Moral and Pragmatic Considerations about Healthcare in America

Moral and Pragmatic Considerations about Healthcare in America     Gerry OShea

The provision of health care in any society has a strong moral component. Who gets treated in hospitals and clinics and who pays the bill lead inevitably to ethical considerations.

The famous Hippocratic Oath, clearly including a moral dimension, instructs doctors not only to protect their patients from disease but also from "harm and injustice."It also warns physicians not to prey on patients' vulnerability for their own gain.

The United Nations Declaration of Human Rights in 1948 asserts a universal right to adequate health care for citizens of every member country. In recent times the American Medical Association, which previously resisted government interference in their domain, has come out for the right of all citizens to comprehensive health care.

In addition polls show that between 65% and 75% of  Americans, including 51% of Republicans, favor a system of health care for everyone as a right. Why is this strong popular policy preference not reflected in legislation in Washington?

There is no easy answer to this quandary where a big majority of Americans want universal health coverage, but the present Republican administration has no intention of introducing legislation to change the unsatisfactory current situation which excludes millions of citizens from hospital and doctor care.

On the contrary, Trump and company correctly saw the Affordable Care Act (ACA) as the signature achievement of the Obama administration, and from the beginning of the Trump era in January 2017 they have focused unremittingly on rescinding it.

 This was barely averted by a dramatic vote against the proposed change by the late Senator John McCain which ensured the defeat of the Republican Bill in the Senate. They have now decided to try to overturn it on constitutional grounds in the federal courts.

Amazingly, after all the years opposing the ACA, which they dismissively dub Obamacare, they have no alternative proposal, nothing to put in its place. Before the 2016 presidential vote, Donald Trump said he had a replacement plan which just needed a few minor adjustments.

 Lately, he declared that Republicans would not be presenting a health care plan before the November 2020 presidential vote but that he will be ready with a detailed proposal after he is re-elected. Will the voters settle for this kind of procrastination on this crucial issue?

Meanwhile in the 2018 congressional elections the number one issue for voters, according to all polls, was dissatisfaction with the availability and cost of family healthcare - and mainly as a result of voter frustration with this one issue the Democrats gained an unprecedented 40 seats in the House.

Americans see themselves as pragmatists, preferring to judge any legislative changes by results. In other words, the first "everyman" question about the success or otherwise of any set of policies asks: how did it all work out?

Using that yardstick, the brief answer indicates the dismal failure of the current system. America pays over $11,000 per person each year for healthcare services, more than twice what other countries in the Organization for Economic Co-Operation and Development (OECD) pay. The members of this group are all developed countries with similar living standards to the United States. We are talking here about the United Kingdom, Germany, Japan, France, Australia and other similar advanced economies - all of which have universal health coverage.

It costs Americans away more annually, so surely our results should be better; all these medical payouts must mean that, for instance, we live longer. Unfortunately, that is not the case. Americans, on average, live to 79 while our friends in the OECD countries last until 82 or better.

Prior to the reforms introduced by the ACA, about 45 million Americans did not have healthcare insurance; today the figure is closer to 25 million - a very significant reduction, but still a hefty number of Americans without coverage.

 In addition Obamacare mandates that no insurance policy can exclude pre-existing conditions and children have the right to remain on their parents' policies until the age of 26.

 Not surprisingly, close to 55% of Americans now want to keep the ACA, especially the requirement for insurance companies to include coverage for pre-existing conditions. That was a major factor in the mid-term elections last November which were so disastrous for Republicans.

In summary, focusing strictly on pragmatic principles that judge the current system only on results, the United States is faring very poorly. Our longevity is three years less on average than comparable advanced countries; we pay twice as much for the service; and more than 25 million of our citizens have no health insurance.

Failing to provide some minimum care for this last group of uninsured people involves another bad deal for American taxpayers. When they get sick, they can't be refused treatment - and surely they shouldn't be - in the Emergency Care Department of a hospital where costs are at a premium. These patients - mostly poor people on low wages working with companies that don't provide coverage for their employees - do not have a primary care physician and so they are cut off from preventive treatments like taking prescription drugs or benefiting from recommended palliative dietary or lifestyle changes that are commonly recommended by family doctors.

The two dozen candidates currently in the Democratic presidential field all report that healthcare is one of the top concerns they hear about at their town hall meetings. Bernie Sanders and Elizabeth Warren favor a medicare-for-all Canadian-style program. They credibly estimate that this solution involving the dismantling of the private insurance industry would save more than two trillion dollars over ten years. However, the transition away from private insurance companies to a government program would undoubtedly be cumbersome and might well be strongly resisted by people who are happy with their present coverage.

Other Democratic candidates contend that we would be better off expanding the Affordable Care Act to include all uninsured people and add a public option which President Obama wanted in the original Bill but which was strenuously - and finally successfully - opposed by the insurance lobbyists. The public option should be in any Democratic proposal because it would open up competition and reduce costs by providing a government-run policy as a viable alternative to private company coverage.

Competition, so often promoted by capitalists as the core value in their economic doctrine, could end the exploitation of the system by insurance companies whose number one goal is making big profits. In this new arrangement people who wish to maintain their current insurance arrangement would be free to do so, but the option would be there to compare the benefits of their present policy with a new government  offering that, most likely, would reduce significantly the cost of premiums.

So  pragmatic considerations point to an urgent need for change in how healthcare is provided in America. In addition, the moral imperative, which is anchored in the belief that we are our brothers' keepers, also provides a strong argument for a new and fairer system.