The Sreenivasan article discusses how health should not be a determining factor for ‘fairness’, rather, ‘fairness’ should be determined by equal opportunity to life options. Sreenivasan states that ‘equal opportunity rationale is simple and appealing. Unfortunately, it is also invalid’. I agree with him that rationing out healthcare to everyone is unrealistic because some people have more health problems than others, and by rationing the help, these people are unable to actually get the healthcare that they need because they have already used up their ’ration’ of healthcare. However, Sreenivasan continues on to discuss what he believes reality should look like. He believes that ‘each person’s share of opportunity ought to be (more or less) the same as everyone else’s share’. I believe that his argument is invalid because it is more Utopian than realistic. Because of the society that we live in, certain people will have more of an advantage than others. This advantage does not just involve financial resources, but also cognitive abilities. Sreenivasan’s argument makes it sound like society should allow certain people who have more opportunities in life to have worse health than everyone else in order to level the playing field. This is immoral because this is saying that one person’s health is more important than another person’s health. For example, if we had a society like what Sreenivasan imagines, then we could say that the president of America should receive the same ‘ration’ of healthcare as say the vagrant who is living on the streets. In Sreenivasan’s society, the vagrant should receive more healthcare than the president in order to level the opportunities available. This is immoral because the president needs to be able to make wise decisions for the sake of all citizens, and being in poor health would not give him that ability. I am not saying that the health of the vagrant is not important—it is, but in our society, there needs to be a gradient in order to protect the health of everyone.
I agree more with Buchanan in that everyone has a right to a decent minimum healthcare, rather, everyone has a right to the access of healthcare. I believe that in a perfect world, everyone would have perfect health/healthcare. However, in our society, this is unrealistic because, like Buchanan stated, everyone would expect the same level of healthcare, even when determining factors change, causing this healthcare system to be more of a burden than a useful resource to society. Another burden to the healthcare system would be individuals who have severe, lifelong health problems. Is it up to society to provide care for this individual their entire life, or is it up to the individual and his or her family? In a way, this can be seen to be a moral issue. Should society provide care for this individual for life, help him achieve the same level of self-help as everyone else. Or, should society let him suffer for life, struggling to pay bills and keep a job in order to pay more bills. There is no clear right answer for this issue as of yet.

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 and Engelhardt introduce the history of healthcare and provide insightful examples of countries that offer socialized medicine, starting with Germany and Britain. This article alone mentions discouragement of treatment to more advanced technology as reasons for healthcare success, but these reasons themselves are not enough to reveal how they are more moral.

I also encourage you to check out this revealing attempt by the Internet (the ever-entertaining Yahoo Answers)  in responding to a related question: https://answers.yahoo.com/question/index?qid=20101119020726AApz3pv

(It is funny picking up on how everyone thinks they are the expert, and answers range from education reform to budgeting to immigrant policies!).

In addition to Germany and Britain, we should perhaps take a look at Scandinavian countries like Norway and to understand more deeply why they are healthier – healthier bodies, and healthier wallets. Their systems are consistently more successful in the big picture.

The Nordic countries are considered to be the best-governed nations in the world (The Economist). Sweden, Denmark, Finland, and Norway are ranked highest overall, taking into account all factors to ensure relevancy to health. These include global competitiveness, innovation, corruption perceptions, ease of doing business, human development, and prosperity. However, these high marks are a result of  subjective perceptions from outsiders just as much as what numbers reveal. As a consequence, people also attach higher levels of morality with the original affairs. By this I am suggesting the US is capable of providing the healthcare everyone deserves, as we are capable of handling large scale economic calibers. While some say we are disadvantaged for having invented Coke and McDonald’s, their global prevalence gives us no grounds to suggest we are doomed to spend more on our health outcomes. Since the basic conditions are met and align with other first world countries, the problem is not that we do not have the means, but that something is holding us back. This is a moral problem. The situation denies what the US government promises its people, and American individuals have been stuck as the victims of this moral dilemma. Brody and Engelhardt ask many questions as to how approach a solution, but answers need to come from politicians and businessmen who must look at this as ethicists. After all, healthcare is where politics and economics collide.

They do not need to start from scratch. It is already established the prevention is cost efficient. The resulting health benefits and lower costs of treating disease, thus ethically serve us. Since prevention is the key to our deserved outcomes, it is, as a result, moral to push vaccinations, limit smoking, and consumption of sugar. While it is not completely mandatory (preserving the freedom also promised by out government), it serves us better than if public health efforts did not get this chance – to have as much influence as for-profit and often illness-inducing corporations. The US needs to take a hint and realize that what works best is investing in prevention, for the sake of its budget and the health and promise to its people.

References:

The Secret of their Success, The Economist. http://www.economist.com/news/special-report/21570835-nordic-countries-are-probably-best-governed-world-secret-their Last Accessed April 7, 2014.

Brody, Baruch A., and H. Tristram Engelhardt. Bioethics: Readings & Cases. Englewoods Cliffs, NJ:Prentice-Hall, 1987. Print.

 Every countries has its own health care system. Is one better than the other that we should adopt the best one in the world? Should we have the same health care system in each country so that everyone can be equal? People may have wondered why don’t we just copy exact the same thing like France, the best healthcare system according to Business Insider?

In Taiwan, where I live for almost my entire life, our health care system is National Health  Insurance, which almost everyone is covered just paying taxes and minimal fees. However one major problem that we are facing is that it’s too cheap that people especially elders go to the hospitals so often even when they don’t have problems. Basically many people abuse the health care by getting medicines so often that they don’t need it. This situation causes the government to waste a lot of money. So how can we solve this situation? To increase the payment for health insurance? In fact, the Taiwanese government has tried to implement a health care reform that bases on income, in which the government can gain a bit more money to avoid bankrupt. However, some people believe that this might influence some lower income families not being able to pay the medical bills.

During this spring break, I went to Nicaragua and found out that they also have national health insurance. Citizens don’t pay anything for public medical services. Doesn’t it sound good? But there are a lot of underlying problems. For example, the quality. The quality isn’t as great. The hospitals lack medical resources but not patients. Everyday, the hospitals are full of people lining up. People have to wait for hours and hours to actually get to see the doctors. Even the doctors and nurses aren’t well paid. Then one might think, is this problem caused by the free medical services? Not exactly, the culture, society, geography, and the economy also play major roles in health care. In addition, because of poverty, the citizens have hard to transporting to the main cities to the hospitals. Therefore besides from quality, access is also another problem that the Nicaraguan government is facing.

In the article “Access to Health Care,” it gives us three interesting cases. In case A, is it fair that once a person lose his job, he loses his health insurance and not being to get access to health care? And for case C, the professor is not eligible to get Medicaid payment for nursing home care for Alzheimer’s disease. Alzheimer’s disease is also a health problem, then why can’t it be included in Medicaid. It is indeed really hard to come up with the best health care, which everyone is under coverage. The government has to consider many factors not just the percent coverage of health care but also the affordability, quality, and accessibility. Since health is also a human right, everyone should have the right to be healthy and get access to good health services. But is it possible to come up with the perfect health care in which everyone is equal? Or when does health care system consider as socially acceptable to everyone?

Sources

B. Brody and T. Engelhard,  “Access to Health Care,” Bioethics: Readings and Cases

Over the past hundred years, the field of healthcare has undergone immense scrutiny as once black and white lenses have been introduced to various shades of grey.

Within the last decade specifically, the idea of access to healthcare has gained more and more importance, playing a critical role within the last election. Paul Ryan, Mitt Romney’s vice presidential running mate, said “if health care is a right, then those who provide it become servants of those who need it and would be deprived of “being traders like everyone else in a free society.”” He reasoned that a universal healthcare plan, not dissimilar to Obamacare would bind doctors and other healthcare providers to the will of the bureaucracy. Conversely, President Obama and Vice President Joe Biden are advocated of universal, leading to “Obamacare”, a health care plan that is affordable and available to everyone. If one chooses not to enroll in any healthcare plan, they must pay a small fee.

Universal healthcare has come under attack for a variety of reasons, primarily economic. However, economic criticisms of any single model of universal health care, such as Obamacare, do not address whether the idea of allowing every citizen healthcare is ethical. If one considers life to be a right and the duty of the government to facilitate that right within reasonable limits, then it logically follows that universal healthcare is not only desirable, but an obligation of the government.

Yet others would say that health care is a privilege. But the very foundation of life is health, and if millions have not the means to afford it or access it as others do, is the life of such a person unable to obtain health care any less worthy than someone who can afford and access the best medical science has to offer?- It seems clear from Zaremski’s tone that he believes the answer to be a resounding “No”.

Many believe that the Obamacare makes a respectable effort to ensure that buying healthcare is not mandatory for everyone (another ethical issue), by allowing people to forgo any healthcare plan at the cost of a small fee. However, where does the ethicality lie in this?

http://www.huffingtonpost.com/miles-j-zaremski/health-care-reform_b_1892221.html

     Norman Daniels provides a different outlook on healthcare that questions the equality of health care and if it is distributed fairly.

One question that I asked myself while reading Daniels piece was whether certain social issues or conflicts (adventitious needs) warranted health care provision just as course of life needs are provided for. Should a nose augmentation be done if its purpose is not to enhance the ability to breathe, but to enhance self-esteem? Does not psychosocial or psychological issues warrant health care as well?

It is my opinion that certain procedures are more important than others and individuals who are in need of these procedures should receive the health care that is necessary to complete the procedure. If the disease or illness negatively affects normal opportunity range, then it is necessary to receive health care. I believe, however, that it is these differences and variances between individuals (effective opportunity) that constitute and allow that health care be just a little different amongst people. This does not mean that there should be a large variance in health care which will lead to unfair mistreatment and neglect of some patients over another, but it will make it so that all patients receive the healthcare that will most benefit their needs while giving all the opportunity to return to their normal opportunity range.

When comparing the lungs of a smoker and the lungs of an individual who is not a smoker, but has developed some type of lung disease, it is possible to see that these individuals are both in need of the same kind of health care. However, who should receive the better kind of care? Who should receive more attention? Who should be addressed first? Though many may say that the smoker placed these health issues on themselves and caused their disease or illness, it is only moral to provide healthcare to both these individuals. However, because no one is the same, the health care that is provided to both patients can vary in many ways. For example, the smoker may have been born with other health issues that make it more difficult to treat the lung problems the patient may suffer from. The other patient who developed the lung disease may also be an athlete and thus it is required that the kind of health care provided must also consider this health factor. Regardless of the extraneous issues that the patients may face, it is only moral and fair that these patients both receive health care that can allow the patients to return to their normal opportunity range.

Daniels also discusses there are some born with an advantage and a very lucky “natural lottery” (Daniels 465). Daniels indicates that health care addresses things that are not equally distributed; one person may never get sick, and another person must live their live on medication. I believe that this issue is one that undoubtedly must be cared for with health care, but the amount of health care that is provided depends on the severity of each case. Someone with constant allergies may need more care than someone who is allergic to animals. Alternatively, if someone is deathly allergic to cats, and another individual is allergic to multiple things but is not morbidly ill, the person with the possibly fatal allergy must be given more attention and health care in the case of a reaction.

Individual health care needs vary due to genes, location, family, and personal strengths, and many other factors. These factors do have a strong hand in deciding what kind of health care is most beneficial to a patient. I believe that it is moral to provide varying levels of health care if it means that all patients will be able to return to their normal opportunity range as Daniels describes.

Daniels, Norman. “Health-care needs and distributive justice.” Arguing About Bioethics. By Stephen Holland. London: Routledge, 2012. 457-471.

I wanted to share an article on Professor Elena Conis of Emory University, whose research aims to understand how over time, history, especially environmental history, has led people to evaluate the risks and benefits associated with vaccines so differently. Enjoy!

http://news.emory.edu/stories/2014/04/er_mellon_fellows_profile_elena_conis/campus.html

In the article discussing public health initiatives to combat obesity and their ethicality, Holm argues that there are three different forms of paternalism: hard paternalism (direct coercion), soft paternalism (giving unwanted information or foreclosing some options for action), and maternalism (control by inducing a guilty conscience). He then applies these types of paternalism to a discussion of the ethics behind obesity interventions. The first question is whether it is justifiable to promote a person’s own health or well-being, if they do not want intervention. I immediately thought of the ethicality of posting calorie counts at restaurants. If the person does not want the information, this is most definitely a form of soft paternalism, and even a little bit of maternalism as guilt may prevent someone from ordering what they want. But is it justified? 

Recent Studies 

Recent studies have found that while an estimated 15% of restaurant customers used calorie listings to help them choose healthier foods, the majority of listings were too confusing to guide diners to make healthier decisions.  Programs like these often encourage businesses to work towards putting healthier and more nutritious items on their menus as they know that customers will be provided with the nutritional facts in an easy and convenient way. For example, it is embarrassing for McDonald’s to have to disclose that 20 Chicken McNuggets is 860 calories. Thus this provides both an incentive for business owners to provide healthier alternatives as well for consumers to make healthier eating decisions.

Autonomous Decision Making 

Misinformation, along with busy lifestyles and too many unhealthy choices, has been pegged as one of the leading causes of the obesity epidemic. In order for consumers to make a fully autonomous decision based on informed choices, they must have enough information to do so. While it is likely that the calorie listings encourage people to make healthier decisions, the information provided is in no way biased. The calorie listings are simply stating the facts and thus I don’t think it is fair to view them as a bias or a source of forced paternalism. I think the main question is whether or not society or the state is justified in interfering in our personal choices. But is it really interfering if they are only helping us make a more well informed decision? I argue that no. The displays of calorie values are ethical as well as important to the health of our society.  There is no loss of freedom or autonomy in being provided the extra information, in fact autonomy is actually increased as more information allows one to form a better informed decision.