Bioethics Mod 9 - Healthcare

PHL 116

what does the govt provide?

representation, education, some food, libraries, police, firemen; basic services, social programs, etc.

US patchwork healthcare system

1965: medicare and medicaid

1997 State Children’s health insurance program

Tricare and VA hospitals

1986 EMTALA - hospitals must stabilize patients even w/o insurance

2010 Obamacare Affordable Care Act - individual insurance mandate; repealed in 2017

universal health care in which countries

canada, UK, france, germany, australia, new zealand, austria, belgium, denmakr, cuba, south africa, taiwan, and more. 

single payer universal health care

one government agency provides insurance for everyone

mandated multi-plan universal health care

completed patchwork; this was the intent of obamacare

UK’s NHS

singer payer, est. 1948 after WWII; can supplement with private insurance

emphasis on preventative care to avoid later larger costs

problems can include wait times, cost, and accountability for errors

Canada Medicare

single paer, est. in 1962

lower cost; per capita ½ of American system

one of the lowest infant mortality rates

covers most doc vists, hospitalization, historically, not Rx, dental, or vision (now varies by province)

Jase Yoder

born with spinal muscular atrophy, often fatal genetic disease (older sister died at 15 months from it)

new medication spinraza approved in 2016 grant him life

cost of one does is $125,000; need 3 doses yearly

moral foundations supporting medicare for all

care, fairness, loyalty, sanctity

moral foundations against medicare for all

authority, sanctity, liberty

arguments for universal

not everyone is covered currently, high costs for every little thing currently

arguments against universal

lack of competition and innovation; hidden costs, not consumer-driven; generational pyramid scheme (unsustainable financing); healthcare valued over legitimate health and well-being

Amy Gutmann (1949-)

author of “For and Against Equal Access to Healthcare” (1981)

was president of Penn and US ambassador to Germany

philosophy and political science

justice/fairness demands: equality of access not results; and not necessarily a single-payer system (obamacare, for example, may suffice)

fairness and economic systems

John Rawls says a mixed economy where the worst off are better than the worst off in communism is the fairest system

which principles make a fair society?

we must decide under a veil of ignorance, in which we do not know what position we will be in the society

under the veil, we would choose the Principle of equal acces

every person who shares the same type or degree of health-need must be given an equally effective chance of receiving appropriate treatment of equal quality so land as that treatment is available to everyone. 

health isnt a luzury

it is essential for people to function in society

harm objection by Goldhill

free healthcare incentivizes bad health habits

^false dichotomy

a more consumer-centered health care system would use different sorts of financing for different elements of care

false dichotomy fallacy

assuming only two options are available when there are other possibilities

Gutman’s reply to Goldhill’s harm objection

fairness trumps quality and cost

unfairness objection: its unfair to tax and redistribute my earnings! especially for preventable diseases

Gutmann’s reply:

not unfair if democratic majority choose it; we use it for police protection, fire stations, public education, etc. some people deserve these services more than others; why not implement this into healthcare?