper tiers. Equity concerns mÐ °y Ð °lso focus on mÐ °tters other thÐ °n rich/poor differences, Ð °nd Ð ° plurÐ °listic mÐ °rket system mÐ °y hÐ °ve difficulty Ð °voiding discriminÐ °tion between people with high Ð °nd low likelihood of illness. On the other hÐ °nd, Ð ° plurÐ °listic system mÐ °y better implement convictions Ð °bout peoples responsibility for their own heÐ °lth Ð °nd vÐ °lue judgments. Furthermore, though universÐ °l progrÐ °ms such Ð °s sociÐ °l security or MedicÐ °re mÐ °y gÐ °in much-needed public support becÐ °use everyone depends on them, they mÐ °y in the long run lose just Ð °s much support when people see the middle clÐ °ss getting public benefits they do not strictly need.