Health care rights and responsibilities.
On my previous thread on Republicanism, access to health care was raised a few times as an important right in a modern society. It is hard for any sensitive person to witness the suffering of someone who is sick and suggest nothing should be done. But how far does our moral obligation extend, and what responsibilities lie on the individual? The argument is often framed in the terms that quality of health care provision should be independent of ability to pay. The first thing to point out is that this is unrealistic. Even if private medicine was outlawed, those with enough money would be able to travel elsewhere for better treatment. The only way that it could achieved is if the government spent so much on health care that the marginal impact of any extra spending was effectively nil. But not even rich Western nations have those kind of resources to spend even if they had the will to do so. Even at current growth rates, health care spending may become prohibitive. In the US, it is projected that health care may account for 20% of its economy within the next decade. Every dollar, pound or euro spent on health care is one not spent on other things which may have equal claim or greater utility. The NHS may cost much less than the private system in the US, but it effectively rations care through waiting lists.
So when health care is claimed as a right, how far does it extend? Do we mean that a certain minimum standard of health care should be provided? Some democratically agreed level of provision, or a best effort at matching the best private care? Is the right equal over different types of care – acute such as heart surgery, and chronic such as dementia? How do we draw the line, without seemingly uncaring or arbitrary?
The second thing to consider is what responsibilities an individual has, and how it interacts with their other rights. Imagine if a pill was developed that, if taken regularly, could produce large and measurable weight loss. Regardless of expense, there would be an outcry to get it available on the NHS. If a patient then did not take the medicine regularly and had complications as a result, many people would feel that it would be justified to refuse further treatment due to negligence of the patient. But if the doctor proscribed regular exercise and a better diet, and then suggested refusing other treatment if the prescription was not followed correctly, there would likely be a public outcry at an overbearing state (or doctors) invading the rights of the individual to live life as they choose. Should the government have the power of coercion to produce better health outcomes? If not, what can they do?
These are more than just an academic debate. The UK is justifiably proud of the NHS; access to health care remains a hot button issue in the Republic and the US. But attitudes can often be reflexive and unthinking, particularly on the left. How we develop policy depends largely on the answers to these questions. This might have been egalitarian, but did it make sense?
I can honestly say I’ve never seen anyone advocate abortion to spare the NHS. Nor euthanasia. That is usually made as a quality of life issue. There are though suspicions that this happens in Holland, which is a very good reason for opposing euthanasia.
Re USA
40% of population have no cover,
illness is commonest cause of personal bankruptcy
average cost of health insurance in 2006 – $3000 per individual ($1000 per month for average family)
two recent people I met who had to use American Healthcare while on holidays, a man with a minor transient stroke – bill $500000, young woman with simple bladder infection $11500
Re NHS
15% of patients fail to turn up for appointments,
estimated up to 30% of treatments (drugs, physio, therapy etc) not complied with.
rationing by stealth (by waiting list, by postcode) and by regulation (NICE Guidelines)
Or we could try the European model with co-payments and compulsory Social Insurance with the insurance market managed to prevent cherry picking of healthy patients by Insurance companies (as Mary Harney tried to do in the South). The theory being that the co-payments encourage responsibility and an appreciation of the value of the service while the compulsory insurance stops unfortunate people with expensive illnesses losing everything. No proof it works though.
Some problems do not have a solution and health provision is one such. A health service could spend 100% of GDP if it was allowed to and still have gaps and deficiencies.
A balance with fairness, protection of the vulnerable, tough business dealings with drug companies (who are as entitled to reasonable profits as anyone else and do have huge R&D;costs) along with a ceiling or cap resulting in explicit, up front rationing seems the reasonable goal and sounds very like the NHS (with less political interference and a stronger version of NICE). Of course the rich will get around the cap and rationing by going abroad but we will at least do the best we can for the resources we commit.
lamh dearg ,
Ironically the present financial crisis in the USA looks like it could be the final straw that breaks the back of resistance of the Insurance Industry , the Drug Companies and many in the Medical Profession to ‘universal health care ‘ or a one payer system as per this article -author quoted below.
‘The huge increase in the federal debt that these bailouts will entail intensifies the pressure to rein in health-care costs. This favors comprehensive rather than incremental reform.
Before the financial crisis, the most likely options for controlling government health-care costs involved tinkering around the edges–striking a new deal between Medicare and physicians on their pay, initiating more demonstration projects in paying for performance and efficiency, and assessing comparative effectiveness of new tests and treatments.
While absolutely valuable, these policies are far from certain to control health-care costs–and it will be five or 10 years before they are likely to generate savings. Paradoxically, only more radical changes in the health-care system are likely to actually save money and improve care–and more quickly. For instance, the Wyden-Bennett health-care bill–which proposes more extensive changes than either Barack Obama’s or John McCain’s proposals–is the only health-care legislation scored as budget neutral by the Congressional Budget Office. The CBO said that in the first year of full implementation, the expenditures would equal revenues, and in subsequent years the Wyden-Bennett bill would generate a surplus because it would save the health-care system money. The Lewin Group, a health-care policy research and management consulting firm, estimated that within a decade this plan could save as much as $1.4 trillion. No other health-care legislation comes close.
Some will find this comprehensive reform unpalatable because it removes employers from health care altogether. As the economy stagnates, this may be absolutely necessary to keep employers afloat. Facing a rising deficit, more comprehensive reform that can really control costs begins to look more realistic than a few untested adjustments here or there.
The dean of health-care economists, Victor Fuchs of Stanford, has long maintained that we will get health-care reform only when there is a war, a depression or some other major civil unrest. It’s beginning to look like we might just have all three.
While the financial crisis has appeared to knock health care off the national agenda, in the strange chemistry that is American politics, it may in fact make comprehensive health-care reform more politically feasible, indeed maybe even absolutely necessary for fiscal stability.
Ezekiel Emanuel is an oncologist and chair of the Department of Bioethics at the National Institutes of Health. He is the author of Healthcare, Guaranteed: A Simple Secure Solution for America.
lamh
The problem with explicit rationing is that you have to refuse drugs to people who are very, very worthy.
How about this for “up front rationing” though — where there is a generic drug that is reasonably effective but has been superceded by a newer, better drug, the public purse will pay for the generic, but require co-payments to meet the cost of the new drug?
“I can honestly say I’ve never seen anyone advocate abortion to spare the NHS. [b]Nor euthanasia[/b].”
Gari you haven’t been paying attention of late.
Dementia sufferers have a ‘duty to die’
Some juicy quotes:
“The veteran Government adviser said pensioners in mental decline…should be allowed to opt for euthanasia even if they are not in pain.”
“…there was “nothing wrong” with people being helped to die for the sake of…society.”
“Lady Warnock goes further by claiming that dementia sufferers should consider ending their lives through euthanasia because of the strain they put on their families and [b]public services[/b]”
Welcome to Nurse Ratchett’s Brave New World, it’s for your own good, drink it up, all of it.
Fair enough Harry. Never saw that, and never heard anyone else said it. I don’t think she’s representative, and – and here is the important part – she is not calling for other people to be able to make the decision to kill someone when they become a burden, but rather for people who feel they have become a burden to have the right to opt for suicide.
It’s a slippery slope Gari.