Wednesday, August 12, 2009

Bioethicists Weigh in on Health Care Reform

Today's Star Tribune noted a statement by the Association of Bioethics Program Directors about the health insurance reform situation. These are the academics like Jeff Kahn at the University of Minnesota and Art Caplan at the University of Pennsylvania who spend their time thinking about the tough issues that confront doctors every day.

What do they have to say about the current debate? They state flat out that "the current state of health care is unethical," and point out the top three myths that are circulating about possible changes to the status quo:

  • Myth #1: That it would interfere with individual control of health decisions
  • Myth #2: That expensive treatments would be unavailable as a cost-control measure
  • Myth #3: That older people would be euthanized or hurried toward their deaths. "This may be the most pernicious myth of all," they wrote.
In conclusion, they wrote, "There is no morally defensible reason why some Americans get excellent medical care at costs they can afford and other Americans lose their homes or go into bankruptcy attempting to secure treatment for a seriously ill loved one."

Full statement at

In the same issue of the Strib, I appreciated this letter to the editor:
Good insurance is meant to be socialist

Health insurance is socialist. Get over it.

In addition to Medicare and Veterans Affairs being "socialist" systems, the whole concept of insurance itself is socialist: The more fortunate subsidize the less fortunate in a collective effort to maximize the well-being (health and wealth) of the group. The aim of any individual may be self-protection, but the only effective and just means to achieve this goal is to maximize the well-being of the whole. The cost of any individual's misfortune is shared by the entire group; that's what insurance is. Once we can swallow the fact that we are all in this particular boat together, perhaps we can agree that it would be nice for us to have a say in how the system is run and where our money goes.

The current private system can't even accurately be called insurance: It's not insurance when companies routinely deny coverage on technicalities and even pay teams of people to find reasons to deny claims; it's not insurance if the administrators work as hard as they can to make sure only the healthy are covered. (Ultimately that just means the taxpayer ends up paying for some of the worst cases anyway.)

The current private system is really just an expensive lottery with bad odds. A public system would help us more efficiently achieve the goal of the healthy subsidizing the sick as opposed to the whole group subsidizing corporate executives and shareholders.

Ben Seymour, Minneapolis
An expensive lottery with bad odds. That just about sums it up!

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