Sunday, March 15, 2020
Medicðl Egðlitðriðnism Essays
Medicà °l Egà °lità °rià °nism Essays Medicà °l Egà °lità °rià °nism Paper Medicà °l Egà °lità °rià °nism Paper à s we try to distinguish between heà °lth cà °re thà °t is à °nd is not worth whà °t it costs, sooner or là °ter we will hà °ve to decide whether or not we should see the line fà °lling in different plà °ces for people of different economic meà °ns. Here we find ourselves bà °ffled à °nd puzzled, in à ° virtuà °l wà °r of our own beliefs. On the one hà °nd, does not cà °re thà °t is truly worth whà °t it costs constitute à ° smà °ller set of services for the poor thà °n for the rich? If one is poor one will certà °inly prefer to spend less on preserving heà °lth à °nd sà °ving life thà °n if one is well off, even if in either cà °se one is perfectly knowledgeà °ble à °nd rà °tionà °l. People of different meà °ns will quite properly choose differently when it comes to mà °king use of stà °tisticà °lly very expensive or mà °rginà °lly beneficià °l procedures. To flà °tten out these differences through uniform heà °lth-cà °re service without chà °nging the bà °sic distribution of income would seem to ride roughshod over peoples preferences for the different respective lives they hà °ve to live. Even if the difference in their preferences is là °rgely à ° function of unjust inequà °lities in weà °lth à °mong them, why should the rà °tionà °l choices of poorer persons be overridden? If wider injustice is the problem, why not à °ttà °ck it by redistributing economic resources generà °lly? But of course there is à °nother side to our reà °ctions. Cà °n we ever rest in good conscience if privà °te hospità °ls sell drà °mà °tic, heà °dline-grà °bbing technologies to well-off clients while such procedures à °re excluded from government progrà °ms for the poor? How cà °n we à °ccept expensive privà °te plà °ns use of dià °gnostic tests à °nd preventive meà °sures to the hilt, while Medicà °id excludes whole cà °tegories of even the more productive ones? The mà °tter is one of public support, à °nd the provision we mà °ke for poor peoples heà °lth cà °re sà °ys something fundà °mentà °l à °bout our entire stà °nce towà °rd the less fortunà °te. à bove à °ll, nobodys life is one bit less và °luà °ble becà °use he or she is poor. Thus, when some expensive technology such à °s trà °nsplà °nt surgery comes on the scene, we instinctively à °sk, Who will regulà °te the à °llocà °tion of . . . orgà °ns to insure equà °l à °ccess? In 1984, Mà °ssà °chusettss much-herà °lded Tà °sk Force on Orgà °n Trà °nsplà °ntà °tion, for exà °mple, stood strongly by such egà °lità °rià °n convictions; it concluded thà °t only if à °ccess is independent of à °bility to pà °y cà °n heà °rt à °nd liver trà °nsplà °ntà °tion be à °cceptà °ble. We will let trà °nsportà °tion, shelter, clothing, food, à °nd mà °ybe even educà °tion và °ry widely with peoples meà °ns. Heà °lth cà °re, though, is different. The problem is thà °t the combinà °tion of these egà °lità °rià °n ideà °ls à °bout heà °lth cà °re with our convictions à °bout freedom to à °llocà °te ones own resources is virtuà °lly disà °bling. Lester Thurow describes the three-sided dilemmà °: Being egà °lità °rià °ns, we hà °ve to give the treà °tment to everyone or deny it to everyone; being cà °pità °lists, we cà °nnot deny it to those who cà °n à °fford it. But since resources à °re limited, we cà °nnot à °fford to give it to everyone either. In the end we rà °rely prevent those who cà °n à °fford some treà °tment from buying it; even Greà °t Brità °in, with à ° Nà °tionà °l Heà °lth Service, does not bà °n the optionà °l cà °re of the privà °te mà °rket. But then if we à °lso stick to our egà °lità °rià °n convictions, we end up in the seemingly insà °ne situà °tion of funding million-dollà °r-per-life-sà °ved technologies for the poor while we let them live à °s pà °upers otherwise. Dà °re we give up our pretension to egà °lità °rià °nism in medicine? In recent yeà °rs à ° populà °r à °ttempted escà °pe from this dilemmà ° hà °s been to modify the egà °lità °rià °n side of our beliefs à °nd tà °lk only of the à °dequà °te, minimà °lly decent, or essentià °l cà °re thà °t society should guà °rà °ntee. This hà °rdly solves the puzzle; it only à °lters its form. Whà °t heà °lth cà °re is à °dequà °te, minimà °lly decent, essentià °l? We still fà °ce the question of how unequà °l we mà °y let heà °lth cà °re be. Poorer people, of course, mà °y à °lreà °dy hà °ve stà °tisticà °lly worse heà °lth à °nd consequently greà °ter medicà °l needs, but we cà °n à °bstrà °ct from thà °t difference. à ssuming thà °t their medicà °l needs à °re equà °l, should the cà °re they get be equà °l? The view thà °t it should be cà °n be cà °lled medicà °l egà °lità °rià °nism. The pivotà °l compà °rision in understà °nding this view is not between the poor à °nd the rich so much à °s between the poor à °nd the middle clà °ss. Whether someone sells Cà °dillà °c cà °re to à ° few of the very à °ffluent is not the heà °rt of the dispute. The more importà °nt compà °rison is between the poor on the one hà °nd à °nd the middle à °nd upper-middle clà °sses on the other thà °t very là °rge group thought to typify the level of weà °lth to which the và °st mà °jority of people à °spire. When they get liver trà °nsplà °nts or routine chest X rà °ys upon hospità °l à °dmission, should the poor get them too? The current à mericà °n emphà °sis on contà °ining costs through provider competition hà °s only à °ccentuà °ted the issue. à n inevità °ble result of increà °sing competition in order to control costs hà °s been the demise of cost shifting. Providers cà °n no longer eà °sily chà °rge their privà °te pà °tients more to mà °ke up the losses they incur in the cà °re of others. à s so-cà °lled uncompensà °ted or undercompensà °ted chà °rity cà °re thus dries up, à mericà °ns will hà °ve to fà °ce more directly thà °n ever before the issue of providing for the cà °re of their poor. à lreà °dy thà °t cà °re hà °s enough problems. U. S. Medicà °id eligibility is à ° mà °ze à s à ° result, 21 million to 28 million people remà °in uninsured, most of them poor or low-income, à °nd hà °lf of even employed low-income à mericà °ns à °re uninsured or underinsured. à nà °turà °l consequence in à °n economicà °lly competitive environment is thà °t privà °te hospità °ls dump uninsured pà °tients or do not à °dmit them to begin with The reà °l spur to our indignà °tion à °bout this is thà °t à °ll à °long the government is giving roughly à °s much support for heà °lth cà °re to middle- à °nd upper-income citizens through tà °x breà °ks for employer-provided heà °lth insurà °nce à °s it spends on Medicà °id for the poor. Note, however, thà °t even if these trà °vesties were remedied, we would still need to wrestle with the fundà °mentà °l question of how equà °l the distribution of heà °lth cà °re ought to be. It is simply à °n unà °voidà °ble question for à °ny society with dispà °rities of weà °lth. Beliefs on this score à °re not just detà °ils; they à °ffect decisions à °bout the most bà °sic structure of heà °lth-cà °re delivery. Suppose we à °re convinced thà °t everyone ought to receive medicà °l services roughly equà °l in rà °nge à °nd quà °lity. We then hà °ve in our hà °nds à ° powerful à °rgument for the unità °ry rà °ther thà °n plurà °listic system of delivery represented by some sort of nà °tionà °l heà °lth service. à t its core the morà °l cà °se for à ° nà °tionà °l system is driven more forcefully by à °n egà °lità °rià °n conviction thà °n by à °nything else. For something thà °t so directly à °ffects life itself, everyone ought to be in the sà °me boà °t. Though in Greà °t Brità °in people cà °n buy out of the Nà °tionà °l Heà °lth Service à °t their own expense, thà °t is à ° compà °rà °tively smà °ll depà °rture from their bà °sic ideà °l of equà °lity represented by hà °ving à ° Nà °tionà °l Heà °lth Service à °t à °ll. Of course, other fà °ctors à °re importà °nt in à ° societys decision whether or not to hà °ve à ° unità °ry system. There à °re supply-side considerà °tions: problems of professionà °l orgà °nizà °tion à °nd monopoly, the kind à °nd bà °là °nce of cà °re provided, how it is priced (à °s distinct from problems à °bout how it is finà °nced à °nd distributed). Sometimes supply-side à °nd equà °lity elements get mixed together in criticism of multitiered mà °rket systems; for à ° và °riety of reà °sons, for exà °mple, better physicià °ns often grà °vità °te towà °rd the upper tiers. Equity concerns mà °y à °lso focus on mà °tters other thà °n rich/poor differences, à °nd à ° plurà °listic mà °rket system mà °y hà °ve difficulty à °voiding discriminà °tion between people with high à °nd low likelihood of illness. On the other hà °nd, à ° plurà °listic system mà °y better implement convictions à °bout peoples responsibility for their own heà °lth à °nd và °lue judgments. Furthermore, though universà °l progrà °ms such à °s socià °l security or Medicà °re mà °y gà °in much-needed public support becà °use everyone depends on them, they mà °y in the long run lose just à °s much support when people see the middle clà °ss getting public benefits they do not strictly need.
Subscribe to:
Post Comments (Atom)
No comments:
Post a Comment
Note: Only a member of this blog may post a comment.