Supporting Health Care Reform Is the Right Thing to Do
Why We Must Fix an Unfair System
SOURCE: AP/LUCAS FLORY
In supporting health care reform, we can be good citizens and morally responsible neighbors, and still do right by those we love.
Print
New polls suggest that Americans’ support for health care reform is wavering. Attacks by opponents of reform appear to be succeeding in increasing fears that health care reform is bad for those of us who already have insurance—that is to say, bad for most of us. The critics claim that government will get between ourselves and our doctors, we will get less care and have fewer choices.
That none of this is true seems almost beside the point. Americans are getting nervous and that is not good news for health care reform. Supporters of reform are now working overtime to reassure us that health care reform will not make us worse off, that it will instead improve the quality of the care we get, and that if we like what we have, we can keep it. Health care reform will not change, in any way that matters to us, the self-interested world we each inhabit.
At the risk of sounding like a Pollyanna, we want to try a different tack. Each of us should support health care reform because it is the right thing to do.
We should say at the outset that although we do ethics for a living, we are neither impartial nor indifferent to the needs of those we love. When someone in our families is ill, we do every thing in our power to get them every medical intervention whose benefits outweigh the harms. We desperately want them to have the best. And because we have excellent employer-sponsored insurance, and have the resources to pay for whatever out of pocket costs there might be, we usually succeed.
But we are always painfully aware that what we can do for our families, many other people cannot. And we are also aware that there is no morally defensible reason why we are in this position and they are not. Our system is just unfair.
Most of us who have insurance—whether through our employers or through Medicare—do so because the government pays a big chunk of the bill. Most of us who don’t have insurance don’t qualify for the tax breaks that go along with employer-sponsored health insurance and are just too young for Medicare.
Not that insurance insulates a family from the staggering financial burdens of a serious illness. If you are happy with your health insurance it may be because no one in your family has ever had advanced cancer, serious arthritis, a debilitating brain accident, or any number of illnesses or injuries where the cost of care can exceed by tens of thousands of dollars a year your insurance benefits. Putting aside the contentious issue of whether those wealthy enough to absorb such costs deserve to be that much better off, surely in a country as rich as ours no family should have to be in the awful position of being unable to secure critical medical care because they cannot afford it.
So what does this have to do with a personal moral responsibility to support health care reform? We each have a duty to take care of our loved ones and that extends, of course, to making sure that what is good and valuable about the health care they now have is preserved. But don’t be misled into thinking you are being asked to trade away your family’s interests. The next time you hear how health care reform is going to get between you and your doctor or deny you needed care, press for specifics. Despite the hype, the proposals currently being debated in Congress impose minimal or no burdens on most of us. Indeed, we will be more secure with health care reform than we are now. After all, while we may be healthy or have good insurance today, that may not be the case tomorrow.
But even if, in the near term, some of us may be slightly worse off than we are today, there is a line between appropriate self interest and simple selfishness. Opposing health care reform crosses that line.
This is a case where we can have our moral cake and eat it too. In supporting health care reform, we can be good citizens and morally responsible neighbors, and still do right by those we love. We want a country in which all families, not just ours, have affordable, high quality health care. Don’t you?
Ruth R. Faden is the Wagley Professor of Biomedical Ethics and Director of the Johns Hopkins Berman Institute of Bioethics. Jonathan D. Moreno is the Silfen University Professor of Medical Ethics at the University of Pennsylvania and a Senior Fellow at the Center for American Progress.
Comments on this article
Public Option that Doesn’t Directly Compete with Private Insurance
The cost of a government health insurance plan could be based on the average health care cost for people in each age group plus a certain percentage. For example the government insurance for a person born in 1950 could be the average health care cost of everyone born in 1950 plus a percentage such as 2 to 10% minus likely deductibles and co-pays.
more info on possible health structure
Public Option that Doesn’t Directly Compete with Private Insurance
The cost of a government health insurance plan could be based on the average health care cost for people in each age group plus a certain percentage. For example the government insurance for a person born in 1950 could be the average health care cost of everyone born in 1950 plus a percentage such as 2 to 10% minus likely deductibles and co-pays.
Private insurance companies could pick their customers, they could not cancel their customers, their rates would have to be the same for all people in each age group, and they would have to cover preexisting conditions.
Private insurance companies and insurance cooperates would likely pick the healthiest people, leaving the less healthy people and people unable to pay to be covered by the government insurance. People without private insurance would automatically be in the government plan.
People would pay the government insurance though employer withholding and though sending the money to the government. The cost of the government insurance would be limited to a certain percentage of a person’s total income. The percentage of income that is limited could be higher for older people.
For example a 25 year old person’s government insurance cost could limited to 3 percent of that person’s income, while a 60 year old person’s cost could be limited to 12 percent. A person’s total income could include income from work, capital gains, dividends, interest, gifts, and inheritances.
This type of government plan would not directly compete with private insurance, but still it would keep private insurance companies from charging extreme amounts. The government plan may need extra funds since the plan would be covering the less healthy and people not paying the full amount.
Possible ways of getting extra funds would be to tax capital gains and dividends at the same rate as regular income for people with incomes over $250,000 and taxing high income people more.
This type of plan would increase payroll payment on some people, however they would be covered and they would have incentives to be healthy to find cheaper rates. Medicare could be funded though the general fund to somewhat lessen payroll payments.
Thank you
August 31st, 2009 at 12:14 pmDoug Seger
812-678-3850
6915 N 925 E
French Lick, IN 47432
Well said! Especially the correlation you suggest between happiness with a health plan and one’s non-use of said plan.
Imagine how different the debate would be if all the voices of those who’ve been directly affected by the current system could be heard. Unfortunately, those same voices of people who’ve suffered with the shortcomings and inherent injustice of the system are, by virtue of their weakened physical or financial conditions, the people least likely to be heard. And, ironically, those who champion the cause on behalf of those unfortunates, have become easy objects of attack by healthcare reform opponents.
Opponents have become so clever and devious that it’s almost impossible to prove they’re kicking the sick, weakened, and disenfranchised while they’re down. But, they’re sure kicking-the-hell out of the people who are trying to help those others get up.
August 31st, 2009 at 12:23 pmUnfortunately, the ethical and morally pleasing aspects of health reform do not jive with reality. Of course, it is ridiculous that persons in our country can go bankrupt because of medical bills. But ethics in health care coverage cannot be divorced from the practicality of financing.
Our country is in massive debt. Medicare as it stands now is financially unsustainable even over the short term. The public option, however, is poised to deliver Medicare benefits, which are essentially limitless, to a much larger public(Keep in mind that The medical system already loses money on Medicare/Medicaid patients). So once utilization of health services through the public option increases(as it surely will, even with preventive services), the program will be a fiscal train wreck. When this happens, our government will choose to either go into more ruinous debt or drastically cut costs via hospital payments, provider payments, and most importantly benefits. When this happens, we will have a public system that rations care in very discomforting ways.
(Also remember, the enrollment in the public option is, if anything, underestimated. The public option has to, by definition, be the cheapest option available. Otherwise, this whole reform exercise is ridiculous. So if its the cheapest option, more people will drop their private insurance and switch, thereby hastening the bankruptcy of the plan).
So how do we begin to create an ethically satisfying system based in reality? We must first realize that there is no perfect solution to satisfy our ethical ethos. From there, we can start with the easy stuff. Insurance industry reform – abandon medical underwriting, abandon employer based insurance(give that cash to the employees), allow inter-state insurance commerce, and mandate coverage. The government can help here by picking up the tab on costly chronic conditions if and when insurance caps are reached. Second, create a safety net insurance program for persons of insufficient means. This program would have a fixed budget and thus would have to ration care. Remember, these persons have no insurance to begin with, so reasonable care is better than no care (Recall this is what Britain does). For seniors, their relationship with government will have to eventually change, given Medicare’s impending insolvency. Some ideas include enrolling seniors in the safety net plan with the option to purchase further supplemental insurance. Other ideas include allowing their children to include them on their plans. Fundamentally, however, any major changes to seniors would have to be phased in slowly (ie 20 yrs) so that persons have time to plan and adapt. Ultimately, the scale and scope of this government program could increase as resources increase. As the above article discusses, the author would pursue every avenue of treatment for his loved ones. Reckless reform would eventually take away that choice from most consumers. Most importantly, though, this sort of system gets everyone covered, allows choices for americans, and does it in a fiscally responsible way.
September 9th, 2009 at 4:34 pm