In Brody and Englehardt’s article “Access to Health Care” the authors discuss various healthcare systems. They conclude the article with many questions concerning the justice of healthcare, as well as the validity and practicality of implementing a universal healthcare system. These questions present a number of valid concerns, including Singer’s question of whether a health care system must have only one tier in order to provide acceptable healthcare to the poorest members of society. The culmination of these questions seems to be the relationship between social equity and individual rights.
While these questions are valid, Brody and Englehardt make a singularly important point early on in their article: since the nineteenth century, societies have made an effort to provide those who could not afford healthcare with the bare minimum, even if this were for the sake of society as a whole and not out of care for the individuals most at risk. In the early nineteenth century, this meant providing basic public health measures such as proper sewage disposal. In nineteenth-century Germany, basic health care coverage included “third class” care. In twentieth-century Britain, it included enrollment under a general practitioner for 95% of the population.
There are many messages to glean from this article, and many questions are raised. However, what stands out to me is that societies supposedly far less evolved than ours managed to provide the minimum standards of healthcare to upwards of 90% of their populations. Why does it seem like this is such a hard goal to accomplish in the US today?
It seems to me like the question Singer raises is not yet applicable to healthcare in the United States. Before we debate the merits of social equity versus individual rights, we must make sure that everybody has the bare minimum. Until then, whose rights according to the free market are being denied is a moot point.
When I was reading the questions at the end of the article, my mind wandered to every American’s right to counsel under the constitution. When a US citizen is accused of a crime, he is guaranteed the right to a legal representative. The quality of this representative is not ensured. He may hire a different one if he so chooses and can afford to. While this does not provide the perfect analogy for healthcare, which is arguably more important and much more fickle, it seems to me that at least these general guidelines should be in place for healthcare provision in America. Other people may have better healthcare than you. If you have enough money, you may have different or better options than those of a lower economic standing. But you will always have the right to a doctor.
Perhaps this seems idealistic or simplistic in light of the questions which Brody and Englehardt raise. However, I would argue that a change in the US healthcare system needs to start somewhere, and that providing every patient with a doctor is a logical place to start.
References
Brody, Baruch A., and H. Tristram Engelhardt. Bioethics: Readings & Cases. Englewoods Cliffs, NJ:Prentice-Hall, 1987. Print.
In many ways it does seem simple to target the United States and ask why we still have not found a way to provide the most basic care. I completely agree with the comparison to the right of an attorney – we are not expected to provide the best care but we are expected to at least provide basic care. This, in theory, makes perfect sense to me however in my opinion (not that I agree) there is much of the story that is still being ignored.
It all comes down to the existing system. Truth be told, the resources to provide basic care are not really there anymore. Doctors go into specialties leaving a lack of PCP’s who would be able to provide the first defense of care for those patients. Furthermore, with medical school expenses so high doctors are forced to go into more lucrative fields continually leaving a gap in the populations that truly need access to care. Beyond just resources, do commit to something as true as universal healthcare that you describe would mean completely shifting an already existing system that functions on a for profit basis. Costs for procedures are still extremely high as the insurance companies negotiate for individuals leading to patients continually getting ripped off with extremely high costs of care. To me, the way the money flows in and out of the system as of now and simply the for-profit basis of our healthcare system means a complete strip before we can really achieve something like universal healthcare. If changes are really seen in emergency costs with the passing of Obamacare, under the theory that those with new coverage will now see PCPs without needing to go to the emergency room there may be a shift towards expansion in all states – but that is the only realistic outcome I can see.
I really liked the parallel that you drew from the US constitution and legal system to that of medicine. Currently, 8-11 percent of Americans do not have any form of health insurance, meaning that approximately 90% of Americans do have health insurance and those 8-11 percent will utilized free clinics and charity hospitals for their healthcare.
However, like you said our constitution should include a clause referring to if you cannot afford healthcare, one will be provided for you. This is why I agree with the Western German system of healthcare whereby they provided healthcare to those under a certain income level and those above the income level could purchase additional levels of care if they so chose. The only downside to providing everyone healthcare if determining how to pay for it. The only way to do so would be increasing taxes and that rolls into another political debate of who and how to tax the population.
Ultimately, I think everyone agrees that everyone should have access to healthcare, it is just a matter of how to provide it to everyone.
For a time, my family and I did not have any health insurance and I did not qualify for Medicaid because I was neither a mother nor pregnant. I find that it is unfair that as a disadvantaged Emory student I was not disadvantaged enough to obtain Medicaid and just not wealthy enough to purchase the Emory offered $2000 plus health insurance plan. Thankfully now I have health insurance but that was a long process.
I believe that the US just has trouble finding the means to provide for the middle of the group individuals who do not fall under the restrictions of Medicaid but do not have a job that offers health insurance. I believe that a big part of society is unprotected and must find ways to fend for themselves.
An issue undoubtedly lies with funding as the US is one of the top spenders in healthcare but we have the WORST numbers- we have an infant mortality higher than many developed countries, we have a very high risk of heart disease, obesity, and other illnesses. I believe the US cannot afford universal health care- because the money is being spent in the wrong places- fixing the problem instead of preventing it. If the US uses the money for prevention, then I believe there will actually be a decrease in the amount of health care money that is wasted.
I really enjoyed your comparison of universal healthcare coverage to right to representation (“When a US citizen is accused of a crime, he is guaranteed the right to a legal representative”). Health is defined as a state of mental, physical and social well-being and I would argue that this is a preeminent value for the majority of US citizens. Having a basic level of health is often a prerequisite to achieving many other values, whether that be family, success, happiness, etc. Therefore, why shouldn’t we treat a coveted value such as health the way we treat legal protection? When set up this way, it seems only logical that everyone be entitled to a basic level of healthcare coverage. I also can relate to the confusion regarding why so many other, less developed countries are able to provide their constituents with universal health insurance, and the advanced United States is not. I think it is important to study the models used in other countries and try to incorporate the elements that have worked best in future US policy.
You have made some valid and effective points in this blog. To answer to your questions about why is that societies far less advanced than ours provide the minimum standards of healthcare to their populations and why is it such a hard goal to accomplish in the US today, I would tell you something interesting which I also learned very recently bout the International Covenant on Economic, Social and Cultural Rights (ICESCR). ICESCR is a joint treaty that obligates participant countries to work toward the granting of economic, social, and cultural rights including the right to health, and a right to an adequate standard of living. Although the United States has signed international conventions that include the right to health, it has NOT signed the ICESCR. This means that the U.S is not currently obligated to provide any such rights to its citizens. I think the US has not ratified the ICESCR because the nation has not accepted that rights should be given and not earned. The U.S does not consider the economic, social, and cultural rights as the real rights. Rather, they are overlooked as desirable social goals and thus, the U.S does not want to sign binding agreements with other states to protect these rights. Also, any attempt to grant universal rights of health or economy are touted as being “socialist” movements. Another reason the US has not ratified the ICESCR is because of a failure to acknowledge economic and social rights as legitimate. I think the US should ratify the ICESCR because health, economic, social, and cultural rights should be available to everyone. They are natural, human rights. If our nation ratified the ICESCR, I believe there would be more equality in terms of healthcare, income, etc. If we were obligated by General Comment 14 to sign, our entire healthcare system would have to change because doctors would no longer be able to shaft uninsured Americans, or provide lesser care.
Unfortunately, as you have stated, having the right to health care is different than having the right to legal representation. Agreeably, everyone has a right to “life, liberty, and pursuit of happiness”, and maintaining one’s health can help satisfy these rights. However, it is difficult to draw the line at basic health needs. To give everyone a physicians seems fair enough, but what kind of physician? The patient cannot just have one general doctor, and may need a specialized physician or a team of doctors in order to address certain conditions. For example, many homeless people cannot function properly in normal society due to mental illness; therefore, they may need access to a psychiatrist and maybe a psychologists. Yet, they may also have other problems such as cardiovascular disease, so they may also need a cardiologist. Still, should they be allowed to get a general well check up in order to ensure that everything is okay? What about a nutritionist to help maintain a balanced diet? The point is, it can be hard to draw a definitive line as to where basic medical care stops and specialized care begins. Another example is breast augmentation. A woman may be slightly unhappy with her cup size and want to undergo the procedure, and this procedure is often deemed unnecessary. But what about patients who underwent a double mastectomy? Today’s society places so much emphasis on how breasts are indicators of womanhood. Many women who have their breasts removed as a last resort to battle breast cancer often feel “less like a woman,” which can cause extreme depression and could in turn lead to suicidal thoughts. Should they be covered in order to undergo breast augmentation? Maybe they should be covered for psychotherapy instead. As demonstrated by this case, it is also hard to determine the best way to cover patients in special circumstances.
I think your blog post takes our discussion to a new direction. I think of what we can do for progress, when you bring up that the authors explain, “since the nineteenth century, societies have made an effort to provide those who could not afford healthcare with the bare minimum, even if this were for the sake of society as a whole and not out of care for the individuals most at risk.” Investing in the bottom in terms of health sure does make the common good better. Another component to this is what this means in today’s society. While chronic diseases are replacing main concerns that used to be infectious disease in our country, poorest health is still seen most among the bottom tier. Thus, when you mention public health and cite that, “In the early nineteenth century, this meant providing basic public health measures such as proper sewage disposal. In nineteenth-century Germany, basic health care coverage included “third class” care. In twentieth-century Britain, it included enrollment under a general practitioner for 95% of the population,” it is proof that public health has historically been a means to improve the health of a country. However, knowing we are currently running an inefficient healthcare system, I think it would be interesting to see where mandated insurance can take us.